Purpose: Palliative care is constructed by various kinds of professionals. This study aimed to identify the challenges that dental hygienists (DHs) encountered when working with other professionals in a multidisciplinary team approach in palliative care for advanced cancer patients.
Methods: We conducted the following two studies: (1) a questionnaire-based survey for DHs who belong to Japanese Society for Oral Care (JSOC) on oral care in palliative care settings (n = 1,290), and (2) surveys on education for DHs in universities. Items in this study included the following: 1) a cross-sectional analysis of the curriculum on palliative care at 10 universities and 2) a questionnaire-based survey on palliative care education at 1 of the 10 universities (n = 75).
Results: (1) Seventy-three percent had experience in oral care in palliative care settings. The number of DHs with =20 years’ experience was significantly higher than those with <10 years’ experience (76% vs 66%, p = 0.042). Further, 92% received no formal palliative care education, and 94% perceived a lack of knowledge on palliative care. These data did not differ based on the years of experience. (2) (a) There was no specific curriculum on the subject of palliative care in 10 universities. Lectures on palliative care were provided at 3 universities. (b) Fifty-five percent of students attended lectures on palliative care. However, 88% of them experienced anxiety, and 78% perceived few classes on palliative care.
Conclusions: For DHs, to positively contribute to multidisciplinary palliative care team approach, it is important to establish pregraduate and postgraduate education systems.
Aim: Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings.
Design: An exploratory qualitative study.
Methods: Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis.
Results: Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."
Background: oral health problems among people receiving palliative care are common and can significantly affect quality of life. Nurses are at the frontline of palliative care in Australia. However, how optimal oral health care is addressed in clinical practice by palliative nurses is not known.
Aim: To explore the perceptions of nurses working in Australian palliative care settings to determine the acceptability, challenges and recommendations that need to be considered to develop and implement an oral health care model in palliative care settings.
Methods: Two focus groups were conducted with community (n = 8) and inpatient nurses (n = 10) working in urban palliative care settings.
Findings: Four main themes were developed through consensus: 1) Oral health is important in the palliative care setting; 2) Additional training could enhance what nurses already do; 3) Barriers to receiving oral care: a structural issue; 4) Exploring alternative pathways to dental services.
Discussion: Nurses recognised the importance of oral health in palliative care; however, the paucity of set protocols based on existing guidelines meant that oral care was often unstructured. Systemic factors reduced the number of available options for people receiving palliative care to access professional dental treatment. Although alternative solutions, including teledentistry services, were explored, there were some constraints.
Conclusion: A palliative care oral health model of care would need to integrate existing formal guidelines into a comprehensive framework specific for palliative care nurses and develop palliative care oral health training for them taking into consideration existing barriers for people to receive professional dental treatment.
BACKGROUND: High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions.
METHODS: An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included.
RESULTS: Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients.
CONCLUSIONS: This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.
Life-limiting diseases such as cancers and its related treatments often compromise normal oral microbial flora and predispose a palliative patient to diverse oral infections. Knowledge on microbial flora in the oral cavity of patients with life-limiting diseases is essential to develop treatment options for clinical practitioners. This review aimed to systematically synthesize the published evidence on the oral microbiology of palliative patients. An integrative review was undertaken with defined search strategy from five databases with manual search through key journals and reference list. Studies included were published during the year 2000-2017 focusing on microbiological evidence associated with oral conditions among palliative patients. Candida presence was reported in the oral cavity of terminally ill patients in seven of nine articles, with Candida albicans being the predominant species. The majority of the included studies used oral swabs as a technique for isolation of the organism. This review is first to systematically synthesize the published evidence on the oral microbial flora of palliative patients, taking into account the techniques for identification of the microbiota. Larger multicenter studies may help in developing standardized clinical guidelines for the oral care of these patients.
Background: Oral problems are frequent in palliative care and can cause disabling symptoms such as orofacial pain, dysgeusia, and xerostomia. Even if oral care is an essential aspect of nursing, it is often not considered as a priority, especially when various complex patients? needs have to be managed.
