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

7.项目摘要 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 口腔干燥、口腔疼痛或感染、软组织病理学和其它口腔健康问题。不良的口腔健康限制了食物的选择， 干扰社会交往，并损害生活质量（QoL）。它也会影响一个人的容忍能力 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， 深颈间隙感染，甚至死亡，给接受姑息治疗的人造成可预防的痛苦， 他们的家庭照顾者（FCG）。 在目前的实践模式下，口腔健康的价值被大大低估。口腔健康尚未在 国家PC实践指南。医生经常忽视口腔健康，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也经常低估口腔健康。因此，口腔健康需要 PRPC患者很少得到适当的评估和治疗，导致更大的并发症和痛苦。同时， 牙医往往缺乏培训，在临终牙科护理，导致绝症疗养院居民，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的治疗。这些证据清楚地 表明目前的实践模式未能适当地解决PRPC的口腔健康需求。一项新的临床 我们迫切需要一个范例来解决这一危机。 有见及此，拟议的研究旨在制定一项口腔健康干预措施，以提高口腔健康意识， 牙科转诊PRPC参加爱荷华州大学姑息治疗（UIPC）诊所。研究分为两 阶段。在I期，将对约32例PRPC进行口腔检查和症状审查，以确定其 口腔健康状况，之后将与PRPC及其FCG完成定性结构化访谈， 回顾他们的口腔健康调查结果，并试图了解二元的感知需求，治疗目标和护理 与每个记录的条件相对应的偏好。根据这些信息和PC专家的输入， 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，口腔症状回顾表，针对二人组的个性化培训模块，以及PC的牙科转诊指南 提供商UIPC医疗团队，20名新招募的PRPC/FCG二人组和一名支持性护理护士（PRPC/FCG 培训师），以评估将建议的干预措施纳入日常PC实践的可行性。 可行性测试将侧重于五个领域：可接受性、需求、执行、实用性和一体化。 这项研究的成功完成将为开发第一个跨学科协作PC提供基础数据 包括牙科在内的全国范围内的实践。基于这一创新模式和研究成果，我们下一步将 检查这种干预如何作为日常PC实践的正式组成部分，可以改善PRPC的口腔健康和QoL， 为开发一种新的临床模式以提高PRPC的护理质量提供必要的证据。

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.