Background
Review question
Methods
Search strategy
Database 2000–2023 | Search terms | Papers retrieved |
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CINAHL | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 433 |
Cochrane | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 6 |
Google Scholar | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 31 |
Medline | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 190 |
PubMed | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 2472 |
ScienceDirect | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 53 |
Scopus | "Cancer patient" OR "tumor patient" AND "chemotherapy" AND "knowledge" AND "nurses" AND "oral health management" OR "oral Care" AND "patient quality of life" | 183 |
Inclusion and exclusion criteria
Study selection
Quality assessment
Cross-sectional studies | ||||||||||||||||||||||||||||||||
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Citation | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | % | |||||||||||||||||||||||
Tewogbade A, FitzGerald K, Prachyl D, Zurn D, Wilson C. 2008 | Y | Y | Y | Y | Y | Y | N | N/A | 75.0 | |||||||||||||||||||||||
Wei X, Jing M, Zhang X, Li C, Li L. 2022 | Y | Y | Y | Y | N/A | N/A | Y | Y | 75.0 | |||||||||||||||||||||||
Perry AD, Hiroko I, Patton LL, Wilder RS. 2015 | N | Y | Y | Y | N/A | N/A | Y | Y | 75.0 | |||||||||||||||||||||||
Suminski JA, Inglehart M, Munz SM, Van Poznak CH, Taichman LS. 2017 | Y | Y | Y | Y | UC | UC | Y | Y | 75.0 | |||||||||||||||||||||||
Southern H. 2007 | Y | Y | Y | Y | Y | UC | Y | Y | 87.5 | |||||||||||||||||||||||
% | 80.0 | 100.0 | 100.0 | 100.0 | 40.0 | 20.0 | 80.0 | 80.0 | ||||||||||||||||||||||||
Randomized controlled trials | ||||||||||||||||||||||||||||||||
Citation | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Q12 | Q13 | % | ||||||||||||||||||
Pai R, Ongole R, Banerjee S, Prasad K, George L, George A, et al. 2019 | Y | Y | Y | N | N | Y | Y | Y | Y | Y | Y | Y | Y | 84.6 | ||||||||||||||||||
% | 100 | 100 | 100 | 0 | 0 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | |||||||||||||||||||
Quasi-experimental studies (non-randomized experimental studies) | ||||||||||||||||||||||||||||||||
Citation | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | % | ||||||||||||||||||||||
Wårdh I, Paulsson G, Fridlund B. 2009 | Y | Y | Y | N | Y | N/A | Y | Y | Y | 77.7 | ||||||||||||||||||||||
% | 100 | 100 | 100 | 0 | 100 | 0 | 100 | 100 | 100 |
Data extraction
Study | Country | Setting/context | Participant characteristics | Groups | Outcomes measured | Main description of results |
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Analytical cross-sectional study form | ||||||
Tewogbade A, FitzGerald K, Prachyl D, Zurn D, Wilson C. 2008 | USA | This study was carried out in the Center for Cancer and Blood Disorders (CCBD) Unit of Children’s Medical Center, Dallas, Texas (CMC) | Pediatric oncology nurses Questionnaires were completed by 33 pediatric oncology nurses: 12 had been licensed for 1 to 3 years, and 11 had been licensed for more than 6 years Experiences: Three of the nurses had been working on the unit for less than 1 year, 13 had been working on the unit for 1 to 3 years, 7 had been working on the unit between 3 and 6 years, and 10 had been there more than 6 years | 33 pediatric oncology nurses | Nurse’s understanding of oral health for hematology and oncology patients | The study examined nurses’ knowledge and practice for different categories: 1) Oral examination: variation among nurses in conducting oral cavity evaluation for both patients with cancer and those undergoing hematopoietic stem call treatment (HSCT) 2) Dental referrals: 3/4 of the participants did not make dental referral; for patients after chemotherapy 3) Oral hygiene instruction (OHI): majority of nurses distributed oral hygiene aid and instructed parents to use them 4) Diagnosis and treatment: Nurses vary in their knowledge of oral diagnosis, treatment, disease etiologies, and hygiene protocols; however, the majority are able to give proper differential diagnoses of mucositis but were more knowledgeable about the proper treatment of fungal infection. Also, the nurses had more difficulty with the diagnosis and treatment of xerostomia An oral care intervention was developed based on the above finding; the new protocol contains 6 steps: 1. Gather information—criteria to determine patient risk and referral 2. Oral hygiene protocol—specific instructions on brushing and