Objective: The aim of this study was to describe oral conditions and evaluate the impact of standard oral care on symptom control and patient's perceived comfort in a sample of terminally ill patients.
Method: A prospective cohort study was carried out among 415 patients who were admitted to hospice. Patients were recruited before undergoing standard assisted procedure for oral hygiene care. Oral cavity condition, symptoms, and comfort were assessed at the recruitment (T0) and after 3 days (T2).
Results: Seventy-five eligible patients were recruited. The Oral Assessment Guide score was significantly decreased after oral standard care (P value <.0001). The average time spent by nursing staff for oral hygiene care was 5.3 minutes. Dysgeusia and xerostomia were significantly decreased after oral standard care (P = .02 and P = .03). Patients reported a high level of comfort (86.6%) after the procedures for oral hygiene care.
Conclusion: Patients admitted to hospice had frequent alterations in oral cavity with partial loss of its functions that can compromise their quality of life. Standard procedures for oral hygiene care are simple and fast to perform, and they may improve oral cavity conditions, symptoms control, and patients' comfort.
Most patients in palliative care have problems with dry mouth caused by medication or as a direct result of their condition. Dry mouth may cause problems that affect the primary disease negatively and contribute to poorer quality of life in palliative patients. This randomized controlled trial compared the efficacy of three different oral moisturizers: 17% watery solution of glycerol; oxygenated glycerol triester (marketed as Aequasyal in Europe and as Aquoral in the USA); and a newly developed product, Salient. Of the three products, glycerol provided the best relief from xerostomia directly after application, but had no effect after 2 h. By contrast, the effects of Aequasyal and Salient were largely maintained over the same period. The findings for oral discomfort and pain and speech problems showed a similar pattern. Despite its poor effect after 2 h, patients preferred glycerol over Salient and Aequasyal, probably because of the unpleasant taste of Aequasyal and the consistency and mode of application of Salient. Within the limitations of this study, none of the three products tested was found to be clinically completely adequate. However, the glycerol solution was preferred by this group of patients, and its short-lived effect can be compensated for by frequent applications.
PURPOSE: Dry mouth is a highly prevalent and significant symptom in patients with advanced progressive diseases. It is a poorly understood area of research, and currently, there is no standardised outcome measure or assessment tool for dry mouth.
METHODS: To assess responses to self-reported dry mouth questions, the impact of dry mouth, methods used to reduce symptoms and relevance of the questionnaire. A cross-sectional multisite study of 135 patients with advanced progressive disease experiencing dry mouth. Participants were located in the inpatient, day care, outpatient or community setting.
RESULTS: The majority (84.4%) of patients rated their dry mouth as moderate or severe using the verbal rating scale (VRS). Seventy-five percent (74.7%) had a numeric rating scale (NRS) score of 6 or more for dry mouth severity. Patients reported that dry mouth interfered most with talking and was the most important function to assess (median score 6 out of 10) followed by eating (median 5) and taste (median 5). Taking sips of drink was the most common and most effective self-management strategy. Over half of patients (54.6%) also reported impact on swallow and sleep and associated dryness of lips, throat and nasal passages.
CONCLUSIONS: This study highlights the severity of dry mouth in advanced disease. Important factors when assessing patients with dry mouth should include the functional impact on day-to-day activities including talking, dysphagia and sleep. Simple considerations for patients include provision of drinks and reviewing medications. This study could be used to develop a standardised assessment tool for dry mouth to use in clinical practice.
Le risque d’altération de la bouche est majoré en phase palliative d’une maladie du fait de l’assèchement de la muqueuse buccale par les thérapeutiques. Affaibli, le patient boit et s’alimente peu, voire plus. Sa perte d’autonomie amène les soignants à prendre le relais des soins d’hygiène et de confort. Le soin de bouche préventif, d’hydratation et de confort, associé au soin de bouche d’hygiène devient indispensable.
