Providing oral care in haematological oncology patients: Nurses’ knowledge and skills

Knowledge, attitudes, barriers and practices concerning cancer therapy-associated oral mucositis amongst oncology nurses: A mixed methods systematic review

Objectives

To evaluate oncology nurses' knowledge, attitudes, barriers and practices regarding the prevention and management of cancer therapy-associated oral mucositis.

Methods

A systematic review was conducted by ​mixed-methods; searches were conducted in PubMed, EMBASE, Medline, CINAHL, Cochrane Library and Web of Science databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed for the systematic review. Searched relevant literature ​published in English between January 2000 and December 2023. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies.

Results

A total of 15 studies were included: 10 cross-sectional studies, 4 non-randomized controlled trials, and one qualitative study. This review provides an overview of the studies: nurses had limited knowledge of cancer therapy-associated oral mucositis; generally positive attitudes towards oral care; there is a slight difference in oral care practices. The main barriers of nurses' prevention and management of cancer therapy-associated oral mucositis were lack of time, lack of knowledge, and lack of staff.

Conclusions

Our results highlight the importance of training for oncology nurses regarding the management of cancer therapy-associated oral mucositis. It is suggested that oncology nurses should focus on strengthening and continuing education in oral care, adopting evidence-based practice and evaluation systems, implementing institution-specific written standards for oral care protocols, and promoting multidisciplinary team cooperation.

Effectiveness of Video-Assisted Educational Program Regarding Prevention of Oral Mucositis among Patients Receiving Radiotherapy

Objectives:

Oral mucositis refers to erythematous and ulcerative lesions in the oral mucosa observed in patients with head and neck cancer receiving radiotherapy (RT). It is an acute complication or side effect of RT. The aim of the study was to assess the effectiveness of video assisted educational program regarding the prevention of oral mucositis in terms of knowledge and reported practices among patients receiving RT.

Materials and Methods:

A quantitative approach, pre-experimental one group pre-test post-test design was used among 50 head and neck cancer patients coming to the radiation unit by non-probability purposive sampling technique. Structured knowledge interview schedule tools, that is, socio-demographic variables, knowledge MCQ’s and reported practices rating scale were used. Data analysis was performed using Statistical Package for the Social Sciences version 20.

Results:

The study findings reveal that there is a significant improvement in the level of knowledge of patients (t = 4.54, P < 0.05) and reported practices of patients (t = 6.08, P < 0.05) which proves that video-assisted educational program on oral mucositis prevention was effective in improving the knowledge and practices of head and neck cancer patients. The result shows a significant association of pre-test reported practices with the occupation of the patient. There is a moderately positive correlation (0.54) between knowledge and reported practices in pre-test and a strong positive correlation (0.76) between knowledge and reported practices in post-test.

Conclusion:

The present study reveals that video-assisted educational program regarding the prevention of oral mucositis was effective in improving the knowledge and reported practices among head and neck cancer patients receiving RT.

A randomized controlled trial of manual versus powered tooth brushing during haematopoietic stem cell transplantation

Aim

To compare manual and powered tooth brushing (MT and PT) with respect to patient compliance to brushing frequency advice, plaque removal and severity of oral mucositis (OM) in patients undergoing hematopoietic stem cell transplantation (HSCT) after high‐dose chemotherapy.

Materials & methods

A randomized controlled trial was conducted. Forty‐six patients scheduled to receive myeloablative conditioning regimen before autologous HSCT were included and randomly assigned to control (MT, n = 23) or test (PT, n = 23) groups. Starting at day 1 (day of hospital admission for HSCT), brushing frequency (patient recorded diary), plaque scores (Plaque Control Index) and oral mucositis (Oral Mucositis Nursing Index) were recorded daily. Data for days 1 to 17 were analysed using regression analysis and general linear models.

Results

Few patients maintained 4 times per day brushing, but most brushed at least 2 times per day throughout the study. In PT, overall plaque scores were lower by 6.98% (p = .006) as compared to MT. No differences were seen in OM scores between the groups (p = .968). A small but significant positive correlation was found between plaque scores and OM severity: R²=0.15 (p < .01).

Conclusions

Powered tooth brushing resulted in lower plaque scores, but was not associated with reduced OM severity. Individual plaque scores were positively related to OM severity.

