Good-Behavioral Sciences Final Exam 2024 PDF

Summary

This document is a lecture about behavioral science, focusing on communication in dentistry and the transtheoretical model of behavior change. It discusses the importance of communication between patients and dentists, and the various psychosocial concepts relevant to oral health.

Full Transcript

Lecture 1 At GSDM, we define behavioral sciences as patient centered approaches for promoting, improving, and maintaining oral health encompassing self-efficacy, motivational interviewing/brief counseling and reflective listening. We apply these principles though the application of the Transtheoreti...

Lecture 1 At GSDM, we define behavioral sciences as patient centered approaches for promoting, improving, and maintaining oral health encompassing self-efficacy, motivational interviewing/brief counseling and reflective listening. We apply these principles though the application of the Transtheoretical model of behavior change. Importance of communication in dentistry Good communication between patient and dentist is associated with increased efficiency and more accurate diagnosis, improved patient outcomes and satisfaction and less likelihood of complaints or litigation. Communication is also a complex (and clinical) skill but, interestingly, its importance is not always accepted or valued, either by students or those with more experience. Dentists who spend time communicating effectively with their patients and colleagues are likely to have better interpersonal relationships and a more satisfying working life. This, in turn, is likely to make consultations more efficient and improve patient outcomes. Strong doctor/patient relationships require trust from both parties Patients must be able to trust that they can be completely open and forthright when communicating with you about their overall health status. It’s important for them to know that you and your staff need this information in order to accurately assess their oral health needs and design an appropriate treatment plan. Providers must be able to trust that patients have provided comprehensive pictures of their current medical conditions. Recognize that some patients may not understand why their dentist is asking for information about their personal medical histories, drug use or even their personal behaviors. Let your patients know that the information they provide will help you accurately assess their dental health and allow you recommend treatment that should yield a positive outcome. Reassure them that their information is confidential and that your staff is a team of professionals who respect and honor the trust your patients have placed in you. Use as little technical language as possible when discussing diagnostic tests and findings from oral exams, radiographs, photographs or during treatment such as surgery. Psychosocial Concepts Relevant to Oral Health 1. Internal and external locus of control 2. Self-efficacy 3. Stress 4. Social support Lecture 2: Theory Driven Approach: Transtheoretical Model of Behavior Change Behavior Change What does research suggest? The Role of Interpersonal Skills and Behavior Change A dentists "way of being" can influence a patient's behavior and willingness to change. A one-size fits all approach will not work with every patient. A dentist should be flexible in their approach as they consult with patients. Research suggests matching consulting style with the behavioral style of the patient may lead to the best outcomes (Rollnick et. Al., 2007). It is the patient's task to say how and why they may change their behavior. It is the provider's role to help the patient elicit arguments for change and agree on priority areas. Considering our patients’ unique life context (SDOH) Fear Appeals A "do this or else" message where non-compliance to a recommended behavior has the intention of creating fear Work until a moderate amount of fear is conveyed and then there is no added benefit. Theoretical Frameworks Provide a particular perspective, or lens, through which to examine a topic. Often used to define concepts and explain phenomena. Theoretical Models of Behavior Change Social Cognitive Theory Health Belief Model Theory of Planned Behavior Self-determination Theory Transtheoretical Model of Behavior Change Social Cognitive Theory Includes the concept that environmental factors (such as socioeconomic status and familial status) influence self-efficacy, motivation and beliefs. An individual is 1) a product of and 2) can influence their environment. Health Belief Model An individual's likelihood to change a health behavior is influenced by two factors: o The perception of the threat o How likely the proposed intervention or treatment will be successful Theory of Planned Behavior The best predictor of a behavior is an individual's intention. One's intention is influenced by: o Attitudes o Subjective norms o Perceived behavioral control Self-Determination Theory Behavior is influenced by: competence, autonomy, and relatedness Transtheoretical Model of Behavior Change 1. Pre-contemplation a. Persons in this stage do not consider their behavior to be affecting their health negatively in any way. b. Persons do not see any reason why they should consider changing their behavior despite evidence that suggests otherwise. 2. Contemplation a. At this stage, persons have become aware that a problem exists and begin to think about change. b. Persons may flip between focusing on change and no change as they decide what they want to do. c. Persons can weigh pros and cons of change in this phase. 3. Preparation a. Persons move out of contemplation phase when they have clear intention to change their behavior. b. Persons have not yet integrated this change fully into their lives; however, they are exploring ways to follow through on their plan to change. 4. Action a. Persons are actively engaged in their changed behavior. b. A time of high motivation as persons may start to feel the benefits of the change and feel successful. c. Persons are highly vulnerable to relapse and old patterns. 