Improving oral health awareness and dental referrals for adult patients receiving palliative care

提高接受姑息治疗的成年患者的口腔健康意识和牙科转诊

• 批准号: 10348739
• 负责人: Xi Chen
• 金额: $ 19.23万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10348739
• 关键词: Address; Adult; Affect; American; Aspiration Pneumonia; Awareness; Care given by nurses; Caring; Cessation of life; Clinic; Clinical; Confusion; Consensus; Data; Dental; Dental Care; Dental Research; Dentistry; Dentists; Dentures; Development; Diagnosis; Education; Family; Family Caregiver; Feasibility Studies; Focus Groups; Food; Foundations; Future; Goals; Guidelines; Health Care Costs; Health education; Healthcare; Impaired cognition; Impairment; Individual; Infection; Intake; Intervention; Interview; Iowa; Lead; Life; Life Expectancy; Light; Medical Care Team; Medicine; Modeling; Mouth Diseases; Mycoses; Neck; Needs Assessment; Nursing Homes; Nutritional; Oral; Oral Examination; Oral health; Pain; Palliative Care; Participant; Pathology; Patient Care; Patients; Perception; Persons; Phase; Physicians; Pneumonia; Practice Guidelines; Process; Protocols documentation; Quality of Care; Quality of life; Radiation therapy; Reporting; Research; Sample Size; Savings; Septicemia; Series; Social Interaction; Structure; Supportive care; Symptoms; Terminal Disease; Terminally Ill; Training; Training Activity; Universities; Work; Xerostomia; aggressive therapy; base; care preference; care providers; chemotherapy; comorbidity; dental surgery; end of life; end of life care; feasibility testing; functional decline; hospice environment; impression; improved; innovation; mortality; neglect; oral care; oral infection; oral pain; palliative; prevent; recruit; response; satisfaction; soft tissue; success; theories; Address; Adult; Affect; American; Aspiration Pneumonia; Awareness; Care given by nurses; Caring; Cessation of life; Clinic; Clinical; Confusion; Consensus; Data; Dental; Dental Care; Dental Research; Dentistry; Dentists; Dentures; Development; Diagnosis; Education; Family; Family Caregiver; Feasibility Studies; Focus Groups; Food; Foundations; Future; Goals; Guidelines; Health Care Costs; Health education; Healthcare; Impaired cognition; Impairment; Individual; Infection; Intake; Intervention; Interview; Iowa; Lead; Life; Life Expectancy; Light; Medical Care Team; Medicine; Modeling; Mouth Diseases; Mycoses; Neck; Needs Assessment; Nursing Homes; Nutritional; Oral; Oral Examination; Oral health; Pain; Palliative Care; Participant; Pathology; Patient Care; Patients; Perception; Persons; Phase; Physicians; Pneumonia; Practice Guidelines; Process; Protocols documentation; Quality of Care; Quality of life; Radiation therapy; Reporting; Research; Sample Size; Savings; Septicemia; Series; Social Interaction; Structure; Supportive care; Symptoms; Terminal Disease; Terminally Ill; Training; Training Activity; Universities; Work; Xerostomia; aggressive therapy; base; care preference; care providers; chemotherapy; comorbidity; dental surgery; end of life; end of life care; feasibility testing; functional decline; hospice environment; impression; improved; innovation; mortality; neglect; oral care; oral infection; oral pain; palliative; prevent; recruit; response; satisfaction; soft tissue; success; theories

