Acquaintance, attitude, practices and challenges of palliative oral care among healthcare professionals: A cross-sectional survey at a tertiary healthcare institute in India
Abstract
Introduction: To assess knowledge, experiences, perceptions and barriers of healthcare professionals regarding oral palliative care.
Material and methods: The study involved 150 participants working at a tertiary healthcare institute in India. The data collection tool was pretested and self-administered with sections on demographics, knowledge, attitude and practices, patient referral, perspectives, and barriers to oral palliative care.
Results: The majority of participants 142 (94.6%) believed that palliative care patients need oral care, 85 (68.6%) participants had treated palliative care patients with dental problems. However, 60 (40%) had not received formal training for assessment and referral of patients with oral problems; 95 (63.4%) had never used tools to assess oral conditions of palliative care patients. According to 69 (46%), the best method to maintain oral hygiene is rinsing with saline and 81 (54%) expected physicians to be responsible for oral care of palliative care patients. The main challenges in providing oral care were lack of proper guidelines listed by 117 (78%) and lack of formal training indicated by 60 (40%) respondents.
Conclusions: This study highlighted the need for effective assessment of the mouth and appropriate oral care. Training of healthcare professionals, educating families and patients with oral palliative care are necessary to effectively manage oral symptoms. An appropriate patient follow-up and care delivery system should be structured at comprehensive cancer centres, which can improve the quality of life and compliance of patients. There is a need for the development of assessment tools and referral practices for providing relief, comfort and consolation to patients and families.
Keywords: advanced diseasecancerhospiceoral carepalliative care
References
- World Health Organisation: Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en 2013.
- Venkatasalu MR, Murang ZR, Ramasamy DT, et al. Oral health problems among palliative and terminally ill patients: an integrated systematic review. BMC Oral Health. 2020; 20(1): 79.
- Singer AE, Goebel JR, Kim YS, et al. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med. 2016; 19(9): 995–1008.
- Hsu YC, Chu FY, Chen TJ, et al. Lots of little ones: Analysis of charitable donations to a hospice and palliative care unit in Taiwan. Int J Health Plann Manage. 2019; 34(4): e1810–e1819.
- Ragesh G, Zacharias L, Thomas PT. Palliative Care Social Work In India: Current Status and Future Directions. Indian J Palliat Care. 2017; 23(1): 93–99.
- Webster R, Lacey J, Quine S. Palliative care: a public health priority in developing countries. J Public Health Policy. 2007; 28(1): 28–39.
- Lakew S, Musema H, Shimeles T, et al. Assessment of knowledge, accessibility and utilization of palliative care services among adult cancer patients at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia, 2014: a cross-sectional institution based study. BMC Res Notes. 2015; 8: 657.
- Chaturvedi SK, Chandra PS. Palliative care in India. Support Care Cancer. 1998; 6(2): 81–84.
- Sharma D. Experts discuss palliative care in India. The Lancet Oncology. 2003; 4(4): 201.
- Daniel S, Venkateswaran C, Sunder P, et al. Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The Context and Process of Developing and Disseminating Training Resources and Guidance for Low- and Middle-Income Countries from Kerala, South India. Indian J Palliat Care. 2020; 26(Suppl 1): S8–SS16.
- Sadhu S, Salins NS, Kamath A. Palliative Care Awareness among Indian Undergraduate Health Care Students: A Needs-Assessment Study to Determine Incorporation of Palliative Care Education in Undergraduate Medical, Nursing and Allied Health Education. Indian J Palliat Care. 2010; 16(3): 154–159.
- Samuriwo R, Laws E, Webb K, et al. "I didn't realise they had such a key role." Impact of medical education curriculum change on medical student interactions with nurses: a qualitative exploratory study of student perceptions. Adv Health Sci Educ Theory Pract. 2020; 25(1): 75–93.
- Venkatasalu MR, Murang ZR, Husaini HA, et al. Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists. Nurs Open. 2020; 7(5): 1330–1337.
- Wiseman M. The treatment of oral problems in the palliative patient. J Can Dent Assoc. 2006; 72(5): 453–458.
