Quality of life and severity assessment by provider and patient in oral and skin conditions

University dissertation from Malmö University, Department of Oral Public Health

Abstract: A good communication between patient and provider has the aim to understand the patient’s problems, to establish and maintain a caring relation, and to inform about disease. The quality of communication may have an influence on different important aspects, such as satisfaction and adherence to treatment. In this thesis, the overairching aim was to evaluate the effects of the communication between patient and provider, by comparing their evaluation of either the health-related quality of life of patients, or the severity of the disease. It was chosen to focus on oral and dermatological conditions, since skin and teeth are some of the most important components of the appearance of a person, and conditions which affect them can have deep psychosocial implications on patients’ life. Paper I concerns skin conditions. Dermatologists’ opinions on skin health-related quality of life and psychological problems in patients were compared to the patients’ reports. Papers II and III concern oral conditions. The evaluation of oral health-related quality of life problems in patients by the caregivers was compared to the evaluation given by patients. In Paper IV, about oral mucosal conditions, the comparison was made between the evaluation of the severity of the disease by patients and providers. Paper I: as regards quality of life, physicians tended to overestimate impairment in several conditions, particularly in alopecia. In many diagnostic categories, an underestimation of the frequency of depression and anxiety by dermatologists was observed. Paper II and III: the correlation between patients’ and caregivers’ evaluation of oral health-related quality of life was low. In general, caregivers tended to overestimate the quality of life impairment of their patients, particularly for women, for elderly people, and for patients with a low number of teeth. The difference between patient and caregiver evaluation did not depend on the professional status of the caregiver (dentist or hygienist), nor on the clinics. Paper IV: in oral mucosal conditions, the agreement between patients’ and providers’ evaluation of severity was very low. Physicians tended to underestimate severity more in older than in younger patients, and in patients with a higher quality of life impairment compared to the others. The underestimation by the physician was also positively associated to psychological problems and the presence of alexithymia. This thesis showed a low agreement between patient and provider in the evaluation of quality of life and psychological problems of patients, and of the disease severity, both in dental and dermatological conditions. The discrepancies were both in the direction of an underestimation and an overestimation by the caregiver.

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