5. Maintenance a. The new behavior is fully integrated into their lifestyle and routines. i. (Relapse) – maintenance fails and cycle starts again Lecture 3: Workshop: Linking Behavioral Science to Professionalism Definition of Professionalism “The skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well” Merrium-Webster, n.d. “Professionalism” is commonly understood as an individual’s adherence to a set of standards, code of conduct or collection of qualities that characterize accepted practice within a particular area of activity” Universities UK et al. 2004 6 Value based statements defining professionalism in dental education Professionalism: Importance of Communication Types of Ethical Issues: Right vs Wrong: compliance-based ethical issue. o Right versus wrong decisions are not really ethical dilemmas. o They are simply decisions in which we are tempted to do what we know is not right. Right vs Right: values-based ethical dilemma o No clear right answer. Analyzing Ethical Issues: Do you really have an ethical dilemma? The Legal Test The Professional Standards Test The Gut-Feeling Test The Front-Page Test The Role-Model Test Dentistry in the USA Sources for dental professional standards: ADA Principles of Ethics and Code of Professional Conduct – universal bioethical principles, code sections, advisory opinions and the American College of Dentists’ Core Values and ACD Test What are sources for dental legal requirements? Federal and state laws, as well as regulations applicable to licensed dentists. Jurisprudence – state licensure law. State Dental Practices Acts and regulations promulgated by State Boards of Registration in Dentistry. Professional Dental Ethics Bottom Line: A dentist must put the best interests of the patient before his/her own interests. ADA Ethical Principles: 1. 2. 3. 4. 5. Autonomy: The dentist has a duty to respect the patient's rights to self-determination and confidentiality. Nonmaleficence: The dentist has a duty to refrain from harming the patient. Beneficence: the dentist has a duty to promote the patient’s welfare Justice: the dentist has a duty to treat people fairly Veracity: the dentist has a duty to communicate truthfully Lecture 4: Motivational Interviewing and Reflective Listening Part 1 Motivation: the reason or reasons one has for acting or behaving a certain way Approaches to motivation should be tailored to each patient DISC System: Dominant Style Patients Influencing Style Patients Steady Style Patients Often very friendly and agreeable but may be more guarded and introverted than an influencing patient. Trust is an essential component of doctor-patient interaction. Often risk averse. Appreciate when providers close attention to dears and concerns. Favor tried-and-true procedures over new techniques. Cautious Style Patients Generally approaches all situations as threats. Could have more dental anxiety than other styles. Logical, systamatic and data-driven. Prefer the evidence-based approach to treatment. When explaining options, provide all details and the rationale for all options. Can be paralyzed by analysis. Communication Styles: Directing, Following, Guiding Directing Following Guiding How to Implement Guiding communication style: OARS Open Questions: Affirmation: Reflective Listening: Serves two functions: o Enables the listener to check what they have understood from the speaker. o In the process, it makes the speaker feel understood. Consider two purposes: o Content o Meaning Summarizing: Before moving on it is helpful to summarize and demonstrate to the patient that you have listened, understood, and considered what they have said. Moving from Summarizing Pertinent information to Providing Patient Counseling Elicit Provide Elicit First explores what the person already knows Then seeks permission to offer new information in a nonjudgemental And then explores the person’s response about the new information. way. Motivational Interviewing Four Principles of MI Express Empathy Develop Discrepancy: Involves exploring with patients the gap between their goals or values, or how they ideally would like things to be, and their current behavior. Roll with resistance: “Pushing back”, arguing, persuading often increases resistance In MI dentists roll with resistance to deflect or minimize its effect Support Self-efficacy and optimism Research suggests individuals who have confidence in their behavior are more likely to engage in that behavior. Dentists work to increase optimism and confidence in their ability to change. Lecture 5: Motivational Interviewing and Reflective Listening pt 2 Moving from Eliciting Info to Providing Counseling Why health literacy is important: Low health literacy affects how you: navigate the system, understand nutrition, seek support, and organize health care appointments Lecture 6: Vulnerable Populations Considerations/best practices for talking to patients with diverse needs: Patient assessment starts before patient sits on chair Understand expectations (productive, respectful and comfortable) Presume capability Achievable goals Ask about previous experiences Listen/Observe Include observations in your notes Person First language: person with autism NOT autistic person When talking to parent and caregivers Ask questions (about patient and previous experiences) Visit preparation (social stories, desensitization, call...) Listen to inputs Understand expectations (productive, respectful and comfortable) Explain appointment structure Strategies Be empathetic (try to understand in a compassionate and non-judgmental manner, including external factors) Presume competence Use caregiver knowledge Build rapport and individualize care (sports, music...) Practice flexibility and patience Accommodate communication needs Be aware of sensory needs Respond to challenge behavior Build knowledge Lecture 7: Moving Towards Clinic: Applying Principles of Behavioral Science to the GDSM Patient Treatment Center Elicit First and Counsel Second Before you can provide proper counseling to your patient you must collect all pertinent information. o Almost always this requires additional questions beyond surface review of a patient's medical history. o Topics include: ▪ Current actions ▪ Desired actions ▪ Past experiences ▪ Motivation Asking questions and collecting information first allows the provider to tailor specific counseling and recommendations. Counseling in the dental office requires collaboration with other healthcare professionals Intraprofessional Interactions with Members of