Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.20260038
Revista de Odontologia da UNESP
Original Article

Effects of expectancy and empathy communication strategies on patient-reported outcomes and experiences during periodontal examination: a pilot randomized clinical trial

Efeitos de estratégias de comunicação baseadas em expectativa e empatia sobre os desfechos e as experiências relatados pelos pacientes durante o exame periodontal: um estudo clínico randomizado piloto

Paola Elizabete Bezerra da Silva GALVÃO; Jamille Mendes SILVA; Fernanda Neves AMARANTE; Manoela Almeida Santos da FIGUEIRA; Mariana Fampa FOGACCI; Francisco Wilker Mustafa Gomes MUNIZ; Rafael Scaf de MOLON; Davi da Silva BARBIRATO

http://dx.doi.org/10.1590/1807-2577.20260038 Rev. odontol. UNESP, vol.55, e20260038, 2026
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Abstract

Introduction: Periodontal examinations may elicit fear, anxiety, and discomfort, potentially compromising patients’ experiences and acceptance of care. Communication strategies involving expectancy and empathy manipulation may improve patient-reported outcomes and experiences, although their individual and combined effects remain poorly understood in periodontal practice.

Objective: 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.

Material and method: Participants were randomized into four groups: (i) Control – 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).

Result: A total of 24 patients were included, the majority being women, with no significant differences in age or sex across groups. All participants were diagnosed with periodontal health. Empathy manipulation 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 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.

Conclusion: Our findings suggest that 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.

Keywords

Periodontal disease, patient-reported experience measures; patient reported outcome measures; periodontitis; periodontal examination

Resumo

Introdução: O exame clínico periodontal pode provocar medo, ansiedade e desconforto, comprometendo a experiência do paciente e a aceitação do cuidado. Estratégias de comunicação baseadas na manipulação de expectativas e na empatia podem melhorar os desfechos e as experiências relatados pelos pacientes, embora seus efeitos individuais e combinados ainda sejam pouco compreendidos na prática periodontal.

Objetivo: Este estudo teve como objetivo avaliar os efeitos individuais e combinados da manipulação da expectativa e da manipulação da empatia sobre os desfechos relatados pelos pacientes (patient-reported outcome measures – PROMs) e as experiências relatadas pelos pacientes (patient-reported experience measures – PREMs) em adultos submetidos a um exame clínico periodontal.

Material e método: Os participantes foram randomizados em quatro grupos: (i) Controle – atendimento padrão; (ii) Manipulação da expectativa; (iii) Manipulação da empatia; e (iv) Manipulação combinada da expectativa e da empatia. Os desfechos avaliados incluíram percepção e expectativa de dor, ansiedade, humor, empatia e satisfação, mensurados por instrumentos validados, como o State-Trait Anxiety Inventory (STAI-estado), a Positive and Negative Affect Schedule (PANAS), o CQ-index e o Interpersonal Reactivity Index (IRI).

Resultado: Foram incluídos 24 pacientes, sendo a maioria do sexo feminino, sem diferenças significativas entre os grupos quanto à idade ou ao sexo. Todos os participantes apresentavam saúde periodontal. A manipulação da empatia reduziu o medo do exame clínico periodontal (p = 0,034) e aumentou a satisfação dos pacientes. Entretanto, os participantes expostos simultaneamente à manipulação da expectativa e da empatia relataram maior percepção de dor durante/após o exame clínico. De modo geral, a comunicação aprimorada pela empatia demonstrou benefícios clinicamente relevantes, incluindo redução do medo, aumento da satisfação e maior engajamento nos cuidados periodontais. A manipulação isolada da expectativa pareceu estimular maior interesse dos pacientes pelo exame clínico periodontal, mas também esteve associada a maior antecipação da dor.

Conclusão: Nossos resultados sugerem que a manipulação da empatia exerceu um potencial efeito semelhante ao placebo, reduzindo o medo, superando objeções, aumentando o interesse e a participação ativa dos pacientes no cuidado, além de melhorar a satisfação com o exame clínico periodontal.

Palavras-chave

Doenca periodontal; medidas de experiência relatadas pelos pacientes (PREMs); medidas de desfechos relatados pelos pacientes (PROMs); periodontite; exame periodonta

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Submitted date:
06/29/2026

Accepted date:
10/02/2026

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