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

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. 项目概要 每年有 600 万美国人需要姑息治疗 (PC)。这些人中有很大一部分遭受痛苦 口干、口腔疼痛或感染、软组织病理以及其他口腔健康问题。口腔健康状况不佳限制了食物的选择， 干扰社交互动并损害生活质量 (QoL)。也会影响一个人的耐受能力 化疗或放疗，加速认知能力下降，并导致危及生命的败血症、吸入性肺炎、 颈部深部间隙感染，甚至死亡，给接受姑息治疗（PRPC）的人带来本可预防的痛苦 他们的家庭照顾者 (FCG)。 在当前的实践模式下，口腔健康被严重低估。口腔健康问题尚未得到解决 国家 PC 实践指南。医生经常忽视口腔健康，因此口腔健康对他们来说似乎不太重要。 由于受到这种错误印象的打击，PRPC 和 FCG 也经常低估口腔健康。因此，口腔健康需要 PRPC 很少得到适当的评估和治疗，导致更大的合并症和痛苦。同时， 牙医往往缺乏临终牙科护理方面的培训，导致疗养院居民身患绝症，包括那些在 生命的最后 3 个月，接受广泛的牙科手术和其他积极治疗。这些证据明确 表明当前的实践模式未能适当满足 PRPC 的口腔健康需求。一种新的临床 迫切需要解决这一危机的范式。 为此，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增加 前往爱荷华大学姑息治疗 (UIPC) 诊所就诊 PRPC 的牙科转诊。这项研究包括两个 阶段。在第一阶段，将对大约 32 名 PRPC 进行口腔检查和症状审查，以确定他们的症状 口腔健康状况，之后将与 PRPC 及其 FCG 完成定性结构化访谈，以 审查他们的口腔健康检查结果，并尝试了解二人的感知需求、治疗目标和护理 与每个记录条件相对应的偏好。基于此信息和 PC 专家的输入 小组中，我们将在第二阶段制定和完善拟议的干预措施，预计将包括一个培训模块 PC 团队、口腔症状审查表、双人个性化培训模块以及 PC 牙科转诊指南 提供商。 UIPC 医疗团队、20 名新招募的 PRPC/FCG 双人组以及一名支持护理护士（PRPC/FCG） 然后将招募培训师来评估将建议的干预措施纳入日常 PC 实践的可行性。 可行性测试将重点关注五个领域：可接受性、需求、实施、实用性和集成性。 这项研究的成功完成将为开发第一台跨学科协作PC提供基础数据 在包括牙科在内的国家执业。基于这一创新模型和研究成果，我们的下一步将是 研究这种干预措施作为日常 PC 实践的正式组成部分如何改善 PRPC 的口腔健康和生活质量， 为开发新的临床范例以提高 PRPC 护理质量提供重要证据。