Impact of Provider–Patient Communication on Patient-Reported Outcomes and Experiences in Periodontal Assessment: A Double-Blinded Randomized Clinical Trial

Abstract

Abstract Objectives This study aimed to evaluate the individual and combined effects of expectation manipulation and empathy manipulation on patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in adults undergoing a periodontal clinical examination. Materials and Methods Participants were randomized into four groups: (i) Control (CTRL) – standard care; (ii) Expectation manipulation; (iii) Empathy manipulation; and (iv) Combined expectation and empathy manipulation. Outcomes included pain perception and pain expectation, anxiety, mood, empathy, and satisfaction, assessed using validated instruments such as the State-Trait Anxiety Inventory (STAI-state), Positive and Negative Affect Schedule (PANAS), CQ-index, and Interpersonal Reactivity Index (IRI). Results A total of 24 patients were included, the majority being women, with no significant differences in age or gender across groups. No participants were diagnosed with periodontitis. Empathy manipulation significantly reduced fear of the periodontal clinical examination (p = 0.034) and increased patient satisfaction. However, participants exposed to both expectation and empathy manipulation reported higher pain perception during/after the clinical examination. Overall, empathy-enhanced communication demonstrated clinically relevant benefits, including reduced fear, improved satisfaction, and increased engagement in periodontal care. Expectation manipulation alone appeared to stimulate greater patient interest in the clinical examination but was also associated with heightened anticipation of pain. Conclusions Empathy manipulation exerted a potential placebo-like effect, reducing fear, overcoming objections, increasing patient interest and active participation in care, and improving satisfaction with the periodontal clinical examination. Clinical relevance Incorporating empathetic communication strategies into routine periodontal examinations may improve patient experiences and foster greater trust and engagement in dental care. Keywords Periodontal disease, patient-reported experience measures, patient reported outcome measures, periodontitis, periodontal examination.