Anxiety reduction via brief intervention in dentally anxious patients : a randomized controlled trial

Aim: To compare the degree of anxiety reduction in dentally anxious patients attending a Dental Access Centre where the dentist did or did not receive the patients’ assessment of dental anxiety. Methods: Patients attending two Dental Access Centres in England, completed the Modified Dental Anxiety Scale (MDAS). Those that scored high completed a state anxiety questionnaire (STAI-S) and were randomized into three groups (n=182) to test the hypothesis that patients sharing assessment information about their dental anxiety to members of the dental team has beneficial effects on their state anxiety. Group 1 were controls (n=60), Group 2 gave their MDAS to the receptionist who passed it onto the dentist unknown to the patient (n=62) and Group 3 handed their MDAS to the dentist (n=60). After their appointment they repeated the STAI-S. Results and conclusion: Patients in Group 3 were less anxious (by more than STAI-S 3 scale units) on leaving the surgery than those from the other groups especially if they entered into a discussion with the dentist about their concerns (by more than 5 scale units). Brief assessment of dental anxiety shared by the patient with the dentist collaboratively has the potential to reduce anxiety on completion of the appointment. Dental anxiety is common, has a multifactorial aetiology, and is far from being homogenous, as individuals seem to differ in the origins, age of onset and manifestations of their dental fears (Locker et al., 2001b); (Milgrom et al., 1988). Previous negative experiences are a major factor in the development of dental anxiety (Kleinknect et al., 1973); (Bernstein et al., 1979); (de Jongh et al., 1995); (Locker et al., 1999); (Ost and Hugdahl, 1985). For some individuals, their fear of dentistry may be associated with concurrent anxiety disorders, or more general psychopathology (Locker, 2003); (Locker et al., 2001a).PreprintPeer reviewe

The relationship between fears of cancer recurrence and patient gender : a systematic review and meta-analysis

Background: A significant concern for patients treated for cancer is fear of cancer recurrence (FCR). Although a common experience, some patients report high levels of FCR that are difficult to manage and result in over vigilant checking and high use of health services. There has been speculation about the relationship of FCR with gender with mixed reports from several systematic reviews. Aims: To determine the association of FCR with gender in previous reported studies and investigate the strength of this relationship with various moderators including year of publication, type of cancer and measurement attributes of self-reported FCR instruments. Methods: A systematic review was conducted with searches of the literature from the MEDLINE, PubMed, Embase, and PsycINFO databases following PRISMA guidelines. All the included papers were divided into two groups, namely: ‘pure’ that comprise only of patients with cancer types that both men and women can contract and ‘mixed’ that report on patients with a variety of cancer types. The association between gender and FCR level was assessed by meta-analysis. A meta-regression was performed to investigate the moderating effects of factors including: the year of publication, cancer type, mean age of the sample and the length of the FCR scale measurement. This review was registered with PROSPERO, ID: CRD42020184812. Results: Finally, 29 studies were included. The N size of pooled participants was 33339. The meta-analysis showed females to have an overall higher level of FCR than males (ES = 0.30; 95% CI, 0.23. 0.36). The meta-regression of moderating or control variables found little, if any, systematic variation in effect-sizes. Conclusion: This systematic review has clarified a potentially confused pattern of previous results in understanding the relationship between gender and FCR. Women report higher levels of FCR than men and this feature is one that clinicians and researchers can factor into their practice and future studies. The effect size is moderate, hence there is ample variation in FCR level, independent of gender, that requires further investigation.Publisher PDFPeer reviewe

Towards objective and reproducible study of patient-doctor interaction : automatic text analysis based VR-CoDES annotation of consultation transcripts

While increasingly appreciated for its importance,the interaction between health care professionals (HCP) and patients is notoriously difficult to study, with both methodological and practical challenges. The former has been addressed by the so-called Verona coding definitions of emotional sequences (VRCoDES)– a system for identifying and coding patient emotions and the corresponding HCP responses – shown to be reliable and informative in a number of independent studies in different health care delivery contexts. In the present work we focus on the practical challenge of the scalability of this coding system,namely on making it easily usable more widely and on applying it on larger patient cohorts. In particular, VR-CoDES is inherently complex and training is required to ensure consistent annotation of audio recordings or textual transcripts of consultations.Following up on our previous pilot investigation, in the present paper we describe the first automatic, computer based algorithm capable of providing coarse level coding of textual transcripts. We investigate different representations of patient utterances and classification methodologies, and label each utterance as either containing an explicit expression of emotional distress (a ‘concern’), an implicit one (a ‘cue’),or neither. Using a data corpus comprising 200 consultations between radiotherapists and adult female breast cancer patients we demonstrate excellent labelling performance.Postprin

