Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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.

Abstract

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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Denton D A, Newton J T, Bower E J . Occupational burnout and work engagement: a national survey of dentists in the United Kingdom. Br Dent J 2008; 205, E13E13.

    Article  Google Scholar 

  2. 2

    Cooper C L, Watts J, Baglioni A J, Kelly M . Occupational stress among general practice dentists. J Occup Organ Psychol 1988; 61: 163–174.

    Article  Google Scholar 

  3. 3

    Osborne D, Croucher R . Levels of burnout in general dental practitioners in the south-east of England. Br. Dent J 1994; 177: 372–377.

    Article  Google Scholar 

  4. 4

    Moller A T, Spangenberg J J . Stress and coping among South African dentists in private practice. J Dent Assoc S Afr 1996; 51: 347–357.

  5. 5

    Lazarus R S, Folkman S . Stress, appraisal, and coping. New York: Springer Publishing Company, 1984.

    Google Scholar 

  6. 6

    Bretherton R, Chapman H R, Chipchase S . A study to explore specific stressors and coping strategies in primary dental care practice. Br Dent J 2016; 220: 471–478.

    Article  Google Scholar 

  7. 7

    Chapman H R, Chipchase S Y, Bretherton R . Understanding emotionally relevant situations in primary care dental practice: 1. Clinical situations and emotional responses. Br Dent J 2015; 219: 401–409.

    Article  Google Scholar 

  8. 8

    Chapman H R, Chipchase S Y, Bretherton R . Understanding emotionally relevant situations in primary dental practice. 2. Reported effects of emotionally charged situations. Br Dent J 2015; 219, E8.

    Article  Google Scholar 

  9. 9

    Gorter R C, Albrecht, G, Hoogstraten J, Eijkman M A . Professional burnout among Dutch dentists. Community Dent Oral Epidemiol 1999; 27: 109–116.

    Article  Google Scholar 

  10. 10

    Maslach C, Schaufeli W B, Leiter M P . Job Burnout. Annu Rev Psychol 2001; 52: 397–422.

    Article  Google Scholar 

  11. 11

    te Brake J H, Bouman A M, Gorter R C, Hoogstraten J, Eijkman M A . Using the Maslach Burnout Inventory among dentists: burnout measurement and trends. Community Dent Oral Epidemiol 2008; 36: 69–75.

    PubMed  Google Scholar 

  12. 12

    Leiter M P, Maslach C . Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm 1999; 21: 472–489.

    PubMed  PubMed Central  Google Scholar 

  13. 13

    Maslach C, Jackson S, E, Leiter M et al. Maslach Burnout Inventory Manual. Menlo Park, California: Mind Garden Inc, 1986.

    Google Scholar 

  14. 14

    te Brake H, Smits N, Wicherts J M, Gorter R C, Hoogstraten J . Burnout development among dentists: a longitudinal study. Eur J Oral Sci 2008; 116: 545–551.

    Article  Google Scholar 

  15. 15

    Bakker A B, Schaufeli W B, Sixma H J, Bosveld W, van Dierendonck D . Patient demands, lack of reciprocity, and burnout: A five-year longitudinal study among general practitioners. J Organ Beh 2000; 21: 425–441.

    Article  Google Scholar 

  16. 16

    Taris T W, Le Blanc P M, Schaufeli W B, Schreurs P J G . Are there causal relationships between the dimensions of the Maslach Burnout Inventory? A review and two longitudinal tests. Work & Stress 2005; 19: 238–255.

    Article  Google Scholar 

  17. 17

    Deligkaris P, Panagopoulou E, Montgomery A J, Masoura E . Job burnout and cognitive functioning: A systematic review. Work & Stress 2014; 28: 107–123.

    Google Scholar 

  18. 18

    Shanafelt T D, Balch C M, Bechamps G et al. Burnout and medical errors among American surgeons. Ann Surg 2010; 251: 995–1000.

    Article  Google Scholar 

  19. 19

    West C P, Huschka M M, Novotny P J et al. Association of perceived medical errors with resident distress and empathy. JAMA 2006; 296: 1071–1078.

    Article  Google Scholar 

  20. 20

    Balch C M, Freischlag J A, Shanafelt T D . Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg 2009; 144: 371–376.

    Article  Google Scholar 

  21. 21

    Osterberg K, Skogsliden S, Karlson B . Neuropsychological sequelae of work-stress-related exhaustion. Stress 2014; 17: 59–69.

    Article  Google Scholar 

  22. 22

    Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R . The impact of stress on surgical performance: a systematic review of the literature. Surgery 2010; 147: 318–330, 330.

    Article  Google Scholar 

  23. 23

    Tsutsumi A, Umehara K, Ono H, Kawakami N . Types of psychosocial job demands and adverse events due to dental mismanagement: a cross sectional study. BMC Oral Health 2007; 7: 3.

    Article  Google Scholar 

  24. 24

    Janis I L, Mann L . Decision making: a psychological analysis of conflict, choice, and commitment. New York: The Free Press, 1977.

  25. 25

    Anderson C J . The psychology of doing nothing: Forms of decision avoidance result from reason and emotion. Psychol Bull 2003; 129: 139–167.

    Article  Google Scholar 

  26. 26

    Mann L, Burnett P, Radford M, Ford S . The Melbourne Decision Making Questionnaire: An instrument for measuring patterns for coping with decisional conflict. J Behav Decis Mak 1997; 10: 1–19.

    Article  Google Scholar 

  27. 27

    Mann L, Radford M, Burnett P et al. Cross-cultural differences in self-reported decision-making style and confidence. Int J Psychol 1998; 33: 325–335.