- Wiseman MA. Palliative care dentistry. Gerodontology. 2000; 17(1): 49–51.
- Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009; 45(4-5): 309–316.
- Keboa M, Beaudin A, Cyr J, et al. Dentistry and nursing working together to improve oral health care in a long-term care facility. Geriatr Nurs. 2019; 40(2): 197–204.
- de Pauli Paglioni M, Faria KM, Palmier NR, et al. Patterns of oral mucositis in advanced oral squamous cell carcinoma patients managed with prophylactic photobiomodulation therapy-insights for future protocol development. Lasers Med Sci. 2021; 36(2): 429–436.
- Yarom N, Hovan A, Bossi P, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines - part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Support Care Cancer. 2020; 28(5): 2457–2472.
- Al Rababah DM, Nassani MZ, Baker OG, et al. Attitudes and practices of nurses toward oral care of hospitalized patients – A cross-sectional survey in Riyadh, Saudi Arabia. J Educ Health Promot. 2018; 27(7): 149.
- Pai RR, Ongole R. Nurses' Knowledge and Education about Oral Care of Cancer Patients Undergoing Chemotherapy and Radiation Therapy. Indian J Palliat Care. 2015; 21(2): 225–230.
- Araújo S, Luz M, Silva G, et al. Cancer patients with oral mucositis: challenges for nursing care. Revista Latino-Americana de Enfermagem. 2015; 23(2): 267–274.
- Shankar A, Roy S, Bhandari M, et al. Current Trends in Management of Oral Mucositis in Cancer Treatment. Asian Pac J Cancer Prev, 2017. Asian Pac J Cancer Prev. 2017; 18(8): 2019–2026.
- Saito H, Watanabe Y, Sato K, et al. Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Support Care Cancer. 2014; 22(11): 2935–2940.
- Bausewein C, Simon S, Pralong A, et al. Palliative Care of Adult Patients With Cancer. Deutsches Aerzteblatt Online. 2015; 112(50): 863–870.
- Lanzós I, Herrera D, Lanzós E, et al. A critical assessment of oral care protocols for patients under radiation therapy in the regional University Hospital Network of Madrid (Spain). J Clin Exp Dent. 2015; 7(5): e613–e621.
- Hazelwood DM, Koeck S, Wallner M, et al. Patients with cancer and family caregivers: management of symptoms caused by cancer or cancer therapy at home. HeilberufeScience. 2012; 3(4): 149–158.
- Ezenwa M, Fischer D, Epstein J, et al. Caregivers’ perspectives on oral health problems of end-of-life cancer patients. Supportive Care in Cancer. 2016; 24(11): 4769–4777.
- Shah AH, Naseem M, Khan MS, et al. Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre: an analytical study. Ann Stomatol (Roma). 2017; 8(3): 110–116.
- Elad S, Raber-Durlacher JE, Brennan MT, et al. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer. 2015; 23(1): 223–236.
- Samim F, Epstein JB, Zumsteg ZS. Oral and dental health in head and neck cancer survivors. Cancers Head Neck. 2016(1): 14.
- Bluck S, Mroz EL, Baron-Lee J. Providers' Perspectives on Palliative Care in a Neuromedicine-Intensive Care Unit: End-of-Life Expertise and Barriers to Referral. J Palliat Med. 2019; 22(4): 364–369.
- Dhaliwal JS, Murang ZR, Haji Husaini HA, et al. The need for oral assessment and referral practices tool for palliative patients in Brunei Darussalam: A cross-sectional study. Nurs Open. 2021; 8(1): 39–47.
- Everaars B, Weening-Verbree LF, Jerković-Ćosić K, et al. Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review. BMC Geriatr. 2020; 20(1): 4.
- Rapone B, Nardi GM, DI Venere D, et al. Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal. Oral Implantol (Rome). 2016; 9(Suppl 1/2016 to N 4/2016): 90–97.
- Lee JS, Somerman MJ. The Importance of Oral Health in Comprehensive Health Care. JAMA. 2018; 320(4): 339–340.
