Humanizing clinical dentistry through a person-centred model

Apelian, Nareg; Vergnes, Jean-Noël; Bedos, Christophe

doi:10.26443/ijwpc.v1i2.2

Cited by 33 publications

(40 citation statements)

References 107 publications

(74 reference statements)

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“…During the training, we posited that caring for people living in poverty might include discovering and taking into account their social context. This notion is consistent with most definitions and models of person centered care [ 22 , 34 ], an approach that is gaining ground in dentistry [ 35 ]. Yet in response to strategies designed to gain knowledge of a patient’s social context, several participants raise objections that translate a generalized and predominately biomedical orientation to patient care: My business is their mouth and teeth.…”

Section: Resultssupporting

confidence: 77%

“…Lack of choice and capacity—whether due to budget, time or psychosocial constraints—to follow professional recommendations will not be properly understood, empathized with, nor taken into consideration, unless addressed within a broader frame of reference. Patient centered care models represent a pertinent alternative because they advocate for a bio-psycho-social understanding of the patient as well as for discovering the meaning the latter ascribes to his or her oral health care issue, within the context of his or her life [ 22 , 34 , 35 ]. These are indeed keys to sensitive, trust-building, and relevant healthcare for low-income patients.…”

Section: Discussionmentioning

confidence: 99%

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Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

Lévesque

Levine

Bedos

2015

Int J Equity Health

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BackgroundFront line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients’ health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching.MethodsA qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change.ResultsThe findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the “ineluctable” commoditization of dentistry; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into “deserving” vs. “non-deserving” poor. We discuss implications for oral health policy, orientations for dental education, as well as the role dental regulatory authorities should play in addressing discrimination and prejudice.ConclusionHumanizing care and developing oral health practitioners’ capacity to respond to social determinants of health, are challenged by significant ideological roadblocks. These require multi-level and multi-sectorial action if gains in social equity in oral health are to be made.

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Section: Resultssupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

Lévesque

Levine

Bedos

2015

Int J Equity Health

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“…Finally, as many suggest [ 33 – 35 ], we recommend reinforcing dentists’ sensitivity to the situation of people on social assistance through the development of educational academic programs. We believe that “patient-centred” [ 36 ] and “social competency” approaches, for instance, can help professionals to better understand the perspectives of people living in poverty. These would facilitate the organisation of appointments by identifying appropriate time periods and avoiding the planning of patients’ unwanted visits.…”

Section: Discussionmentioning

confidence: 99%

Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges

Bedos

Loignon

Landry

et al. 2014

BMC Health Serv Res

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BackgroundDentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance.MethodsWe conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists’ experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation.ResultsDentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government’s duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them.ConclusionsThe efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.

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“…Fourth, always following the PCC principles, and among them the dentist-as-person concept [4,10], we also hypothesize that adding some WIDENESS timeslots into professional agendas could result in better working conditions for dentists. It has been shown that dentists have to deal with many significant stressors in their professional lives [33].…”

Section: Interpretation and Implicationsmentioning

confidence: 98%

“…Among various improvement avenues, the organization of the dental work force should evolve with changing perceptions of individuals regarding health in modern societies. In dentistry-as in medicine-there is a trend toward person-centered care (PCC) [4], reflecting the wishes of individuals to have more power and control in their health decisions [5]. Patient-centeredness (a close relative concept to person-centeredness) is now strongly encouraged by various institutions, such as the Commission on Dental Accreditation in the United States [6], the Association of Canadian Faculties of Dentistry [7], or the Association for Dental Education in Europe [8].…”

Section: Introductionmentioning

confidence: 99%

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

Gulion

Vergnes

2019

Dentistry Journal

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Background: We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. Methods: We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. Results: When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants;(2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks-apprehension about long waiting times was mentioned by several participants. Conclusions: Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.

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Humanizing clinical dentistry through a person-centred model

Abstract: Humanizing clinical dentistry through a person-centred model

Cited by 33 publications

References 107 publications

Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

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