How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations : a multilevel study

Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants’ responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients’ expressions of emotional distress and consultants’ responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant reduce space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1–20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants’ responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.PostprintPeer reviewe

Using fundamental frequency of cancer survivors’ speech to investigate emotional distress in out-patient visits

Objective Emotions, are in part conveyed by varying levels of fundamental frequency of voice pitch (f0). This study tests the hypothesis that patients display heightened levels of emotional arousal (f0) during Verona Coding Definitions of Emotional Sequences (VR-CoDES) cues and concerns versus during neutral statements. Methods The audio recordings of sixteen head and neck cancer survivors’ follow-up consultations were coded for patients’ emotional distress. Pitch (f0) of coded cues and concerns, including neutral statements was extracted. These were compared using a hierarchical linear model, nested for patient and pitch range, controlling for statement speech length. Utterance content was also explored. Results Clustering by patient explained 30% of the variance in utterances f0. Cues and concerns were on average 13.07 Hz higher than neutral statements (p = 0.02). Cues and concerns in these consultations contained content with a high proportion of recurrence fears. Conclusion The present study highlights the benefits and challenges of adding f0 and potential other prosodic features to the toolkit of coding emotional distress in the health communication setting. Practice implications The assessment of f0 during clinical conversations can provide additional information for research into emotional expression.PostprintPeer reviewe

Does cancer type influence the impact of recurrence? : a review of the experience of patients with breast or prostate cancer recurrence

Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time.  Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381).  Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type.  Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included.Publisher PDFPeer reviewe

Applying the Verona Coding Definitions of Emotional Sequences (VR-CoDES) in the dental context involving patients with complex communication needs : an exploratory study

This study was conducted as part of a larger collaborative study funded by the EPSRC, between the University of St Andrews and the University of Dundee.Objective The VR-CoDES has been previously applied in the dental context. However, we know little about how dental patients with intellectual disabilities (ID) and complex communication needs express their emotional distress during dental visits. This is the first study explored the applicability of the VR-CoDES to a dental context involving patients with ID. Methods Fourteen dental consultations were video recorded and coded using the VR-CoDES, assisted with the additional guidelines for the VR-CoDES in a dental context. Both inter- and intra-coder reliabilities were checked on the seven consultations where cues were observed. Results Sixteen cues (eight non-verbal) were identified within seven of the 14 consultations. Twenty responses were observed (12 reducing space) with four multiple responses. Cohen's Kappa were 0.76 (inter-coder) and 0.88 (intra-coder). Conclusion With the additional guidelines, cues and responses were reliably identified. Cue expression was exhibited by non-verbal expression of emotion with people with ID in the literature. Further guidance is needed to improve the coding accuracy on multiple providers’ responses and to investigate potential impacts of conflicting responses on patients. Practice implications The findings provided a useful initial step towards an ongoing exploration of how healthcare providers identify and manage emotional distress of patients with ID.PostprintPeer reviewe

MapMySmoke–a context aware mobile phone application targeted at smoking cessation

PostprintPeer reviewe

Psychometric properties of the Hebrew Modified Dental Anxiety Scale in adult Israeli population

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.Publisher PDFPeer reviewe

Lifestyle change in the cancer setting using “the teachable moment” : protocol for a proof-of-concept pilot in a Urology Service

The service and evaluation is funded by the Scottish Government through the Detect Cancer Early Programme.Background: Previous research has shown diagnosis or screening for cancer may be a ‘teachable moment’ for prevention through lifestyle change. Previous trials have been successful, but have been delivered via national programmes targeting patients being screened for colorectal cancer. This manuscript reports the protocol for a proof-of-concept study to assess the feasibility and acceptability of a lifestyle change service targeting men suspected or diagnosed with cancer of the prostate in a secondary care cancer service within the UK. Methods: Lifestyle change will be promoted through integration of a lifestyle change service in a Urology department in one NHS Board. The service is delivered by a Health Psychologist and uses Motivational Interviewing and behavioural change techniques to motivate and support patients to consider and address topics such as increasing physical activity and a healthy diet, smoking cessation, alcohol reduction and weight loss. A service evaluation will assess feasibility and acceptability via a patient experience survey, a survey exploring staff knowledge, attitudes and practice, pre- and post-intervention lifestyle behaviour survey, and an audit of routine patient database. Discussion: This pilot will assess the viability of using cancer testing and diagnosis as a ‘teachable moment’ for lifestyle change in a unique population (i.e. men with suspected cancer of the prostate). If successful, this approach offers potential for preventative services to enhance routine and person-centred clinical cancer care provided within secondary care settings.Publisher PDFPeer reviewe