A Study on Oral Palliative Care : An exploratory study

Abstract

Objective: Xerostomia is a substantial problem for a majority of patients in palliative care. Guidelines that exist for palliative care are mainly based on tradition and longtime experience. Scientific evidence is sparse. Consequently, one of the agents used for lubrication, glycerol, is recommended in some countries, while not recommended in others. Presently, little is known about the effects of different procedures for oral palliative care. Aim: The overall aim was to study procedures and oral care products with the aspiration of contributing in some measure to the body of knowledge within the field of oral palliative care and its future guidelines. Material and methods: A questionnaire study was conducted to explore circumstances surrounding procedures and knowledge regarding oral palliative care in Norwegian healthcare institutions. An in vitro study on reconstructed human oral mucosa was used to explore biological, dose-dependent effects of glycerol. Finally, the effectiveness of three different oral moisturizers were compared in a randomized controlled trial (RCT) in palliative care patients suffering from xerostomia. Results: The questionnaire study revealed that a plethora of different procedures for oral palliative care exist and that 25 % do not have oral palliative care procedures at all. The laboratory study showed that glycerol in concentrations of 42.5% and over led to an increase in cell proliferation and apoptosis, but had no effect on tissue integrity. In the RCT, 17% glycerol had the best effect directly after application, but no effect after two hours. The two other products had long-lasting effect, but were not preferred by the patients. Conclusions: There is an obvious need for awareness about a standardisation of oral palliative care. Glycerol does not seem to harm the mucosa in low concentrations, but lacks long-term effect. Other products may be more effective, but taste and consistency must be modified to suit the patient group.