Developing an oral health screening tool for an integrated model of care to reduce treatment-related oral morbidity in head and neck cancer survivor

摘要 每年约有62,000名美国人患上头颈癌(HNC)。癌症治疗可以 导致口腔结构的正常功能发生无数变化。这些治疗相关的口服 疾病可能会持续患者的一生，使HNC幸存者处于迅速的 不断恶化的口腔健康。除了HNC幸存者可能遇到的其他口腔护理障碍外，许多 这些患者没有保险，无法负担牙科检查以维持对其口腔状况的监测。 未能及早发现这些口腔疾病可能会导致昂贵、效果较差的治疗 到糟糕的生活质量。针对这一不足，德里克·史密斯(PI)博士提出了一项职业发展计划 该项目将提高我们对护理和发展统计基础设施的障碍的了解 需要实施一种新的口腔护理模式。拟议的护理模式将把医疗 专业人员及其支持人员加入口腔健康团队，为他们提供 使他们能够识别口腔疾病的高危患者。史密斯博士是唯一有资格从事 这项研究于2008年完成了他在印第安纳大学的牙医培训，并在 2017年，范德比尔特大学。他参与了许多研究项目和初步研究，以及 在临床牙科方面有丰富的经验，使他成为这一奖项的杰出候选人。史密斯博士 目前是生物统计学和口腔颌面外科的研究助理教授 在Vanderbilt，并获得了受保护的时间、基础设施和出色的指导，以帮助 这项研究计划的发展。拟议的职业发展计划涉及参加AT STEST 大学牙科公共健康奖学金计划和指导以患者为中心的研究。 这一发展计划得到了有指导的研究提案的补充。史密斯医生的护理模式 提议需要一种经过充分验证的筛查工具，医疗专业人员可以使用该工具来识别高危患者 口腔发病率风险和数据驱动的决策规则，帮助提供者决定何时转诊至口腔健康 专业人士是有资格的。在本提案的目标1中，我们将对Vanderbilt负责人进行验证，并 颈部症状调查口腔分量表将患者报告的结果与临床医生的结果相关联 考试。在确定该工具的有效性之后，在目标2中，将从组合中开发一种筛选工具 来自VHNSS和其他经过良好验证的患者报告的结果测量结果的项目，包括口服 健康影响概况。最后，AIM 3将与HNC幸存者进行访谈，以获得更好的 HNC人群对口腔护理的非经济障碍的了解。在这个项目完成时，我们的 团队将拥有在Vanderbilt实施综合护理模式所需的工具，这将改善 口腔健康监测和促进我们未来的研究工作。好了！

Summary Approximately 62,000 Americans develop head and neck cancer (HNC) each year. Cancer treatments can result in a myriad of changes to the normal function of the oral structures. These treatment-related oral morbidities can persist for the duration of the patient’s life leaving HNC survivors in a state of rapidly deteriorating oral health. In addition to other barriers to oral care likely experienced by HNC survivors, many of these patients are uninsured and cannot afford dental visits to maintain surveillance of their oral condition. Failure to identify these oral morbidities early can result in expensive, less effective treatments that contribute to poor quality of life. In response to this shortfall, Dr. Derek Smith (PI) is proposing a career development project which will improve our understanding of the barriers to care and develop the statistical infrastructure required to implement a novel oral care model. The proposed model of care would integrate medical professionals and their support staff into the oral health team by providing them with a screening tool that allows them to identify patients that are at high risk for oral disease. Dr. Smith is uniquely qualified to pursue this research completing his training as a dentist at Indiana University in 2008 and his PhD in Biostatistics at Vanderbilt University in 2017. He has participated in numerous research projects and preliminary studies, and has a wealth of experience in clinical dentistry making him an outstanding candidate for this award. Dr. Smith is currently a Research Assistant Professor in the Departments of Biostatistics and Oral Maxillofacial Surgery at Vanderbilt and has been given protected time, infrastructure, and excellent mentorship to aid in the development of this research plan. The proposed career development plan involves participating in the AT Still University dental public health fellowship program and mentoring on the conduct of patient-centered research. This development plan is complemented by the mentored research proposal. The model of care Dr. Smith has proposed requires a well-validated screening tool that medical professionals can use to identify patients at high risk for oral morbidity and a data-driven decision rule that helps providers decide when a referral to oral health professionals is warranted. In Aim 1 of this proposal we will conduct a validation of the Vanderbilt Head and Neck Symptom Survey’s oral subscale by correlating patient reported outcomes with clinician’s findings on exam. Having established validity of the tool, in Aim 2 a screening tool will be developed out of a combination of items from the VHNSS and other well-validated patient reported outcome measures including the Oral Health Impact Profile. Lastly, for Aim 3 interviews will be conducted with HNC survivors to gain a better understanding of non-financial barriers to oral care in the HNC population. At the completion of this project our team will have the tools necessary to implement the integrated care model at Vanderbilt, which will improve oral health surveillance and facilitate our future research efforts. !