Coding patient cues and concerns in the dental context

Patients express negative emotion either directly as concerns or indirectly as cues. Recognizing and acknowledging cues and concerns has been shown to reduce patient anxiety (Zimmermann et al., 2011). This may be particularly important in dentistry as dental visits often provoke anxiety (Freeman, 2006).
Objective: To establish if patient cues and concerns and health provider responses to patient cues and concerns, as defined in the Verona coding definitions of emotional sequences (VR-CoDES) and health provider responses (VR-CoDES-P) (Del Piccolo et al., 2011), occur in a general dental setting and can be coded reliably.

Methods: 13 dental treatment appointments were video recorded using a portable camera. All videos were coded by one trained coder using VR-CoDES and VR-CoDES-P using The Observer XTv10. 7 of the videos were re-coded by the original researcher (AW) to establish intra-rater reliability and a further 4 videos were coded by a second coder (GH) to establish inter-rater reliability.

Results: Intra-rater reliability was 0.773 (0.688, 0837) and the inter-rater reliability was 0.774 (0.640, 0.862) for cues and concerns. Cues were found in every consultation and concerns occurred in 6 (46%) consultations. Cues occurred on average 0.58 times per minute (SD 0.24) in appointments with the dentist and 0.24 times per minute (SD 0.14) in appointments with the hygienist. The most common response to cues and concerns, by both the dentist and dental nurse, was to non-explicitly reduce space and by the hygienist was to explicitly reduce space. In order to apply the VR-CoDES and VR-CoDES-P in a dental setting additional guidance had been designed to allow for the triadic (including the dental nurse) nature of dental appointments and high reliance of non-verbal cues expressed by patients.

Conclusions: The VR-CoDES and VR-CoDES-P can be reliably applied in a general dental setting.