End-of-life palliative oral care in Norwegian health institutions. An exploratory study

Objective To explore circumstances surrounding procedures and knowledge regarding oral care for terminal patients in Norwegian healthcare institutions. Methods A questionnaire was distributed to randomly selected hospitals (n = 19) and nursing homes (n = 57) in central and rural parts of Norway. The questionnaire included three closed-ended and three open-ended questions about oral care for terminal patients. If procedures existed, the respondents were asked to enclose or describe them. Results The response rate was 84% for hospitals and 79% for nursing homes. Of the responding institutions, 25% had no oral care procedures, nor did 48% recognise their importance. Insufficient knowledge about oral care was reported by 39%. Twenty-one different procedures were identified, and a great number of oral care products used. The most common was glycerol, used by 36% of the institutions. Only 2% used a concentration below 30% – the limit above which the glycerol has a desiccating rather than a moistening effect. The most common patient complaint was dry mouth (49%), followed by plaque, food particles and fungus infections, each experienced by 19%. The most common problem for the personnel was lack of knowledge (43%) and patient cooperation (38%). Conclusions Some terminal patients do not receive adequate palliative oral care in Norwegian healthcare institutions. Those that do are exposed to a great number of undocumented procedures and sometimes harmful products. There is a need for evidence-based procedures for oral care for terminally ill patients in health institutions, establishing interprofessional palliative healthcare teams and in particular improved training of the nursing staff.