Patient participation starts with patient education

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  Posted by: Dental Design      4th June 2024

The General Dental Council (GDC) Standards for the Dental Team clearly sets patients’ interests at the core of ethical practice. The code elucidates much of this principle in terms of integrity; in honest communications, and holistic clinical care.[i]

Dental professionals are increasingly encouraged to seek patient participation throughout the whole consultation process, from selecting treatments, to managing appropriate self-care. Clinicians often find that delivering the best treatment requires some education, and building rapport and developing communication is key. This increases trust and enables collaboration, contributing to greater case acceptance.[ii]

It can be hard not to take it personally when patients refuse to participate, or to adhere to carefully considered recommendations. Although it may be a simple case of a patient having little interest in following advice, a patient’s inability to listen or to trust professionals may be linked to a number of circumstances. These include poor mental health, treatment burnout due to a chronic illness, learning difficulties, neurodivergence or behavioural disorders.

For example, oppositional defiant disorder (ODD), is a behavioural disorder that is generally seen in children and can persist into adulthood. The condition is characterised by negative, aggressive or defiant behaviour, as well as a mistrust of those in positions of authority. ODD is linked with attention-deficit hyperactivity disorder (ADHD), as well as depression and anxiety, and it negatively effects patients’ overall health and life chances.[iii]

Due to the nature of the condition, it can be difficult to communicate instructions to patients with ODD, or to build a rapport to help them participate in treatment. It can be easy to become defensive in response to unreasonable defiance. Those seeking to educate ODD patients are advised to stay calm, reinforce positive behaviour, offer choices and adopt a collaborative approach as much as possible over a didactic one.[iv]

It may be helpful to remember that many behavioural problems are associated with anxiety as well.[v] Studies have found that about 60% of those with lifetime ODD also met criteria for lifetime anxiety disorders.[vi]

Whatever the reason for a patient failing to follow advice, professionals have a duty to communicate effectively so they can implement a holistic and preventative approach to patient care. Training in persuasive techniques can be helpful.

Quick tips for effective persuasion

  1. Exercise empathy.

Evidence has shown that empathy training can be very helpful in promoting treatment acceptance.[vii]Empathy improves communication skills and builds rapport. Empathetic practice has also been shown to improve the behaviour of patients towards practitioners.[viii]

  1. Educate

Promoting health literacy is key in helping patients develop self-efficacy around their health care needs, and people with high levels of self-efficacy have better health and quality of life.[ix] Patient education and collaborative, partnership approaches to treatment enable genuine participation in treatment, improving outcomes.[x]

  1. Communicate

In order to be most effective, communication should be bi-directional, and educating patients will be more effective if there is a genuine exchange of information – this means listening.[xi] Providing clear information is a vital part of communication and of ethical practice. Clear, visual information for use in-practice and online is particularly helpful for allaying anxieties in those with impaired learning skills.[xii]

  1. Some people just need time.

Sometimes it’s best to provide patients with information about their condition, with advice and options, and give them time to absorb it. Time allows patients to contemplate options, gather additional information, confer with family and friends, consider individual preferences, and address their personal worries or concerns.[xiii]

Knowledge is power

Once options for treatment are discussed with patients, this should be immediately documented. To assist in collaborative decision-making, patients benefit from having direct access to pertinent information and advice. Documentation sent to patients should contain clear, personalised and succinct information related to their diagnosis and treatment options, including clear costs. Ideal documentation should convey complex information in clear terms, and should be educational by outlining the detailed risks and benefits of the treatment options.[xiv]

Kiroku Docs enables clinicians to create any documentation needed. Patient information letters, treatment plans, consent forms and referral letters, can be created from consultation notes in an instant. Powered by AI, the system automatically converts Kiroku Notes into any number of customisable documents. Clinicians have full control over the level of complexity of the language used, ensuring the information is appropriate for every recipient. Instant conversion enables clinicians to spend more time discussing approaches to treatment with patients.

Dental professionals that take time to communicate empathetically with patients, and help them develop knowledge and understanding, reap the benefits in terms of case acceptance and more positive outcomes. Patients, especially those with conditions affecting collaborative skills like ODD, benefit from clear information that allows them to give their fully informed consent to treatments.

To find out more about Kiroku, or to start your free trial, please visit


[ii] Paterick TE, Patel N, Tajik AJ, Chandrasekaran K. Improving health outcomes through patient education and partnerships with patients. Proc (Bayl Univ Med Cent). 2017 Jan;30(1):112-113. doi: 10.1080/08998280.2017.11929552. PMID: 28152110; PMCID: PMC5242136.

[iii] Burke JD, Rowe R, Boylan K. Functional outcomes of child and adolescent oppositional defiant disorder symptoms in young adult men. J Child Psychol Psychiatry. 2014 Mar;55(3):264-72. doi: 10.1111/jcpp.12150. Epub 2013 Oct 10. PMID: 24117754; PMCID: PMC3944082.

[iv] Gonser, S. Edutopia. 6 Ways to Help Students with ODD. Available at: 2021. (Accessed March 2024)

[v] Bubier JL, Drabick DA. Co-occurring anxiety and disruptive behavior disorders: the roles of anxious symptoms, reactive aggression, and shared risk processes. Clin Psychol Rev. 2009 Nov;29(7):658-69. doi: 10.1016/j.cpr.2009.08.005. Epub 2009 Aug 21. PMID: 19729235; PMCID: PMC2758916.

[vi] Drabick DA, Ollendick TH, Bubier JL. Co-occurrence of ODD and Anxiety: Shared Risk Processes and Evidence for a Dual-Pathway Model. Clin Psychol (New York). 2010 Dec 1;17(4):307-318. doi: 10.1111/j.1468-2850.2010.01222.x. PMID: 21442035; PMCID: PMC3063941.

[vii] Teding van Berkhout E, Malouff JM. The efficacy of empathy training: A meta-analysis of randomized controlled trials. J Couns Psychol. 2016 Jan;63(1):32-41. doi: 10.1037/cou0000093. Epub 2015 Jul 20. Erratum in: J Couns Psychol. 2016 Jan;63(1):41. van Berkhout, Emily Teding [corrected to Teding van Berkhout, Emily]. PMID: 26191979.

[viii] Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel). 2020 Jan 30;8(1):26. doi: 10.3390/healthcare8010026. PMID: 32019104; PMCID: PMC7151200.

[ix] Holloway A, Watson HE. Role of self-efficacy and behaviour change. Int J Nurs Pract. 2002 Apr;8(2):106-15. doi: 10.1046/j.1440-172x.2002.00352.x. PMID: 11993577.

[x] Paterick TE, Patel N, Tajik AJ, Chandrasekaran K. Improving health outcomes through patient education and partnerships with patients. Proc (Bayl Univ Med Cent). 2017 Jan;30(1):112-113. doi: 10.1080/08998280.2017.11929552. PMID: 28152110; PMCID: PMC5242136.

[xi] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/


[xiii] Krist AH, Tong ST, Aycock RA, Longo DR. Engaging Patients in Decision-Making and Behavior Change to Promote Prevention. Stud Health Technol Inform. 2017;240:284-302. PMID: 28972524; PMCID: PMC6996004.

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