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A study to explore if dentists' anxiety affects their clinical decision-making

Key Points

  • Describes a model of decision-making style which is relevant to clinical decision-making.

  • Shows that common, anxiety-provoking clinical stressors affect dentists' clinical decision-making.

  • Finds that dentists appear to have a more effective style of decision-making than the general public.

  • Shows how, despite this, decision-making style is associated with burnout.


Aims To develop a measure of dentists' anxiety in clinical situations; to establish if dentists' anxiety in clinical situations affected their self-reported clinical decision-making; to establish if occupational stress, as demonstrated by burnout, is associated with anxiety in clinical situations and clinical decision-making; and to explore the relationship between decision-making style and the clinical decisions which are influenced by anxiety.

Design Cross-sectional study.

Setting Primary Dental Care.

Subjects and methods A questionnaire battery [Maslach Burnout Inventory, measuring burnout; Melbourne Decision Making Questionnaire, measuring decision-making style; Dealing with Uncertainty Questionnaire (DUQ), measuring coping with diagnostic uncertainty; and a newly designed Dentists' Anxieties in Clinical Situations Scale, measuring dentists' anxiety (DACSS-R) and change of treatment (DACSS-C)] was distributed to dentists practicing in Nottinghamshire and Lincolnshire. Demographic data were collected and dentists gave examples of anxiety-provoking situations and their responses to them.

Main outcome measure Respondents' self-reported anxiety in various clinical situations on a 11-point Likert Scale (DACSS-R) and self-reported changes in clinical procedures (Yes/No; DACSS-C). The DACSS was validated using multiple t-tests and a principal component analysis. Differences in DACSS-R ratings and burnout, decision-making and dealing with uncertainty were explored using Pearson correlations and multiple regression analysis. Qualitative data was subject to a thematic analysis.

Results The DACSS-R revealed a four-factor structure and had high internal reliability (Cronbach's α = 0.94). Those with higher DACSS-R scores of anxiety were more likely to report changes in clinical procedures (DACSS-C scores). DACSS-R scores were associated with decision-making self-esteem and style as measured by the MDMQ and all burnout subscales, though not with scores on the DUQ scale.

Conclusion Dentists' anxiety in clinical situations does affect the way that dentists work clinically, as assessed using the newly designed and validated DACSS. This anxiety is associated with measures of burnout and decision-making style with implications for training packages for dentists.

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The authors are indebted to the Shirley Glasstone Hughes Trust for funding this project and to the dentists who gave generously of their precious time. The authors would also like to acknowledge the advice of Professors Leon Mann, Pat Croskerry and Patricia Hollen.

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Correspondence to H. R. Chapman.

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Chipchase, S., Chapman, H. & Bretherton, R. A study to explore if dentists' anxiety affects their clinical decision-making. Br Dent J 222, 277–290 (2017).

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