7. PROJECT SUMMARY Six million Americans are in need of palliative care (PC) every year. A very large proportion of these persons suffer xerostomia, oral pain or infection, soft tissue pathology, and other oral health issues. Poor oral health limits food choices, interferes with social interactions, and compromises quality of life (QoL). It can also affect one's abilities to tolerate chemotherapy or radiotherapy, accelerate cognitive decline, and cause life-threatening septicemia, aspiration pneumonia, deep neck space infection, and even death, causing preventable suffering for persons receiving palliative care (PRPC) and their family caregivers (FCG). Oral health is substantially undervalued under the current practice model. Oral health has not yet been addressed in the national PC practice guideline. Physicians often overlook oral health, and thus it seems to be less importance to them. Discouraged by this false impression, PRPC and FCG also often undervalue oral health. As a result, the oral health needs of PRPC seldom receive appropriate assessment and treatment, leading to greater comorbidity, and suffering. Meanwhile, dentists often lack training in end-of-life dental care, resulting in terminally-ill nursing home residents, including those in the last 3 months of life, receiving extensive dental surgery and other aggressive treatment. These evidence clearly demonstrates that the current practice model fails to appropriately address the oral health needs of PRPC. A new clinical paradigm is urgently needed to address this crisis. In response, the proposed study aims to develop an oral health intervention to improve oral health awareness and increase dental referrals for PRPC attending the University of Iowa Palliative Care (UIPC) clinic. This study consists of two phases. In Phase I, oral examinations and symptom reviews will be conducted with approximate 32 PRPC to identify their oral health conditions, after which qualitative structured interviews will be completed with the PRPC and their FCG to review their oral health findings and attempt to understand the dyad's perceived needs, treatment goals, and care preferences corresponding to each of the documented conditions. Based on this information and the inputs of a PC expert panel, we will develop and refine the proposed intervention in Phase II, which is expected to include a training module for the PC team, an oral symptom review form, a personalizable training module for dyads, and a dental referral guide for PC providers. The UIPC medical team, 20 newly-recruited PRPC/FCG dyads, and a supportive care nurse (the PRPC/FCG trainer) will then be recruited to evaluate the feasibility of integrating the proposed intervention into daily PC practice. The feasibility test will focus on five domains: acceptability, demand, implementation, practicality and integration. Successful completion of this study will provide foundational data to develop the first interdisciplinary collaborative PC practice in the nation that includes dentistry. Building on this innovative model and study results, our next step will be to examine how this intervention, as a formal component of daily PC practice, can improve oral health and QoL for PRPC, providing essential evidence toward the development of a new clinical paradigm to improve the quality of care for PRPC.

7。项目摘要 每年有600万美国人需要姑息治疗（PC）。这些人中很大一部分受苦 静态，口腔疼痛或感染，软组织病理学以及其他口腔健康问题。口腔健康限制了食物的选择， 干扰社会互动，并损害生活质量（QOL）。它也会影响一个人的能力 化学疗法或放射疗法，加速认知能力下降，并引起威胁生命的败血病，吸入性肺炎， 深颈部太空感染，甚至死亡，导致接受姑息治疗的人（PRPC）和 他们的家庭护理人员（FCG）。 在当前的实践模型下，口腔健康被低估了。口腔健康尚未解决 国家PC实践指南。医师经常忽略口腔健康，因此对他们来说似乎不太重要。 由于这种错误的印象，PRPC和FCG也常常低估了口服健康。结果，口腔健康需要 PRPC很少获得适当的评估和治疗，从而导致更大的合并症和痛苦。同时， 牙医通常缺乏诊断牙齿护理的培训 生命的最后三个月，接受了广泛的牙科手术和其他侵略性治疗。这些证据清楚 证明当前的实践模型无法适当满足PRPC的口腔健康需求。一个新的临床 迫切需要解决这一危机。 作为回应，拟议的研究旨在开发口腔健康干预措施以提高口腔健康意识并提高 PRPC的牙科推荐就读于爱荷华大学姑息治疗（UIPC）诊所。这项研究包括两个 阶段。在第一阶段，口腔检查和症状评论将使用大约32个PRPC进行确定 口腔健康状况，此后将与PRPC及其FCG完成定性结构化访谈 审查他们的口腔健康发现，并试图了解二元组的感知需求，治疗目标和护理 对应于每个已记录的条件的偏好。基于此信息和PC专家的输入 面板，我们将开发并完善第二阶段的拟议干预措施，该干预措施预计将包括一个训练模块 PC团队，口服症状审查表格，二元组的个性化培训模块以及PC的牙科推荐指南 提供者。 UIPC医疗团队，20个新招募的PRPC/FCG二元组和一名支持护理护士（PRPC/FCG 然后，将招募培训师），以评估将拟议干预措施整合到日常PC实践中的可行性。 可行性测试将集中在五个领域：可接受性，需求，实施，实用性和整合。 这项研究的成功完成将提供基本数据，以开发第一个跨学科协作PC 包括牙科在内的国家实践。在此创新模型和研究结果的基础上，我们的下一步将是 检查这种干预是每日PC实践的正式组成部分，如何改善PRPC的口腔健康和QOL， 为开发新的临床范式提供基本证据，以提高PRPC的护理质量。