Abstract
There is a dearth of tools designed to inform people about what to expect from person-centred dental encounters and to guide them during the care process. This is why we propose the Montreal-Toulouse Wheel of patients' expectations for dental visits, which describes what people could expect during person-centred clinical encounters. The Wheel comprises four core expectations: 1) be understood; 2) be respected; 3) have power; and 4) be given enough time. It also includes three expectations that are more specific to the process of care: 5) be informed and understand; 6) share decisions with the dentist and even co-construct the treatment plan; and 7) be comfortable during clinical procedures and the whole care process. We also propose a Q-List to help patients reflect on their relationship with dental professionals and engage them in person-centred dental care. This Q-List describes the seven expectations of the Wheel and provides open-ended questions that we invite patients to reflect upon. We also hope that dental professionals and educators will find the Wheel and the Q-List useful to develop person-centredness and promote inclusive and equitable dentistry.
Key points
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The Montreal-Toulouse Wheel of expectations presents what people should expect during person-centred dental visits.
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It comprises four core expectations, plus three expectations that reflect the clinical process.
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The Wheel of expectations comes with a Q-List - a series of open questions - to help patients reflect on their relationship with dentists and engage in person-centred care.
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References
Frank A W. At the Will of the Body: Reflections on Illness. New York: Houghton Mifflin Harcourt, 2002.
Apelian N, Vergnes J N, Bedos C. Humanizing clinical dentistry through a person-centred model. Int J Whole Pers Care 2014; 1: 30-50.
Apelian N, Vergnes J N, Hovey R, Bedos C. How can we provide person-centred dental care? Br Dent J 2017; 223: 419-424.
Hovey R B, Apelian N. Is our incapacity for conversation a serious barrier to person centred medicine? Int J Pers Cent Med 2014; 4: 52-59.
Fenning S J, Smith G, Calderwood C. Realistic Medicine: Changing culture and practice in the delivery of health and social care. Patient Educ Couns 2019; 102: 1751-1755.
Bedos C, Apelian N, Vergnes J-N. Towards a biopsychosocial approach in dentistry: the Montreal-Toulouse Model. Br Dent J 2020; 228: 465-468.
Scambler S, Asimakopoulou K. A model of patient-centred care - turning good care into patient-centred care. Br Dent J 2014; 217: 225-228.
Commission on Dental Accreditation. Accreditation standards for dental education programmes. Chicago: American Dental Association, 2010.
Association of Canadian Faculties of Dentistry. ACFD Educational Framework for the Development of Competency in Dental Programs. 2016.
Manogue M, McLoughlin J, Christersson C et al. Curriculum structure, content, learning and assessment in European undergraduate dental education - update 2010. Eur J Dent Educ 2011; 15: 133-141.
Bourdieu P. Les rĆØgles de l'art: genĆØse et structure du champ littĆ©raire. Paris: Editions du Seuil, 1992.
Stewart M. Patient-Centred Medicine: Transforming the Clinical Method. Oxford: Radcliffe Publishing, 2003.
Lee H, Chalmers N I, Brow A et al. Person-centered care model in dentistry. BMC Oral Health 2018; 18: 198.
Mills I, Frost J, Cooper C, Moles D R, Kay E. Patient-centred care in general dental practice-a systematic review of the literature. BMC Oral Health 2014; 14: 64.
Freeman R, Doughty J, Macdonald M E, Muirhead V. Inclusion oral health: Advancing a theoretical framework for policy, research and practice. Community Dent Oral Epidemiol 2020; 48: 1-6.
Calderwood C. Realistic Medicine: Chief Medical Officer's Annual Report, 2014-15. 2016.
Shields C G, Epstein R M, Franks P et al. Emotion language in primary care encounters: reliability and validity of an emotion word count coding system. Patient Educ Couns 2005; 57: 232-238.
Zachariae R, Paedersen C G, Jensen A B, Ehrnrooth E, Rossen PB, von der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer 2003; 88: 658-665.
Zimmermann C, Del Piccolo L, Bensing J et al. Coding patient emotional cues and concerns in medical consultations: the Verona coding definitions of emotional sequences (VR-CoDES). Patient Educ Couns 2011; 82: 141-148.
Rashid-Kandvani F, Nicolau B, Bedos C. Access to Dental Services for People Using a Wheelchair. Am J Public Health 2015; 105: 2312-2317.
Chisini L A, Noronha T G, Ramos E C et al. Does the skin colour of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study. Clin Oral Investig 2019; 23: 1023-1030.
Umashankar G, Vanishree M, Niharika B. Gender Based Inequality and Use of Oral Health Care Services in Bangalore City. SM Prev Med Public Health 2019; 3: 1027.
Schuch H S, Haag D G, Kapellas K et al. The magnitude of Indigenous and non-Indigenous oral health inequalities in Brazil, New Zealand and Australia. Community Dent Oral Epidemiol 2017; 45: 434-441.
