The assessment and implementation of mouth care in palliative care: a review

From a review of the literature it is evident that the importance and maintenance of oral health for patients with cancer is recognised as an integral part of basic nursing care and yet from practical observation in the hospital environment together with reviewing the published literature it is clear that there appears to be limited evidence of regular assessment of the mouth or implementation of oral protocols on the ward. Furthermore there is a lack of adequate training in the assessment and implementation of mouth care by nurses during their general nurse training. The aim of the present study was to review existing literature published between 1995 and 1999 to determine whether mouth care was effectively assessed and implemented in the palliative care setting.

Relevant articles selected from the 1995-1999 period highlighted the lack of published research in this very important aspect of care. Results from these published articles raised concern about the lack of training and education among nurses in the assessment of mouth care as well as the need to rationalise the assessment tools used on the ward or hospice. Furthermore, while it was recognised in palliative care that a multiprofessional approach was beneficial, in practice this did not appear to apply to mouth care with a few notable exceptions.

This review has highlighted a number of inconsistencies in both the knowledge of mouth care and its implementation by nursing staff. The importance of establishing protocols and setting standards of care was also indicated in this review. It is clear that without effective assessment of the mouth, the appropriate implementation of care will not be delivered. The implementation of mouth care should not be anecdotal in nature but based on research (evidence-based) and this in turn will enable nurses to embrace an evidence-based practice (which will benefit their patients) that can be effectively audited.