flossing techniques were given 3. Viral infection—instruction on treating an oral viral infection 4. Fungal infection—instruction on treating an oral fungal infection 5. Oral assessment guide—allow nurses to adequately diagnose conditions that they were not previously able to recognize 6. Oral care algorithm—an oral care algorithm The following are the summary of finding: Nurse’s training and beliefs about oral care would make more difference in the patient oral hygiene instruction than nurses experience Examination of patients undergoing chemotherapy and/or radiotherapy appeared to be conducted more frequently than for patients undergoing HSCT Referrals to dental services are possibly the most important avenue for children to receive oral care while undergoing treatment for cancer or prior to HSCT To sum up, the nurses surveyed have less than an adequate knowledge of how to provide oral care for children undergoing cancer treatment and HSCT |
Wei X, Jing M, Zhang X, Li C, Li L. 2022 | China | 19 ICUs of 11 tertiary hospitals from Henan province in China | 173 nurses and 19 head nurses online using a structured questionnaire | 173 nurses and 19 head nurses. All of the participants were registered nurses and had worked in the ICU. Also, they have conducted oral care for postoperative patients with oral cancer at least 6 times in the past month | What are the practicing situation of nurses in the intensive care unit (ICU) for postoperative patients with oral cancer and their need for training | The majority of participants claimed that the lack of knowledge and skills surrounding oral care was the main barrier for nurses to implement oral care ICU nurses had no continuing education or training in oral care for postoperative patients with oral cancer Participants stated their preference to receive training on oral care specifically about the indication, contraindication, tools, and mouthwash. On-hand training (scenario simulation) was the preferred method of training. To sum up, the finding shows diversity in practice among groups, lack of oral care knowledge, and the pertinent need for education. Therefore, a standard protocol or clinical practice guidelines for oral care for postoperative patients with oral cancer should be developed to equip nurses with the required skills to deliver quality oral care |
Perry AD, Hiroko I, Patton LL, Wilder RS. 2015 | USA | The study was carried out in the Association of Pediatric Hematology and Oncology Nurses’ (APHON) 36th Annual Conference and Exhibit on October 4 to 6, 2012, in Pittsburgh, Pennsylvania | Pediatric oncology, pediatric oncology, or hematology nurse: 97% were women 70% work 36 h or more a week 54% work as certified pediatric oncology/hematology nurses 53% been employed as a pediatric oncology nurse for 10 or more years 60% did not have a clinical requirement regarding the assessment of the teeth and gums during their nursing school education | 235 pediatric oncology, pediatric oncology, or hematology nurse | Pediatric oncology and hematology nurses’ (1) knowledge, (2) perceived ability, and (3) practice behaviors in assisting with the various oral health care needs of pediatric oncology patients (4) Their demographic characteristics and oral health competencies | Knowledge: 100% were aware of potential oral complications related to cancer treatment Awareness level related to the professional oral health care recommendations for pediatric oncology patients: The use of a soft bristled toothbrush (97%) Daily inspection to determine the presence or absence of oral complications (87%) The use of fluoridated toothpaste 57% Referrals to a dentist for consultation prior to cancer treatment 29% Overall, only 14% of survey participants responded correctly to all informative questions that assessed their knowledge of oral health care recommendations for pediatric oncology patients undergoing cancer treatment Perceived ability: • 77% reported that they are comfortable performing oral procedures • 72% are adequately trained to provide oral health care instructions/education • 84% adequately trained to perform oral care procedures • 70% were very confident in examining for the presence of oral pain and providing oral hygiene instructions • Less than half were very confident in their ability to examine the health of teeth and gums for complications of trismus, dysphagia, and xerostomia Practice behaviors: • 60% reported examining all of their patients for the presence of oral