Information needs and oral epithelial dysplasia: Development and psychometric evaluation of a novel instrument

Patient Education and Levels of Disease-Specific Information Needs Among Individuals With Oral Epithelial Dysplasia

BACKGROUND

Oral epithelial dysplasia (OED) is a histological diagnosis that carries an increased risk of the individual developing oral squamous cell carcinoma. We assessed the information needs (IN) and explored the sources of education used by individuals with OED using a validated OED-specific measurement.

METHODS

A total of 102 adults with OED from the oral medicine clinic of a dental hospital in Central London were selected using convenience sampling. A cross-sectional survey was conducted in which participants completed the 33-item Oral Epithelial Dysplasia Informational Needs Questionnaire (ODIN-Q), which assessed IN and gathered perspectives on patient education.

RESULTS

Approximately two-thirds of the participants (n = 66, 64%) reported meeting the IN, whereas the remaining participants (n = 36, 35%) did not. The mean and median total scores from the questionnaire were 2.43 (± 0.38) and 2.6, respectively, indicating a low sufficient level of IN. Most participants (n = 80, 78%) preferred one-on-one meetings as the primary mode of obtaining information, followed by written materials (n = 64, 62%), audiovisual resources (n = 24, 23%), and group discussions (n = 8, 0.7%).

CONCLUSIONS

Some topics were insufficiently met, necessitating additional educational efforts, such as risk factors and lifestyle modifications, physical and psychological impacts, awareness of potential complications, and seeking medical and psychological support. Sex and degree of dysplasia were associated with the levels of IN. These findings may guide future longitudinal research on OED IN assessment, support the creation of tailored educational tools, and facilitate further evaluation of the psychometric properties of the ODIN-Q.

Confirmatory Factor Analysis of the Oral Epithelial Dysplasia Informational Needs Questionnaire

OBJECTIVE

The Oral Epithelial Dysplasia Information Needs Questionnaire (ODIN-Q) was developed to assess the informational needs of patients with oral epithelial dysplasia (OED). This study aimed to evaluate the six-factor ODIN-Q model to determine its psychometric properties and alignment with a theoretical framework.

METHODS

Confirmatory factor analysis (CFA) was conducted with 165 participants to assess the model's fit. Consensus-based standards for selecting health measurement instruments were followed, and five participants per item in the assessment tool were required for effective CFA. Various fit indices, factor loadings and inter-factor correlations were analysed.

RESULTS

The CFA results indicated a moderate model fit, which was consistent with other multidimensional patient-reported instruments. The average factor loading for all 33 items was 0.58 (highest = 0.84, lowest = 0.28). Only two items with relatively low loadings (< 0.3) were related to doctors' experience and lifestyle adjustments. Additionally, the ODIN-Q distinguished conceptually distinct domains with low inter-factor correlations (< 0.20).

CONCLUSION

The current six-factor ODIN-Q is a psychometrically sound instrument for assessing the informational needs of individuals with OED. Further cross-cultural assessments of the ODIN-Q are required to demonstrate its cultural sensitivity in other English-speaking patient cohorts and globally.

Patient and clinician perspectives of information needs concerning oral epithelial dysplasia

OBJECTIVES

Individuals diagnosed with a chronic oral disease that increase the risk of mouth cancer, such as oral epithelial dysplasia (OED), require appropriate knowledge to make informed decisions. The present study aimed to assess whether patient information needs of a group of patients concerning dysplasia were met and to what degree clinicians agree with patients on 'important' topics.

SUBJECTS AND METHODS

This represented secondary analyses of a cross-sectional study to assess the information needs of 86 patients diagnosed with dysplasia compared with those of 77 clinicians using the validated OED Information Needs Questionnaire. Descriptive, concordance and regression analyses were performed for the collected data.

RESULTS

The mean and median total scores for all items in the amount of information received subscale were 2.33 and 2.44, indicating overall unmet needs concerning dysplasia. Clinicians were generally able to predict topics of greatest importance to patients, although their scores were mainly lower than those of patients (k = 0.06). There was a higher agreement between patients (k = 0.25) than clinicians (k = 0.09).

CONCLUSION

Clinicians are encouraged to assess a patient's information needs to ensure tailored and patient-centred communication concerning OED during all clinical consultations.

Association of Oral and General Health with Nutritional Status of Older Adults Attending Two Medical Centers in Riyadh, Saudi Arabia: A Cross-Sectional Study

Malnutrition could profoundly affect older adults' oral health and quality of life, whereas oral health might, in turn, impact dietary intake and nutritional status. The present study aimed to investigate the association between general and oral health and nutritional status among older adults attending nutrition clinics at two main medical centers in Riyadh, Saudi Arabia. A cross-section study was carried out among adult patients (≥60 years) who attended a geriatric clinic or nutrition clinic at King Khalid University Hospital or King Abdulaziz Medical City, Riyadh. A validated clinician's Mini Nutritional Assessment Short-Form (MNA-SF), Oral Health Impact Profile-5 (OHIP-5), and 36-Item Short Form Survey (SF-36) were collected from each participant. A total of 261 participants with a mean age of 72.14 (±8.97) years were recruited. Diabetes (71%) and hypertension (80%) were present in the majority of patients. The overall MNA-SF score was (10 ± 3). Based on the categorization of the MNA-SF score, 65.9% were classified as malnourished or at risk of malnutrition. Participants with OHIP-5 scores higher than the median (>5) were more likely to be malnourished than those with scores at or lower than 5 (p < 0). The adjusted odd ratio for the MNA-SF score categories indicated that for a one-unit increase in the total SF-36 score, the odds of the malnourished category are 0.94 times less than the risk of malnutrition and normal nutritional status, with OR 0.97 (95% CI 0.94-0.95). Malnutrition or being at risk of malnutrition is likely associated with poor general and oral health. Healthcare providers need to incorporate dietitians into care plans to promote the nutritional health of older adults.

Psychosocial impacts of oral epithelial dysplasia

BACKGROUND

The psychosocial impact of receiving the diagnosis of oral epithelial dysplasia, which presents up to 3.5% increased annual risk of mouth cancer, remains unknown. Using validated instruments, the present study aimed to investigate the prevalence and existing correlations between anxiety, depression and dental anxiety symptoms and burden on oral health-related quality of life.

METHODS

A clinical cohort of 82 patients with oral dysplasia was asked to complete the Hospital Anxiety and Depression Scale, the Modified Dental Anxiety Scale and the shortened version of the Oral Health Impact Profile. Spearman's correlation coefficient and regression analyses were performed.

RESULTS

The participants' scores were in keeping with the presence of anxiety, depression and emotional distress symptoms in 30%, 16% and 26%, respectively. However, 69% experienced anxiety related to procedures that may be required as part of long-term management of oral dysplasia (e.g. local anaesthetic injection). The oral health-related quality of life scores showed 41.5% reporting a recent daily problem due to their oral or dental health. Significant correlations [p >0.05] were found among and between all of the used instruments. Being a female with oral dysplasia also predicted increased odds of indicating higher anxiety and dental anxiety scores than males [p >0.05].

CONCLUSION

Oral dysplasia can adversely impact on the psychosocial well-being of affected persons. Establishing a causal relationship between the measured variables may, however, be challenging and would need further longitudinal studies.