This week on A Tale of Two Hygienists TIPisode we are joined by Hayley Buckner, RDH who is the e-Preventive Care Consultant Supervisor for Elevate Oral Care. This week Hayley talks to us about how to encourage our patients and help them change their behavior in the interest of oral health by finding out what motivates each individual via patient centered communication.
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Episode Highlights
- Patient Centered Communication
- Caries Risk Assessment Questionnaire
- Reflective Listening
- Change Talk
- Goals and Establishing an Oral Care Plan
- In Office and At Home Strategies through Elevate Oral Care
- Follow Up
- Resources Available
Quotes
“Have you noticed if someone tells you to do something it is less effective than If you decide to do it on your own?”
“If we work together with the patient to uncover their needs and values we can help assist them, rather than pushing them to do something”
“…It is entirely preventable, this is important for the patients to know”
“These reflections are validating”
“Reflective listening is the single most important skill when it comes to fostering change in others”
“More change talk means an increased likelihood of change”
“Patients are must more effective when they choose their goal”
Links
Patient Centered Communication Video Series: http://www.elevateoralcare.com/elevatingcare
Elevate Oral Care Website: http://www.elevateoralcare.com
Elevate Oral Care Facebook: https://www.facebook.com/elevateoralcare
Elevate Oral Care Instagram: https://www.instagram.com/elevate_oral_care/
More TIPisodes: https://ataleoftwohygienists.com/tipisodes/
AToTH Website: https://ataleoftwohygienists.com
This TIPisode has been transcribed for your viewing pleasure:
[INTRODUCTION MUSIC]
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Hayley Buckner: Hello, everyone. My name is Hayley Buckner. I’m a registered dental hygienist and a preventive care consultant for Elevate Oral Care. I’m here today to share some tips on how we can encourage our patients and help them change their behavior in the interest of oral health by finding what motivates each individual via patient-centered communication.
Hygienists spend time with patients all day every day going through oral hygiene education and making recommendations to patients on ways to improve their oral and overall health. An example of this is recommending that our patients brush twice and floss daily. This direction seems quite simple and straight forward, yet our patients continue to present with caries, periodontal disease, and poor oral health. So what is patient-centered communication?
Have you noticed that when someone tells you to do something it is less effective than if you decided to do it on your own? Patient-centered communication is a simple, conversational technique that will help to guide a conversation according to a patient’s values and expectations to elicit a change in behavior. It uses shared decision-making where the patient and oral care team work towards one goal of improving the patient’s health. This enables the patient to have a voice; understand their options, risks, benefits, alternatives; and gives them power. This type of care respects the patient’s expectations without disregarding clinical evidence.
A great analogy of this is if you picture a flowing river. When we swim against the current, the current continues to push us back. However, if we swim with the current, we are better able to guide our general direction. Therefore, if we just tell a patient what they should do, they may push back and not follow through with our recommendations. But, if we work together with the patient to uncover their needs and values, we can help assist them as opposed to pushing them to do something.
A patient-centered care approach requires respectful responsiveness to the individual patient’s preferences, needs, and values as these guide all clinical decisions. This focus on the patient improves patient satisfaction with their education, treatment, and outcomes.
At Elevate Oral Care, we have created tools that can help with this process. To start, we have a caries risk assessment questionnaire, which begins with a brief introduction that explains that the disease that causes cavities is not only infectious and transmissible but also almost entirely preventable, which is important for patients to understand.
Next, the patient will find four open-ended questions. Open-ended questions are crucial in patient-centered communication because it promotes engagement. They’re collaborative, evocative, and allows the clinician to get a better understanding of what is important and what they value when it comes to their oral health. One example is “What are your long-term goals for your oral health?” As you can imagine, an open-ended question allows the clinician to gather a lot more information from the patient rather than a simple yes or no that a closed-ended question would provide.
As the patient answers these questions, it allows the clinician to practice reflective listening. Reflective listening is especially important as it demonstrates that the clinician is listening and paying attention. These reflections are validating and have the effect of encouraging the patient to elaborate, amplify, confirm, or correct. Reflective listening is the single most important skill when it comes to fostering change in others.
