Margalit Danielle N, Losi Stephanie M, Tishler Roy B, Schoenfeld Jonathan D, Ann Fugazzotto Jo, Stephens Josie, Cebulski Amy L, Hammerstrand Elizabeth L, Ma Laura, Lopes Holly M, Haddad Robert I, Treister Nathaniel S, Frustino Jennifer L
Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY
Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
J Oncol Pract. 2015 Mar;11(2):151-4. doi: 10.1200/JOP.2014.000414. Epub 2015 Jan 27.
Head and neck (H&N) cancer therapy can have a detrimental effect on oral health by increasing the risk of dry mouth, dental caries, dental infection, and osteonecrosis of the jaw. Pretreatment dental evaluations are recommended for patients with H&N cancer before radiation therapy to minimize the risk of acute and long-term adverse effects. In an earlier effort to educate patients and community dentists about the importance of pretreatment dental evaluations, we created a dental instructional guide (DIG) that outlines the necessary components of the preradiation dental evaluation. Yet our program did not have a system for documenting which patients received the DIG. The aim of this project was to create a reliable system to ensure that patients are given the DIG before radiation therapy and that such patients are readily identifiable, allowing us to confirm that their dental evaluations are complete before starting treatment.
We implemented a tracking template within the H&N oncology program at the Dana-Farber Cancer Institute that documents the date, patient, and clinician who gave the DIG. We used the Model for Improvement methodology and performed plan-do-study-act (PDSA) cycles to test and monitor the results of the template implementation.
We showed a significant improvement in the rate of DIG documentation from a baseline of 0% (range, 0% to 0%) to a mean of 53% (range, 0% to 100%) over 3 months (P < .01).
This intervention was the first step in creating a sustainable system for ensuring timely preradiation dental evaluation, thereby decreasing the risk of dental complications from H&N cancer therapy.
头颈癌治疗会增加口干、龋齿、牙齿感染和颌骨坏死的风险，从而对口腔健康产生不利影响。建议对头颈癌患者在放疗前进行牙科评估，以尽量降低急性和长期不良反应的风险。在早期的一项工作中，为了让患者和社区牙医了解放疗前牙科评估的重要性，我们创建了一份牙科指导手册（DIG），概述了放疗前牙科评估的必要组成部分。然而，我们的项目没有一个记录哪些患者收到了DIG的系统。本项目的目的是创建一个可靠的系统，以确保患者在放疗前获得DIG，并且这些患者易于识别，以便我们在开始治疗前确认他们的牙科评估已完成。
我们在达纳-法伯癌症研究所的头颈肿瘤项目中实施了一个跟踪模板，记录提供DIG的日期、患者和临床医生。我们使用改进模型方法，并进行了计划-实施-研究-改进（PDSA）循环，以测试和监测模板实施的结果。
我们发现，在3个月的时间里，DIG记录率从基线的0%（范围为0%至0%）显著提高到平均53%（范围为0%至100%）（P <.01）。
这项干预措施是创建一个可持续系统的第一步，该系统可确保及时进行放疗前牙科评估，从而降低头颈癌治疗导致牙科并发症的风险。