Oral complications are common among patients with advanced cancer, though relatively little research has been undertaken in this field. This review article discusses the common problem of xerostomia among the terminally ill, together with an overview of oral candidosis, oral viral infections, chemotherapy- and radiotherapy-associated mucositis, and alterations in taste sensation among those with advanced cancer. Suggested management regimes, based on the limited clinical trial data available, are provided where appropriate.
INTRODUCTION: Maintaining oral health is vital for every individual's quality of life. Little consideration, however, has been given to the oral health of patients approaching end-of-life, perhaps due to sensitivities over research ethics. The aim of this rapid review is to synthesize existing evidence on oral health in this population.
METHODS AND RESULTS: A rapid review of the literature was conducted using the key words: "Oral/Dental Health" in "End-of-life" or "Palliative care" patients. Nineteen articles met the inclusion criteria: five retrospective cohort studies, ten cross sectional studies, two experimental studies, one systematic review, and one audit. Quality was medium to low. The prevalence of oral/dental conditions was high in the end-of-life population, as were self-reported symptoms, and poor OHRQOL. Staff placed value on oral health but identified several barriers to providing both routine daily and professional dental care. Professional oral care was beneficial in relieving palliative specific conditions and providing guidance/training for daily care.
CONCLUSION: There is a paucity of high quality research in relation to oral health at end-of-life. The existing literature suggests that oral health and oral health related quality of life are poor and professional support and care for this population is needed.
Introduction: The oral cavity, in palliative care patients, is commonly the first site of discomfort and loss of function. Oral care, however, is often overlooked for these patients. Palliative oral care is a poorly researched area and the experiences of patients, their carers and relatives are seldom explored.
Aims: To explore the oral care experiences of palliative care patients, from the perspective of their carers and/or relatives.
Methods: Blogs and discussion forums, on public internet sites, were used as the data source. Data were analysed using thematic analysis.
Results: Eight blogs and eight discussion forums fulfilled the inclusion criteria and were analysed. Three main themes were identified: symptoms, procedures and emotions. Authors described oral symptoms that they could observe themselves and perceived as being distressing. There was an association between oral care procedures and the oral symptoms observed. However, routine oral care procedures were poorly described.
Conclusion: The data on oral care provided by the blogs and discussion forums included was scarce. It provided, however, preliminary insights into this poorly researched area. In this group, the importance of oral care for terminally-ill patients was frequently overlooked until the person's quality of life became compromised by their oral symptomatology.
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.
L'ouvrage présente, dans une première partie, l'évolution naturelle de la maladie, les conséquences de la maladie sur les relations soignants - malade - famille. Puis des conseils pratiques sont proposés pour les patients et familles. Une dernière partie aborde l'accompagnement en soins palliatifs et les lois relatives à la fin de vie 2005 et 2016 notamment.
The links between oral healthcare and various aspects of general health in children and adults have been well established for some time. Susan Fowler-Kerry, Marcella Ogenchuk and Caprice Knapp make the case for those delivering paediatric palliative care to make regular oral healthcare, as received by healthy children, a standard part of their care, and for nursing research on the oral health needs of children requiring palliative care.
Une autre politique de santé et de protection sociale, qui replace l'humain au coeur du dispositif, semble possible. Cet ouvrage a pour objectif de le démontrer. Il ne prétend pas tout aborder, tout résoudre. D'importants domaines restent encore à explorer. Mais Il entend faciliter et élargir la réflexion collective. Cette démarche est particulièrement significative à quelques temps d'élections présidentielles et législatives. La protection sociale a son avenir en jeu et les Français demeurent attachés à cette protection solidaire.
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Cette enquête étudie les représentations des soignants non spécialisés en soins palliatifs sur les soins de bouche. Les auteures ont utilisé une méthodologie mixte : questionnaire et focus group. La recherche a permis d'identifier les difficultés à effectuer un soin de bouche. Elle a aussi mis en avant ce qui pourrait être ressource pour les soignants afin de faire évoluer leurs pratiques professionnelles.