Oral Health in Adult Patients Receiving Palliative Care: A Mixed Method Study

Abstract

Background: Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Methods: This mixed-method study included 49 English-speaking PRPC (age≥18) recruited from the University of Iowa Palliative Care Clinic. Participants first completed a structured review of oral symptoms, followed by an oral exam. A nested sample of 11 participants also completed a semi-structured, in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Results: Participants averaged 58.4 years. Nearly 70% had terminal cancer and 25% had advanced organ failure. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). Among the 31 dentate participants, 52% had untreated decayed/broken teeth and 33.3% had oral soft tissue lesions. Ill-fitting dentures and denture sores were common among denture users. About 40% of participants reported compromised health and/or quality of life due to oral conditions; however, the perceived impacts were modest. With the exception of painful conditions, oral treatment was not a priority for most of the participants. Conclusion: Oral disease was highly prevalent in PRPC, yet its overall impact was modest. In the absence of painful symptoms, most participants reported limited desire to seek treatment for oral health conditions. However, given the serious impacts of untreated oral diseases, oral healthcare decision should not be based solely on self-reported symptoms or distress.

Oral Palliative Care: А Review

“…In the absence of pain, most patients are rarely willing to seek treatment for oral problems themselves. Given the serious effects of untreated oral diseases on the whole organism, the decision to improve oral health should not be based solely on the patient's self-assessment or the presence of pain (8). The most common oral diseases in adults in palliative care are: • traumatic injuries (maxillofacial fractures, traumatic lesions); • diseases due to insufficient oral hygiene (gingivitis, periodontitis, root caries); • diseases typical of the elderly with late/undiagnosed diseases (precancerous and oncological diseases); • diseases typical of elderly people undergoing psychological distress (oral lichen planus) (9).…”

Development and validation of a nursing home mortality index to identify nursing home residents nearing the end of life in dental clinics

“…To ensure the quality of care, it is essential to have an open conversation following the end‐of‐life care communication guidelines 31 to understand the wishes and dental care preferences of end‐of‐life patients and their families. Existing evidence suggests that although oral disease is highly prevalent, 2,19 with the exception of a few painful conditions, oral treatment was usually not a priority for most patients with serious illnesses 2,44,45 . While many factors may contribute to the limited desire of palliative care patients seeking dental care, it has been reported that the feeling of dentists not understanding their needs is a barrier for these individuals to access necessary care from dental professionals.…”

“… 44 Therefore, with care, empathy and respect, and having an open conversation to understand the wishes, goals and preferences of patients and their families, dental practitioners can develop a care plan to better address their oral health needs and honor their values for care. Such a discussion can also provide an opportunity to help patients and their caregivers clarify some common misunderstandings regarding oral health in end‐of‐life patients (e.g., oral health is not important, oral disease/conditions are effects of disease‐directed treatment, there is not much health professionals can do to eliminate or ease oral health challenges) 45–47,48 and redefine their goals and expectations for the dental care that they want to receive near death. It can also help them better appreciate the risks and benefits of the proposed treatment, make informed decisions, reduce intensive or non‐beneficial treatment near death and therefore improve the quality of life of both patients and the surviving caregivers 49–51 …”

“…Existing evidence suggests that although oral disease is highly prevalent, 2,19 with the exception of a few painful conditions, oral treatment was usually not a priority for most patients with serious illnesses. 2, 44,45 While many factors may contribute to the limited desire of palliative care patients seeking dental care, it has been reported that the feeling of dentists not understanding their needs is a barrier for these individuals to access necessary care from dental professionals. 44 Therefore, with care, empathy and respect, and having an open conversation to understand the wishes, goals and preferences of patients and their families, dental practitioners can develop a care plan to better address their oral health needs and honor their values for care.…”