    Article  Google Scholar 

  28. 28

    O'Connor A M . Validation of a decisional conflict scale. Med Decis Mak 1995; 15: 25–30.

    Article  Google Scholar 

  29. 29

    Dolan J G . A method for evaluating health care providers' decision making: The provider decision process assessment instrument. Med Decis Mak 1991; 19: 38–41.

    Article  Google Scholar 

  30. 30

    LeBlanc A, Kenny D A, O'Connor A M, Legare F . Decisional conflict in patients and their physicians: A dyadic approach to shared decision making. Med Decis Mak 2009; 29: 61–68.

    Article  Google Scholar 

  31. 31

    McGee R A . Burnout and professional decision making: An analogue study. J Couns Psychol 1989; 36: 345–351.

    Article  Google Scholar 

  32. 32

    Croskerry P, Abbass A A, Wu A W . How doctors feel: Affective issues in patients' safety. The Lancet 2008; 372: 1205–1206.

    Article  Google Scholar 

  33. 33

    Croskerry P . Clinical cognition and diagnostic error: Applications of a dual process model of reasoning. Adv Health Sci Educ Theory Pract 2009; 14: 27–35.

    Article  Google Scholar 

  34. 34

    Schneider A, Löwe B, Barie S, Joos S, Engeser P, Szecsenyi J . How do primary care doctors deal with uncertainty in making diagnostic decisions? The development of the 'Dealing with Uncertainty Questionnaire' (DUQ). J Eval Clin Pract 2010; 16: 431–437.

    Article  Google Scholar 

  35. 35

    Gilmour J, Stewardson D.A, Shugars D A, Burke F J . An assessment of career satisfaction among a group of general dental practitioners in Staffordshire. Br Dent J 2005; 198: 701–704, discussion.

    Article  Google Scholar 

  36. 36

    Gorter R C . Stress and burnout in dentistry: a review of the literature. pp 13–44. University of Virginia, 2000. Thesis.

    Google Scholar 

  37. 37

    Field A . Discovering statistics using SPSS. London: Sage Publications Ltd, 2009.

    Google Scholar 

  38. 38

    Gorter R C, Albrecht G, Hoogstraten J, Eijkman M A . Measuring work stress among Dutch dentists. Int Dent J 1999; 49: 144–152.

    Article  Google Scholar 

  39. 39

    Humphris G M, Cooper C L . New stressors for GDPs in the past ten years: a qualitative study. Br Dent J 1998; 185: 404–406.

    Article  Google Scholar 

  40. 40

    Mann L, Tan C . The hassled decision maker: The effects of perceived time pressure on information processing in decision making. Aus J Management (University of New South Wales) 1993; 18: 197.

    Google Scholar 

  41. 41

    Turnipseed D L . Anxiety and burnout in the health care work environment. Psychol Rep 1998; 82: 627–642.

    Article  Google Scholar 

  42. 42

    Organopoulou M, Tsironi M, Malliarou M, Alikari V, Zyga S . Investigation of anxiety and burn-out in medical and nursing staff of public hospitals of Peloponnese. Int J Caring Sci 2014; 7: 799–808.

    Google Scholar 

  43. 43

    Lee W, Veach P M, MacFarlane I M, LeRoy B S . Who is at risk for compassion fatigue? An investigation of genetic counselor demographics, anxiety, compassion satisfaction, and burnout. J Genet Counse 2015; 24: 358–370.

    Article  Google Scholar 

  44. 44

    Khatami S, MacEntee M I, Pratt D D, Collins J B . Clinical reasoning in dentistry: a conceptual framework for dental education. J Dent Educ 2012; 76: 1116–1128.

    PubMed  Google Scholar 

  45. 45

    Schaufeli W B, Maassen G H, Bakker A B, Sixma H J . Stability and change in burnout: A 10-year follow-up study among primary care physicians. J Occup Organ Psychol 2011; 84: 248–267.

    Article  Google Scholar 

  46. 46

    Chapple H, Shah S, Caress A L, Kay E J . Exploring dental patients' preferred roles in treatment decision-making – a novel approach. Br Dent J 2003; 194: 321–327.

    Article  Google Scholar 

  47. 47

    Richards H J, Benson V, Donnelly N, Hadwin J A . Exploring the function of selective attention and hypervigilance for threat in anxiety. Clin Psychol Rev 2014; 34: 1–13.

    Article  Google Scholar 

  48. 48

    Kimble M, Boxwala M, Bean W et al. The impact of hypervigilance: Evidence for a forward feedback loop. J Anxiety Disord 2014; 28: 241–245.

    Article  Google Scholar 

  49. 49

    Chambers D W . The role of dentists in dentistry. J Dent Educ 2001; 65: 1430–1440.

    PubMed  Google Scholar 

  50. 50

    Moore R, Brodsgaard I . Dentists' perceived stress and its relation to perceptions about anxious patients. Community Dent Oral Epidemiol 2001; 29: 73–80.

    Article  Google Scholar 

  51. 51

    Dillman D A . The design and administration of mail surveys. Ann Rev Sociol 1991; 17: 225–249.

    Article  Google Scholar 

  52. 52

    Edwards P J, Roberts I, Clarke M J et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; Mr000008.

  53. 53

    Ben-Nun P . Respondent fatigue. In Encyclopaedia of survey research methods. Lavrakas P J (ed). Thousand Oaks, CA: Sage Publications Inc. 2008.

    Google Scholar 

Download references

Acknowledgements

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to H. R. Chapman.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/sj.bdj.2017.173

Download citation

Further reading

Search

Quick links