Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations.

Abstract

100 Background: Pre-treatment dental evaluations are recommended for head and neck (H&N) cancer patients (pts) prior to radiation therapy (RT) to minimize the risk of acute and long-term side effects of treatment. We previously created a dental instructional guide (DIG) outlining the necessary components of the pre-radiation dental evaluation for pts undergoing community-based dental evaluation. Yet our program did not have a system for documenting which pts received the DIG. We aimed to create a system to ensure that pts are given the DIG early in their care-plan and that such pts are readily identifiable so we can follow-up and confirm that the recommended dental care is complete prior to starting RT. Methods: Chart review was performed to determine the percentage of eligible pts with documented provision of the DIG. A diagnostic survey of H&N oncology clinicians was analyzed with a Pareto chart to determine common barriers to DIG provision and documentation. Clinicians were surveyed on potential ways to document DIG provision to eligible pts. The Model for Improvement and DMAIC (Six Sigma) methodologies were used and multiple Plan-Do-Study-Act (PDSA) cycles were performed to implement the intervention and monitor change. Change data was analyzed using a P-chart, 3-sigma. Results: We used a process map to identify 3 potential care-plans within the H&N oncology program and assist in defining which providers had primary responsibility for providing the DIG. We then designed and implemented a template within the electronic medical record that documents the clinician who gave the DIG and the date it was given. There was an improvement in the rate of DIG documentation from a baseline of 0% (range 0-0%) to a mean of 40% (range 0-100%) over 3-months (p<0.01). This improvement was sustained through last follow-up at 5 months. Conclusions: Through a multidisciplinary approach, we implemented an intervention to identify pts undergoing community-based dental evaluation prior to RT for H&N cancer. Further efforts are focused on increasing the DIG documentation rate and increasing our interaction with community dentists to promote expeditious pre-radiation dental care.