Through reflection, you can help guide the conversation towards the behavior change that is important to your patient. After you ask these engaging questions, be sure to affirm their values and repeat back their answers to make sure you are both on the same page. This moves your traditional caries risk assessment to more of a caries risk conversation.
After you have established what is important to the patient and what their goals are, it is time to evoke change talk and listen. Simply put, change talk is any talk that favors movement in the direction of change. This is where you want to ask more open-ended questions specific to their oral health. One example would be “What do you do at home to keep your teeth clean and healthy?” By asking these questions, you have a strategic focus and are eliciting talk about change, about the pros of changing, and the downside of not making that change. More change talk means an increased likelihood for change.
Recognizing and responding to things that the patient wants to change with reflections and requests for them to elaborate is particularly important during this stage. These reflections of change talk tend to elicit more change talk, which is predictive of eventual behavior change and leads to better oral health.
So, now that you have a good understanding of the patient’s goals and concerns and what they currently do in working towards their oral health, it is time to work together to develop a plan for them to be successful at achieving their oral health goals. When helping a patient choose a goal, it is important that you do not focus on too many goals at once. Also, the most important part in goal setting is that it is patient driven, which will help the patient to be the most successful at a behavior change.
Another great tool from Elevate Oral Care is our patient menu of in-office and at-home strategies, which has pictures of different options including more frequent dental visits, options to strengthen their teeth with fluoride varnish or silver diamine fluoride, and germ control. As for the at-home strategies, the options include prescriptions to strengthen their teeth, like 5000 parts per million toothpaste, germ control with a stannous fluoride rinse and xylitol products, and tools to improve at-home cleaning, like an electric toothbrush or interdental brushes.
Again, patients are much more effective when they choose their goal. Therefore, you can utilize this menu to present them with different options for them to choose the best in-office and at-home strategies for them.
Now that you have a plan based on their goals, ask permission to check in with that patient at their next visit, and then be sure to follow up with them. During that follow up, focus on the positive, ask questions around future change, affirm the patient, and instill hope. Also, this is a great time to consider whether that goal is the right goal for the patient if they’re not having success.
Great news is that there is research backing this up. There was a recent study from the Journal of Dental Research. This study determined efficacy of a dental nurse-delivered intervention, which is a psychosocial intervention that was to be delivered by the dental nurse to parents of children who have had a dental extraction of primary teeth. This intervention is designed to develop shared understanding with parents through communication about adopting healthier behaviors to reduce recurrence of caries in their children. The study found the odds of new caries experience of kids between the ages of 5 and 7 were 51 percent lower versus the control after partaking in patient-centered communications, and relative risk was 29 percent lower in the intervention group versus the control group. Pretty fascinating.
Bottom line, there’s a lot of proof out there that the traditional approach where a health care professional uses their knowledge to make recommendations to patients rarely provides the outcome of a true behavior change. However, this patient-centered approach is about promoting change by listening and individual’s own motivation to change.
A patient-centered approach is more likely to result in a patient taking positive actions towards behavior change in a safe, non-judgmental, and supportive environment. Patients can take control of their behaviors and are therefore more likely to succeed at any subsequent behavior change.
Elevate Oral Care has worked closely with Dr. Matthew Allen, who’s the only US-based dentist member of MINT, which is the Motivational Interviewing Network of Trainers, to produce a free, one hour continuing education video series on patient-centered communications including many patient chairside scenarios. This great course can be found on our website at www.elevateoralcare.com/elevatingcare. Also, to find the tools I mentioned, videos to expand on this, and to schedule a staff meeting to receive AGD PACE continuing education with Elevate Oral Care, visit elevateoralcare.com or call 877-866-9113.
Thanks, and good luck with your patient-centered communication.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at ataleoftwohygienists@gmail.com, and keep listening for more awesome content from your unofficial dental hygiene podcast.
[CLOSING MUSIC]
