Are paediatric oncology nurses well equipped in oral healthcare?

A survey evaluating paediatric oncology nurses from KK Women’s and Children’s Hospital reveals that they may not be well-versed in terms of oral health knowledge.

“Most [of our] participants were experienced, and many worked in paediatric oncology for over 6 years. However, the majority had no specific training or CPE* in oral healthcare,” said the researchers.

Of the 63 participants, 54 percent had ≥6 years of specific experience in paediatric oncology. However, 59 percent did not have oral health-related training, and more than two-thirds did not have oral health-related CPE in the past 5 years. [BDJ Open 2023;9:3]

All were aware that cancer treatment can lead to oral complications, hence the importance of good oral hygiene. Three-quarters knew that the oral cavity is the most common source of sepsis in immunocompromised cancer patients.

All but one knew that twice-daily toothbrushing was necessary for their patients. However, half were under the impression that toothbrushing should be avoided when platelets are low.

Ninety-two percent were unaware of any oral healthcare guidelines in paediatric oncology. Dietary knowledge was also poor – only a third were aware that the frequency of sugar intake is a greater risk factor for tooth decay than the total amount of sugar consumed.

“[These findings imply that] experience … did not improve oral health knowledge scores. This underlines the importance of including formalized oral health training as part of nursing training programmes,” said the researchers.

“A local oral care protocol may help bridge knowledge gaps and ensure correct oral hygiene and dietary recommendations are made to patients/parents … CPE could be useful for increasing knowledge scores, but we need a bigger sample to prove this,” they continued.

 

Carrying out oral checks

More than 90 percent of participants felt comfortable and adequately trained in performing oral care**, but only 75 percent checked their patients’ mouths at least once daily.

Up to 90 percent expressed confidence in performing an oral exam to check for simple pathology or pain, but more severe complications (eg, trismus, dysphagia) diluted their confidence level. “[This highlights] the need to train nurses to identify common oral diseases and complications in children with cancer,” they said.

 

Nurses play a crucial role

Oral complications may manifest in 90 percent of kids with cancer due to their disease or treatment. [Pediatr Dent 1991;13:289-295; Pediatr Dent 2013;35:E185-E193] “To minimize this, it is important to optimize oral health before, during, and following cancer treatment, by referring newly diagnosed patients to dentists who will identify and manage any oral diseases and advise on preventive care to practice during … treatment,” said the researchers.

Paediatric oncology nurses play a crucial role in the oral assessment, care, and education of their patients. “[They] must step in to reinforce and guide oral care in the wards if parents require assistance in caring for the sick child,” they continued.

 

Barriers

However, referrals are limited by the notion that it is not their responsibility, or they lack the authority to do so. “This might be related to local policies and practices where doctors are deemed responsible for referrals,” the researchers noted. Another barrier is the lack of knowledge on the condition warranting the referral.

Regarding the performance of oral care, the main barrier was poor patient cooperation (90 percent). “This [implies that] local nursing training also needs to address strategies to manage uncooperative patients, to target improvement of the practical delivery itself,” said the researchers. Behavioural strategies targeting uncooperative patients may help empower nurses to step up to the plate and deliver oral care effectively.

 

Useful for future guidelines

“[Overall, participants] were motivated to assist in oral care of children with cancer but sometimes felt ill-equipped,” said the researchers. “Hence, these findings are useful to guide the development of an evidence-based interdisciplinary training programme and oral care guidelines for paediatric oncology nurses.”

“Updated national and institution guidelines, didactic and hands-on training, and implementation of practical support could be considered,” they concluded.