the Dental Team Dentist Hygienist Assistants Front Desk Office Manager Interprofessional collaboration is defined as healthcare professionals from different professions working together Primary Care Physician Scope of Practice: Primary care physicians specifically are trained for and skilled in comprehensive, first contact, and continuing care for persons with any undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis. Link to Oral Health: o Medical consults – may be a contact with PCP office o May identify oral health problems in their patients and refer to dentist Link to GSDM Medical History: o #4:Has there been any changes to your health in the last year? o #5: Have you been hospitalized or had a serious illness in the last 3 years? o #6: Are you being treated by a physician now? o #7:Date of last medical exam Nurse Practitioner Scope of Practice: Assess patients, order and interpret diagnostic tests, make diagnoses as well as initiate and manage treatment plans—including prescribing medications. They have advanced clinical training beyond their initial professional RN preparation. Link to Oral Health: o Medical consults – may be a contact with PCP office o May identify oral health problems in their patients and refer to dentist Link to GSDM Medical History: o #4:Has there been any changes to your health in the last year? o #5: Have you been hospitalized or had a serious illness in the last 3 years? o #6: Are you being treated by a physician now? o #7:Date of last medical exam Physician’s Assistant Scope of Practice: Diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. Link to Oral Health: o Provide medical consults o May refer patients to the dental office Link to GSDM Medical History: o #4:Has there been any changes to your health in the last year? o #5: Have you been hospitalized or had a serious illness in the last 3 years? o #6: Are you being treated by a physician now? o #7:Date of last medical exam Occupational Therapist Scope of practice: Help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities. Link to oral health: Oral Hygiene adaption for those with impaired fine motor skills (toothbrushes with larger handles etc.). Link to GSDM Medical History: o #50 During the past 3 months, how often have your experienced the following difficulties because of your teeth or gums?* o Eating certain foods o Avoid going out Physical Therapist Scope of Practice: Diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. o Link to oral health: TMJ evaluation and treatment o Link to GSDM Medical History: ▪ #25 Joint Pain or Stiffness Social Worker Scope of practice: Help people obtain tangible services; provide counseling and psychotherapy with individuals, families, and groups; help communities or groups provide or improve social and health services. Link to oral health: o Determine eligibility for MassHealth, Medicare, and provide referrals to agencies that will assist in the signup process o Assist patients are experiencing difficulties, such as cultural or language differences, unreliable transportation, or lack of food, clothing, and shelter. o Assist a provider with a patient dealing with depression, anxiety, or a substance abuse disorder. o Work with patients to develop a safety plan and provide access to community resources should a provider notice evidence of child abuse or intimate partner violence Link to GSDM Medical History: o #9 Have you had any problems with your prior dental treatment? o #38 Mental illness/psychological conditions (anxiety disorder) o #49 other conditions that may affect dental treatment o #52 In the past three months how often did you feel nervous or self- conscious because of problems with your mouth, teeth, or dentures? Clinical Psychologist Scope of Practice: Provide continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision. Link to oral health: o Referral for anxiety/depression o Prescribe medications that can cause xerostomia – which increases caries risk o In patients which they prescribe xerostomia inducing meds – refer to dentist to increase preventive regimen Link to GSDM Medical History: o #9 Have you had any problems with your prior dental treatment? o #38 Mental illness/psychological conditions (anxiety o #52 In the past three months how often did you feel nervous or self-conscious because of problems with your mouth, teeth, or dentures? Registered Dietician Scope of Practice: Food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living. Link to oral health: o Refer individuals with high caries risk o Refer patients who want to make overall dietary changes Link to GSDM Medical History: o #16 Weight loss o #50- Avoid eating specific foods Optometrist Scope of practice: Provides annual or routine eye exams, including eye health education; diagnosis of eye condition; prescriptions for eyeglasses, contact lenses, and other visual aids. Link to oral health: Referral for vision problems which may interfere with ability to perform proper oral hygiene (and interfere with quality of life). Link to GSDM Medical History: o #29 Blurred vision Athletic Trainers Scope of practice: Provide primary care, injury and illness prevention, wellness promotion and education, emergent care, examination and clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. Link to oral health: o Refer to dentists for avulsed teeth o Promote mouthguards when appropriate Speech and Language Pathologist Scope of Practice: Work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders in all ages. Link to oral health: o Oral health problems such as missing teeth can impact the ability to speak o May serve as referrals to the dentist Pharmacist Scope of practice: Distribute prescription drugs to individuals. Provide advice to patients and other health professionals on how to use or take medication, the correct dose of a drug, and potential side effects/interactions. Administer vaccines. Link to oral health: o May identify drug interactions, especially if patients do not disclose all meds on their med history forms o Can educate patient about xerostomia effects and refer to dentist o Can offer alternative medication choices in case of aforementioned issues Link to GSDM Medical History: o #11 current medications o #12 allergies o #34 dry mouth

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