pathology or oral pain • Half of the participants examine all of their pediatric oncology patients’ teeth and/or gums, detect dysphasia, and provide instructions • 40% or less reported examining all patients for the presence of xerostomia, trismus, and discussing the importance of seeking routine professional dental care • More than one-third reported referring patients to dental professionals prior to the initiation of cancer treatment (39%) and/or during cancer treatment (31%) • 20% reported never referring patients to dental professionals Oncology nurses’ demographic characteristics and oral health competencies • Survey respondents who had a clinical requirement regarding oral health assessment during nursing education presented greater oral health related knowledge and confidence in addition to providing oral care instructions and examining the patient’s mouth more often • More nurses who work full time in direct patient care and have a source for dental referrals responded to oral health knowledge questions correctly • Job title or being certified as oncology nurse and hours spent in oral health education/training during nursing school were not associated with oral health competencies |
Suminski JA, Inglehart M, Munz SM, Van Poznak CH, Taichman LS. 2017 | Ann Arbor | University of Michigan | Included: – 194 responses from 5000 emails – (n = 164) meeting study eligibility Excluded: 29 respondents | Registered oncology nurses or nurse practitioners with a background in treating patients with breast cancer | • Education competency of staff to provide oral instructions • Educating patients about oral health during their visits • Percentage of staff who are performing oral assessment with and without dental specialist collaboration | 164 participants: *The majority often or very often educated their patients about oral health (n = 69, 42%) *Staff well educated to provide oral health instructions report was as follows: - Only 51 (31%) were well or very well educated - 58 (35%) had sufficient knowledge and confidence to perform oral health assessments *For staff performing oral assessments: - Only 56 (34%) used a tongue depressor or flashlight - 28 (17%) performed patient oral hygiene care - Only 20 (12%) often or very often referred their patients to a dental specialist - 16 (10%) collaborated with dental specialists during their patients’ treatment *Barriers: - Only 37 (23%) considered a lack of time as a barrier |
Southern H. 2007 | Ireland | One urban health care institution over a 3-month time frame | Included: *Total sample (n = 100): 72 completed the questionnaire – 37 (51.4%) were general nurses – 35 (48.6%) were oncology nurses | Registered general nurses/specialist cancer nurses | • Knowledge and education of oral care and oral health assessment • Management of oral care: - Information on oral complications - Examination of the oral cavity - Documentation of oral cavity complications or changes - Oral care routines - Influences on knowledge of oral care and performed oral care according to nurses’ age and how often oral hygiene information was provided to patients | • Study p-value of < 0.05 • Nurses lack adequate knowledge of oral care and oral health assessment • Continuing education in oral care for nurses is minimal • There is a lack of dentistry involvement in nurse education and nursing practice in relation to oral care *Knowledge and education of oral care and oral health assessment: General nurse education: - 33 (45.8%) respondents received both theoretical and clinical education in oral care - (n = 7, 9.7%) received lot of education - (n = 31, 43.1%) received no education on cytotoxic drugs or radiation treatment Oncology nurse education: - 22 (62.9%) had received both - Need for continuous education was reported by (n = 68, 94.5%) of all oncology nurses *Management of oral care: - (n = 47, 65.3%) staff were informing patients about oral complications - (n = 59, 82.1%) are recommended daily examination of a patient’s oral cavity, only (n = 47, 65.1%) are performing daily and (n = 12, 16.6%) more often than daily - (n = 34,91.9%) of general nurses and (n = 30, 88.2%) are always documenting of oral cavity findings - (n = 49, 68.1%) of cancer patients reported of performing oral care - There was a statistically significant main effect for age [F (2.63) = 3.302, p = 0.043] nurses who were significantly younger and had greater total self-rated knowledge scores are giving education about oral care for patients - (n = 41, 56.9%) reported feeling comfortable in examining a patient’s oral cavity and nurses who reported dissatisfied were showing less knowledge about oral abnormalities symptoms - (n = 57, 79.2%) reported that patients are receiving referral to hospital dentist. (n = 21, 29.2%) received great support, (n = 20, 27.8%) received some support, (n = 30, 41.6%) large number never received sufficient dental support |
