# Improving oral health awareness and dental referrals for adult patients receiving palliative care

> **NIH NIH R21** · UNIVERSITY OF IOWA · 2021 · $234,020

## Abstract

7. PROJECT SUMMARY
Six million Americans are in need of palliative care (PC) every year. A very large proportion of these persons suffer
xerostomia, oral pain or infection, soft tissue pathology, and other oral health issues. Poor oral health limits food choices,
interferes with social interactions, and compromises quality of life (QoL). It can also affect one's abilities to tolerate
chemotherapy or radiotherapy, accelerate cognitive decline, and cause life-threatening septicemia, aspiration pneumonia,
deep neck space infection, and even death, causing preventable suffering for persons receiving palliative care (PRPC) and
their family caregivers (FCG).
Oral health is substantially undervalued under the current practice model. Oral health has not yet been addressed in the
national PC practice guideline. Physicians often overlook oral health, and thus it seems to be less importance to them.
Discouraged by this false impression, PRPC and FCG also often undervalue oral health. As a result, the oral health needs
of PRPC seldom receive appropriate assessment and treatment, leading to greater comorbidity, and suffering. Meanwhile,
dentists often lack training in end-of-life dental care, resulting in terminally-ill nursing home residents, including those in
the last 3 months of life, receiving extensive dental surgery and other aggressive treatment. These evidence clearly
demonstrates that the current practice model fails to appropriately address the oral health needs of PRPC. A new clinical
paradigm is urgently needed to address this crisis.
In response, the proposed study aims to develop an oral health intervention to improve oral health awareness and increase
dental referrals for PRPC attending the University of Iowa Palliative Care (UIPC) clinic. This study consists of two
phases. In Phase I, oral examinations and symptom reviews will be conducted with approximate 32 PRPC to identify their
oral health conditions, after which qualitative structured interviews will be completed with the PRPC and their FCG to
review their oral health findings and attempt to understand the dyad's perceived needs, treatment goals, and care
preferences corresponding to each of the documented conditions. Based on this information and the inputs of a PC expert
panel, we will develop and refine the proposed intervention in Phase II, which is expected to include a training module for
the PC team, an oral symptom review form, a personalizable training module for dyads, and a dental referral guide for PC
providers. The UIPC medical team, 20 newly-recruited PRPC/FCG dyads, and a supportive care nurse (the PRPC/FCG
trainer) will then be recruited to evaluate the feasibility of integrating the proposed intervention into daily PC practice.
The feasibility test will focus on five domains: acceptability, demand, implementation, practicality and integration.
Successful completion of this study will provide foundational data to develop the first interdisciplinary collaborative PC
practi...

## Key facts

- **NIH application ID:** 10106929
- **Project number:** 1R21DE030248-01
- **Recipient organization:** UNIVERSITY OF IOWA
- **Principal Investigator:** Xi Chen
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $234,020
- **Award type:** 1
- **Project period:** 2021-03-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10106929

## Citation

> US National Institutes of Health, RePORTER application 10106929, Improving oral health awareness and dental referrals for adult patients receiving palliative care (1R21DE030248-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10106929. Licensed CC0.

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