Management of oral mucositis at European transplantation centres

[A description and consensus on the role of the professional in the integral management of the haematology patient: Results of a national multicentre Delphi study]

BACKGROUND AND OBJECTIVE

The Haematology Service has undergone significant advances in recent years. Given the vital part played by the nurse in the care of the haematology patient, ensuring optimal management by adapting their role to meet the current healthcare needs is a priority. The aim of this study was to evaluate the level of agreement among professionals of the Haematology Service regarding the role of the nursing professional and their importance in the comprehensive management of these patients in a multidisciplinary work setting.

PATIENTS AND METHOD

A national multicentre Delphi study with haematology specialists and nursing professionals. A two-round questionnaire was used, and consensus was reached when > 75% of the panellists scored on the same tertile (1-3: disagreement, 7-9: agreement), and the interquartile range of the median of the responses was ≤4.

RESULTS

A total of 33 professionals from the Haematology Department were invited to participate, of whom 19 were haematology specialists and 14 were nursing professionals. In the first round, 25 panellists responded (14 haematology specialists and 11 nursing professionals), and in the second round, 22 panellists responded (12 haematology specialists and 10 nursing professionals). The panel of experts agreed that haematology nurses should have specific training in haematology (96%) and on the definition of the role of nursing in the care process of the haematology patient, except in the possible participation in decision-making with regard to the most appropriate oncological treatment for a patient (58%). The role of the nursing professional as a reference for the patient throughout the healthcare process and their involvement in the process at the time of diagnosis were agreed upon in the second round (72.7% and 68.2%). Their role in the control of nutritional status (100%), visit compliance (96%), and health education for the patient and the family (96%) were included in the highly agreed upon aspects. The panel considered the improvement of adherence to treatment (96%), and the role as consultant for specific care of the haematology patient within the hospital (96%) as important aspects. Together with health education and patient follow-up, a total of 88% of the panellists considered that the haematology nurse reduces patient visits to the emergency department as well as physical visits to the outpatient clinics of the health centre.

CONCLUSIONS

The current profile of the haematology nursing professional implies a high level of specialisation. The competencies of the haematology nursing professional are aimed at guaranteeing an integral management of these patients; with important healthcare functions, as well as a key element in the flow of information, and are framed within a multidisciplinary work setting.

A systematic review of oral assessment instruments: what can we recommend to practitioners in children's and young people's cancer care?

BACKGROUND

Observing and recording the signs and symptoms of oral mucositis are an important part of oral care, essential to the prevention and treatment of mucositis. Structured oral assessment enables a more informed and accurate identification of signs and symptoms and will enable early and individualized interventions.

OBJECTIVE

A United Kingdom-based mouth-care group conducted a systematic review of the published literature through to March 2004 and repeated in 2008. The goal of this review was to identify and evaluate the range of instruments used to assess oral mucositis to recommend in evidence-based guidelines the "best" instrument to use in the field of children's and young people's cancer care.

METHODS

Search sources included the Cochrane Library, MEDLINE, EMBASE, and CINAHL. Studies were selected using defined criteria and reviewed by 3 pairs of group members.

RESULTS

Fifty-four individual oral assessment instruments were identified with only 15 reporting evidence of reliability and validity testing. Only 3 articles reported on oral assessment exclusively in our population.

CONCLUSIONS

The guidelines recommend only 1 assessment instrument, the Oral Assessment Guide, or adaptations of this instrument, to be used in clinical practice. Five factors influenced this recommendation: purpose of assessment, population, outcomes assessed, and quality of the instrument and ease of use.

IMPLICATIONS FOR PRACTICE

The Oral Assessment Guide has been consistently judged to be user-friendly and appropriate for everyday clinical practice with both adults and children, as well as a useful research tool.

The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

The Prospective Oral Mucositis Audit was an observational study in 197 patients with multiple myeloma (MM) or non-Hodgkin's lymphoma (NHL) undergoing, respectively, high-dose melphalan or BEAM chemotherapy and autologous SCT at 25 European centres. We evaluated the relationship between severe oral mucositis (SOM; WHO Oral Toxicity Scale grade 3-4) and local and systemic clinical sequelae and medical resource use. SOM occurred in 44% of patients. The duration of SOM (mean 5.3 days) correlated with time to neutrophil engraftment. The following parameters increased gradiently with maximum grade of oral mucositis: duration of pain score >or=4, opioid use, dysphagia score >or=4, total parenteral nutrition (TPN) use, incidence and/or duration of fever and infection, and duration of antibiotic use. SOM increased the duration of TPN use by 2.7 days (P<0.001), opioids by 4.6 days (P<0.001), and antibiotics by 2.4 days (P=0.045). SOM prolonged hospital stay by 2.3 days (P=0.013) in MM patients, but not in NHL patients (who tended to have a longer hospital stay). In conclusion, this analysis of prospectively collected observational data provides important insight into the scope and impact of SOM in the European transplant setting.