Bedos C, Brodeur J-M, Boucheron L et al. The dental care pathway of welfare recipients in Quebec. Soc Sci Med 2003; 57: 2089-2099.
Alsaggaf D. Determinants of dental care utilization among low-income African-American women. 2017. Available online at https://open.bu.edu/handle/2144/26219 (accessed September 2020).
Charbonneau A. Do people with HIV/AIDS disclose their HIV-positivity to dentists? AIDS Care 1999; 11: 61-70.
Burris S. Dental Discrimination against the HIV-Infected: Empirical Data, Law and Public Policy. Yale J Regul 1996; 13: 1.
Sbaraini A, Carter S M, Evans R W, Blinkhorn A. Experiences of dental care: what do patients value? BMC Health Serv Res 2012; 12: 177.
Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract 2004; 53: 721-730.
Parsons T. The Social System. London: Psychology Press, 1991.
Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equity Health 2012; 11: 12.
Mercer S W, Zhou Y, Humphris G M et al. Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations. Ann Fam Med 2018; 16: 127-131.
Anderson R M, Funnell M M, Butler P M, Arnold M S, Fitzgerald J T, Feste C C. Patient empowerment. Results of a randomized controlled trial. Diabetes Care 1995; 18: 943-949.
Calley K, Rogo E, Miller D, Hess G, Eisenhauer L. A proposed client self-care commitment model. J Dent Hyg 2000; 74: 24-35.
Tew J. Understanding Power and Powerlessness: Towards a Framework for Emancipatory Practice in Social Work. J Soc Work 2006; 6: 33-51.
Apelian N, Vergnes J N, Bedos C. Is the dental profession ready for person-centred care? Br Dent J 2020; 229: 133-137.
Nowak M J, Buchanan H, Asimakopoulou K. 'You have to treat the person, not the mouth only': UK dentists' perceptions of communication in patient consultations. Psychol Health Med 2018; 23: 752-761.
Gross D A, Zyzanski S J, Borawski E A, Cebul R D, Stange K C. Patient satisfaction with time spent with their physician. J Fam Pract 1998; 47: 133-137.
Cape J. Consultation length, patient-estimated consultation length, and satisfaction with the consultation. Br J Gen Pract 2002; 52: 1004-1006.
Howie J G, Porter A M, Heaney D J, Hopton J L. Long to short consultation ratio: a proxy measure of quality of care for general practice. Br J Gen Pract 1991; 41: 48-54.
Schattner A, Bronstein A, Jellin N. Information and shared decision-making are top patients' priorities. BMC Health Serv Res 2006; 6: 21.
Adams R J. Improving health outcomes with better patient understanding and education. Risk Manag Healthc Policy 2010; 3: 61-72.
Martinez L S, Schwartz J S, Freres D, Fraze T, Hornik R C. Patient-clinician information engagement increases treatment decision satisfaction among cancer patients through feeling of being informed. Patient Educ Couns 2009; 77: 384-390.
Carey J A, Madill A, Manogue M. Communications skills in dental education: a systematic research review. Eur J Dent Educ 2010; 14: 69-78.
Shaw A, Ibrahim S, Reid F, Ussher M, Rowlands G. Patients' perspectives of the doctor-patient relationship and information giving across a range of literacy levels. Patient Educ Couns 2009; 75: 114-120.
Shay L A, Lafata J E. Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes. Med Decis Making 2015; 35: 114-131.
Bickerdike L, Booth A, Wilson P M, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017; DOI: 10.1136/bmjopen-2016-013384.
Williams D R, Costa M V, Odunlami A O, Mohammed S A. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. J Public Health Manag Pract 2008; 14 Suppl(Suppl): S8-S17.
Cianetti S, Lombardi G, Lupatelli E et al. Dental fear/anxiety among children and adolescents. A systematic review. Eur J Paediatr Dent 2017; 18: 121-130.
Tellez M, Kinner D G, Heimberg R G, Lim S, Ismail A I. Prevalence and correlates of dental anxiety in patients seeking dental care. Community Dent Oral Epidemiol 2015; 43: 135-142.
Kolcaba K. Evolution of the mid range theory of comfort for outcomes research. Nurs Outlook 2001; 49: 86-92.
Ventres W B. The Q-List manifesto: how to get things right in generalist medical practice. Fam Syst Health 2015; 33: 5-13.
Gawande A. The Checklist Manifesto: How to Get Things Right. 1st ed. New York: Picador, 2011.
Smyth Zahra F, Dunton K. Learning to look from different perspectives - what can dental undergraduates learn from an arts and humanities-based teaching approach? Br Dent J 2017; 222: 147-150.
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Bedos, C., Apelian, N. & Vergnes, JN. What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations. Br Dent J 231, 249ā253 (2021). https://doi.org/10.1038/s41415-021-3322-3
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DOI: https://doi.org/10.1038/s41415-021-3322-3