Center for End-of-Life Transition Research (CEoLTR)

Projects

Project #2 (Dr. Fischer)

Characterizati on of Oral Health Pr oblems at the End of Life

PI (Dr. Fischer)

Our goals are to characterize oral health problems in terminally ill cancer patients undergoing hospice care from the perspectives of the care recipient, primary caregiver, and oral health professional and to determine primary caregiver knowledge about oral health problems and treatment. Oral health problems are common for patients at the end of life, though such problems have gone largely unrecognized and may contribute to symptom burden during the end-of-life transition. The specific aims of this 3-year project are to: 1) characterize the presence, severity, and functional impact of oral health problems (a) using the Oral Problems Scale to measure xerostomia and oral pain, and (b) using the Oral Problems Exam to measure salivary hypofunction, fungal infection, stomatitis, and ulcerations in 120 terminally-ill cancer patients undergoing hospice care; and 2) describe primary caregivers’ knowledge about oral health problems by (a) using an open-ended interview focused on their understanding of oral health problems and treatment, and (b) comparing the primary caregivers’ Oral Problems Scale scores with those of the care recipients'. We propose a prospective, clinical observational study using mixed methods to accomplish the goals of this study. Using the Oral Problems Scale, we will interview 120 cancer patients receiving home level hospice care to determine the oral problems (xerostomia and oral pain) they have experienced in the past week. A qualified Oral Health Specialist will use the Oral Problems Exam, which assesses (a) correlates of salivary hypofunction, (b) fungal infection (from oral inspection and culture with sensitivity), (c) stomatitis, and (d) ulcerations. Additionally, using an open-ended interview, we will query the primary caregivers about their current knowledge of oral health problems and treatment. Primary caregivers will also use the proxy respondent Oral Problems Scale to provide their perspective regarding the care recipients’ oral problems.

There is a need for documented evidence of oral health problems which affect patients at the end of life. This information can help us to pursue management approaches to eliminate or decrease the severity of oral problems, thereby decreasing symptom burden at the end of life. Also, by determining the primary caregivers’ knowledge about oral health problems and treatment, we hope to plan future studies to educate caregivers about oral health problems and treatment in areas where knowledge may be lacking.