Chipchase S Y, Chapman H R, Bretherton R
School of Psychology.
School of Psychology, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS.
Br Dent J. 2017 Feb 24;222(4):277-290. doi: 10.1038/sj.bdj.2017.173.
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.
目的 开发一种衡量牙医在临床情境中焦虑程度的方法；确定牙医在临床情境中的焦虑是否会影响他们自我报告的临床决策；确定职业压力（以倦怠表现）是否与临床情境中的焦虑及临床决策相关；并探讨决策风格与受焦虑影响的临床决策之间的关系。
设计 横断面研究。
背景 初级牙科保健。
对象与方法 向在诺丁汉郡和林肯郡执业的牙医发放一组问卷[马氏倦怠量表，用于测量倦怠；墨尔本决策问卷，用于测量决策风格；应对不确定性问卷（DUQ），用于测量应对诊断不确定性；以及新设计的临床情境中牙医焦虑量表，用于测量牙医焦虑（DACSS-R）和治疗变化（DACSS-C）]。收集人口统计学数据，牙医列举引发焦虑的情境及他们的应对方式。
主要结局指标 受访者在11点李克特量表上自我报告的在各种临床情境中的焦虑（DACSS-R）以及自我报告的临床程序变化（是/否；DACSS-C）。使用多个t检验和主成分分析对DACSS进行验证。使用Pearson相关性和多元回归分析探讨DACSS-R评分与倦怠、决策和应对不确定性之间的差异。定性数据进行主题分析。
结果 DACSS-R显示出四因素结构且具有较高的内部信度（克朗巴哈α系数 = 0.94）。焦虑的DACSS-R得分较高者更有可能报告临床程序的变化（DACSS-C得分）。DACSS-R得分与MDMQ测量的决策自尊和风格以及所有倦怠子量表相关，但与DUQ量表得分无关。
结论 如使用新设计并经验证的DACSS所评估，牙医在临床情境中的焦虑确实会影响牙医的临床工作方式。这种焦虑与倦怠和决策风格的测量相关，对牙医培训方案有影响。