Randomized controlled trial | ||||||
Pai R, Ongole R, Banerjee S, Prasad K, George L, George A, et al. 2019 | India | This study is a randomized, outcome assessor blinded study conducted in a tertiary care hospital in South India in 2 phases. For phase I, the staff nurses were trained on oral care in cancer patients, and for phase II, randomized clinical trial was used to determine the effectiveness of oral care protocol | Patients’ characteristics (70): Patients planned for radiation to the head and neck region, patients who are in any stage of cancer receiving chemoradiation, only radiation or postoperative radiation • Patients in 18–75 years age group • At least 75% of both parotids are within the radiation field Nurses’ characteristics (25): staff nurses working in radiation oncology areas hospital | Experimental arm: (intervention) oral care protocol Patient in this arm receive oral care according to protocol which includes nursing assessment with oral health assessment tool and oral care kit Control: (comparator agent) standard of care (SOC) of oral care Patients in this control arm receive oral care according to SOC of oral care as per the hospital practices | The primary outcome is the Effectiveness of an oral care protocol on chemotherapy- and radiation therapy–induced oral complications in cancer patients by measuring: 1- The incidence of oral complications that will be collected from patient records 2- Oral health assessment tool The secondary outcome measures are the cost analysis, documentation audit, knowledge, and practice of staff nurses | The study is not yet completed. 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 were 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 • Swallowing difficulty, oral mucositis, infection, and the nutritional compromise were delayed in the experimental group Taste alteration, xerostomia, and bleeding gums appeared early in the experimental group in comparison with the control group |
Quasi-experimental study | ||||||
Wårdh I, Paulsson G, Fridlund B. 2009 | Sweden | This study, which had a pre-and post-non-randomized, quasi-experimental design with both intra- and inter-individual comparisons, was conducted on five wards at five different hospitals in Sweden | Registered nurses, n = 133 and auxiliary nurses, n = 109 on five wards at different hospitals providing cancer care. The nursing staff had similar composition according to education, age, and experience | Registered nurses, n = 133 and auxiliary nurses, n = 109 | Long-lasting changes in the nursing staff’s understanding of oral health care for cancer patients after an oral health care intervention. For both registered nurses and axillary nurses | Attitudes to oral health care: No statistically significant improvements were demonstrated in terms of attitudes to oral health care after the intervention compared with the situation before the intervention Implementation opportunities: • Sufficient knowledge for the implementation of oral health care; significant changes could be seen both for registered nurses (p = 0.002) and for auxiliary nurses (p = 0.001) when comparisons were made before and after the intervention • Availability of aids/devices for assistance; there was an equal improvement for both registered nurses and auxiliary nurses (p = 0.002) • Familiarity with practical oral healthcare procedures improved for registered nurses (p = 0.04), but not for auxiliary nurses • The ability to give oral healthcare advice improved for both registered nurses (p = 0.01) and auxiliary nurses (p = 0.03). No changes could be seen in terms of time and ability to influence care receivers, reluctant to oral healthcare assistance Knowledge of importance: Both the registered nurses (p = 0.03) and the auxiliary nurses (p = 0.009) had less knowledge of importance of the diseases affecting the oral cavity after the intervention than before the intervention. The other aspects of knowledge of importance were not influenced by the intervention, in the case of either the registered nurses or the auxiliary nurses |