Yavuz, B., & Bal Yilmaz, H. (2015). Investigation of the effects of planned mouth care education on the degree of oral mucositis in pediatric oncology patients. Journal of Pediatric Oncology Nursing, 32, 47–56. 

To investigate the effects of providing mouth care education to pediatric patients with cancer on their degree of mucositis

This study was designed to provide mouth care education using written and visual material. Participants were placed in the control group (prior to the start of chemotherapy and and the education intervention) and the research group after intervention. Patients and their mothers were taught an oral care protocol including brushing teeth and gargling with salt water glutamine mouth wash twice daily, then brushing teeth an additional two times per day.

• N = 16    
• AVERAGE AGE = 13.9 years (range = 8–18 years)
• MALES: 31%, FEMALES: 69%
• KEY DISEASE CHARACTERISTICS: Overall, 56% of patients were diagnosed with leukemia or lymphoma, 62.5% were at an advanced stage and in a high-risk group, and 44% were receiving chemotherapy for six days or more.
• OTHER KEY SAMPLE CHARACTERISTICS: In total, 68.75% of participants reported that they received mouth care education from healthcare providers, 75% reported that they received education related to oral mucositis, and 93.75% were irregularly practicing mouth care.

• SITE: Single site
• SETTING TYPE: Inpatient hematology/oncology pediatric clinic    
• LOCATION: A university hospital in Turkey

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

This was a quasi-experimental longitudinal study designed to examine the influence of planned mouth care education on oral mucositis severity and associated pain.

• The data collection tools used were the Child and Parent Information Form (CPIF), World Health Organization (WHO) Oral Mucositis Index (OMI), and the Children’s International Mucositis Evaluation Scale (ChIMES) developed specifically to evaluate mucositis-related symptoms in pediatric patients with cancer.

The difference between the median oral mucositis severity before and after the education intervention was statistically significant according to the OMI (p < 0.05). Actual differences varied across study days. Children indicated that they practiced oral care irregularly. There was a statistically significant difference between the children’s pain scores before and after the program.

Planned mouth care education using written and visual material specifically designed for pediatric patients with cancer beginning on the very first day of diagnosis was helpful as an intervention for pain and mucositis. It also promoted the routine monitoring of each patient’s mouth care practices and assessments of oral mucositis and pain severity using valid and reliable scales at each visit.

• Small sample (< 30)
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)  
• Findings not generalizable
• Other limitations/explanation: This study was conducted at one medical center, and there was a time limitation because it was a part of a graduate dissertation project. It was unclear if the information provided regarding the children’s adherence to oral care was gathered from baseline assessments or after the education program. The findings of this study were most applicable to a third-world population with minimal oral hygiene habits.

Nurses have an essential role in providing education and monitoring oral mucositis protocols that can be implemented as part of routine care in a hospital inpatient or infusion clinic setting. The results of this study were favorable in part because of the routine follow-up visits that ensured the effectiveness of the education program. Routine visits were established at the initial visit and included education reinforcement, the promotion of oral care practices, physical assessments, and evaluations of associated pain. These can be supported as interventions for PEP^® pain management. Participants in this study were from a population in which there was little regular oral care as part of regular hygiene habits.