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Development of a Patient-Centred Care Self-Reflection Tool for Dentists

Student thesis: Doctoral ThesisDoctor of Philosophy

Background: Patient-centred care (PCC) has been linked to many positive outcomes in medicine. Dentists currently have no available tool for practicing this approach as part of a daily routine in a dental setting. The latest UK General Dental Council (GDC) standards for dental teams has amplified the need for such a tool (GDC, 2013).
Aim: The overall aim of this thesis is to develop and validate a tool for dentists in order to encourage them to practice PCC in dental settings.
Methods: This research employs a mixed method research design. This thesis is divided into three studies. Study 1 includes semi-structured interviews that were conducted with 20 practicing dentists who had clinical teaching responsibilities at King’s College London. These interviews explored their views and opinions on PCC in general as well as on a published model of PCC and how applicable this model would be in a dental setting. Study 2 builds on study 1 findings by examining the ability of dental students to assess the communication skills of another dentist. This cross-sectional survey exposed students to a stage consultation via a YouTube video clip and then asked them to use the tool to evaluate the performance of the dentist in the clip. Study 3 entails validation of the newly developed PCC self-reflection tool by assessing its face, content, and criterion validity and test-retest reliability. To determine content validity, experienced dentists who were involved in education and practice evaluated the items based on relevance, clarity and representativeness of the construct as well as the ease of response. The criterion validity was determined in parallel with study 2 using a survey. For the test-retest reliability part, the modified tool was assessed twice within a 10-day period to rate a dental consultation clip by dental students (N=25).
Results: The interview analysis highlighted five themes: understanding PCC, the role and influence of patients on the delivery of PCC, the role and influence of dentists on the delivery of PCC, the importance of context and dentists’ views on a hierarchy of PCC. Each of these themes included a number of sub-themes that covered the different issues identified via interview transcript analysis. The themes showed that dentists have a basic and simplistic understanding of the concept of PCC. Dentists identified a number of patient, dentist and contextrelated barriers that could hinder the adoption of PCC. Interviewees thought the hierarchy of PCC they discussed would be useful to aid understanding of PCC but more so for less experienced dentists and dental students. The analysis of the cross-sectional survey study revealed a broad understanding of the basic functions of the communication process, although students’ judgments of the quality of such communication was exaggerated. The development and validation of the tool, led to a final version of the tool containing six items. The tool showed good validity and reliability.
Conclusion: A new, practical, PCC self-reflection tool was developed for dentists based on a review of the literature and interviews with dentists. The tool exhibits good content and criterion validity as well as acceptable test-retest reliability. Dentists may use this tool in dental settings to become more aware of PCC as a concept by focusing on two specific aspects: information provision and choice giving.
Original languageEnglish
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Award date2018

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