The Effect on Nausea and Vomiting of Structured Education Given to Male Lung Cancer Patients Receiving Chemotherapy

The objective of this study was to investigate the effect on nausea and vomiting of structured education given to male lung cancer patients receiving chemotherapy. This quasi-experimental research study had pre- and post-tests control groups. The estimated sample size was at least 20 subjects per group. Data were collected in the chest diseases clinic and outpatient chemotherapy unit of a university hospital in Turkey. An education booklet and structured education were given 30 mins for each patient before chemotherapy. In post-test 1, nausea severity was significantly lower in the experimental group than in the control group (mean difference - 2.50, 95% CI - 1.46 to - 0.17, d = 0.82, p = 0.05). This was also the case in post-test 2 (mean difference - 2.10, 95% CI - 1.50 to - 0.21, d = 0.85, p = 0.01). According to this, the sizes of Cohen's d effect were large (0.82 and 0.85 for post-test 1 and post-test 2 respectively). However, vomiting frequency did not differ significantly between the experimental group and the control group in either post-test 1 or post-test 2 (p > 0.05). Structured education given by nurses had a positive effect on the severity of nausea. Nurses may be able to raise nausea management in cancer patients to a better level by education intervention.

Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit

Objective:

This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM).

Methods:

Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed.

Results:

At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ² = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01).

Conclusions:

One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients’ outcomes.

Oral Care Protocol for Chemotherapy- and Radiation Therapy-Induced Oral Complications in Cancer Patients: Study Protocol

Objective:

The purpose of this study is to describe a randomized control trial protocol that assesses the effectiveness of an oral care protocol on chemotherapy- and radiation therapy-induced oral complications in cancer patients.

Methods:

This study is a randomized, outcome assessor blinded study. For Phase I training phase, one group pretest-posttest design will be implemented for training the staff nurses on oral care in cancer patients and for Phase II Intervention Phase, randomized clinical trial will be used to determine the effectiveness of oral care protocol. Twenty-five staff nurses working in radiation oncology areas hospital will be trained about oral care in cancer patients. Seventy newly diagnosed patients with head and neck cancer admitted to the oncology wards of a tertiary care hospital in South India will be enrolled. Patients will be randomly allotted to a control and intervention group. The primary outcome variables are oral complications and oral health assessment.

Results:

The results of the preliminary survey conducted among 158 staff nurses showed that 81 (51.3%) of the staff nurses had poor knowledge regarding oral care of cancer patients and majority 128 (81.0%) of them suggested for training in the specific area of oral care of cancer patients. A pilot study conducted by the principal investigator to determine the feasibility of the study among 9 participants (4 experimental and 5 control) revealed that there was slight difference found in the incidence of oral complications among the group in relation to weeks of assessment.

Conclusions:

The present study may give data regarding the occurrence of oral complications in head and neck cancer patients, and even, it can enlighten on the effectiveness of oral care protocol on oral complications. If this protocol is found effective, then this protocol can be made part of daily nursing care to improve the patient outcome.

Oral Care: Exploring Education, Attitudes, and Behaviors Among Nurses Caring for Patients With Breast Cancer

BACKGROUND

Patients treated for breast cancer often experience severe oral complications, such as mucositis, xerostomia, and infections, which can result in dose reductions and treatment delays, affecting treatment outcomes.
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OBJECTIVES

The purpose of this article is to explore oncology nurses' perceptions of their educational experiences, professional attitudes, and behavior related to providing oral healthcare education to patients with breast cancer.
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METHODS

The Oncology Nursing Society sent an email to 5,000 nursing team members who cared for patients with breast cancer, requesting participation in a web-based survey; 194 responses were received, with 164 meeting study eligibility.
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FINDINGS

More oral health-related education was received during clinical experiences than during formal or continuing education. Although patient-driven oral care and diagnostic efforts were frequent, actual behavior was less frequent. No major barriers to providing oral care were indicated. Increased oral health-related education and behavior correlated with the reported importance of increased oral health education for nurses.

Oral health knowledge and psychological determinants of oral health behavior of nursing students

This survey examined the oral health knowledge and psychological determinants of oral health behavior of 1019 undergraduate and postgraduate nursing students. Overall, most of the students perceived their oral health to be average, and their flossing and dental visiting frequencies were inadequate. Moreover, the students' oral health knowledge was suboptimal, regardless of the type of study, and it was not significantly associated with oral health behavior. Binary logistic regression showed that toothbrushing self-efficacy and the type of study were both significantly associated with toothbrushing behavior. Furthermore, flossing self-efficacy and dental visiting self-efficacy were both significantly associated with flossing and dental visiting behaviors, respectively.