ABSTRACT
Introduction: Oral cancer remains prevalent, despite being largely preventable. The widespread use of technology at chairside, combined with advances in electronic health record (EHR) capabilities, present opportunities to improve oral cancer screening by dentists, especially for disadvantaged patients with severe health needs.
Design and methods: Using a mixed-methods approach, we will evaluate the feasibility and acceptability of integrating a tele-mentoring component into the identification of oral lesions using the following 3 methods:
1) administering provider surveys that consist of a checklist of 10 key components of the intervention based on process, and asking the dental provider subjects if each one was covered;
2) conducting semi-structured interviews informed by the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework with dental resident subjects to assess specific barriers to sustaining the intervention and strategies for addressing these barriers to facilitate integration of the intervention into the routine workflow of the dental clinics; and
3) administering brief exit interviews with patient subjects regarding the acceptability of the intervention to assess satisfaction with the use of intra-oral cameras at chairside to screen for and refer patients with oral lesions and identification of these oral lesions via EHR and secure e-mail tele-mentoring with an oral pathology expert.
Expected impact of the study for public health: If successful, then later clinical trials will maximize the external validity of the intervention and facilitate the widespread implementation and dissemination of the model for the teaching of dentists and residents, with the ultimate goal of improving patient care.
REFERENCES
1. American Cancer Society. Key statistics for oral cavity and oropharyngeal cancers. 2020. Available from: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html.
2. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol 2015;89:11884-94.
3. Yete S, D’Souza W, Saranath D. High-risk human papillomavirus in oral cancer: clinical implications. Oncology 2018;94:133-41.
4. Henshaw MM, Garcia RI, Weintraub JA. Oral health disparities across the life span. Dent Clin North Am 2018;62:177-93.
5. US Department of Health and Human Services. Tobacco use among U.S. racial/ethnic minority groups–African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics. A Report of the Surgeon General. Executive summary. MMWR Recomm Rep 1998;47:v-xv, 1-16.
6. Kalra P, Srinivasan S, Ivey S, Greenlund K. Knowledge and practice: the risk of cardiovascular disease among Asian Indians. Results from focus groups conducted in Asian Indian communities in Northern California. Ethn Dis 2004;14:497-504.
7. Esperat MC, Inouye J, Gonzalez EW, Owen DC, Feng D. Health disparities among Asian Americans and Pacific Islanders. Annu Rev Nurs Res 2004;22:135-59.
8. May M. A better lens on disease. Sci Am 2010;302:74-7.
9. Weinstein RS, Graham AR, Barker GR. Second-opinion telepathology services for cancer patients. In: Ternullo J, editor. Thought leaders project: e-health, telemedicine, connected health—the next wave of medicine. CreateSpace Independent Platform. 2012. p. 16-28.
10. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER Cancer Statistics Review, 1975-2016. Bethesda, MD: National Cancer Institute. Available from: https://seer.cancer.gov/archive/csr/1975_2016/. Based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
11. Denson L, Janitz AE, Brame LS, Campbell JE. Oral cavity and oropharyngeal cancer: changing trends in incidence in the United States and Oklahoma. J Okla State Med Assoc 2016; 109:339-45.
12. Psoter WJ, Morse DE, Kerr AR, Tomar SL, Aguilar ML, Harris DR, Stone LH, Makhija SK, Kaste LM, Strumwasser B, Pihlstrom DJ, Masterson EE, Meyerowitz C; National Dental PBRN Collaborative Group. Oral cancer examinations and lesion discovery as reported by U.S. general dentists: Findings from the National Dental Practice-Based Research Network. Prev Med 2019; 124:117-23.
13. Stoopler ET, Sollecito TP. Oral cancer. Dent Clin North Am 2018;62:ix-x.
14. Yoshinaga L. The use of teledentistry for remote learning applications. Pract Proced Aesthet Dent 2001;13:327-8.
15. Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): implications for clinical dental care. J Endod. 2020 Apr 6. pii: S0099-2399(20)30159-X. doi: 10.1016/j.joen.2020.03.008. [Epub ahead of print]
16. Alabdullah JH, Daniel SJ. A systematic review on the validity of teledentistry. Telemed J E Health 2018;24:639-48.
17. McLaren SW, Kopycka-Kedzierawski DT, Nordfelt J. Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic. J Telemed Telecare 2017;23:710-5.
18. McCauley HB. The first dental college: emergence of dentistry as an autonomous profession. J Hist Dent 2003;51:41-5.
19. Queyroux A, Saricassapian B, Herzog D, Müller K, Herafa I, Ducoux D, Marin B, Dantoine T, Preux PM, Tchalla A. Accuracy of teledentistry for diagnosing dental pathology using direct examination as a gold standard: results of the Tel-e-dent Study of older adults living in nursing homes. J Am Med Dir Assoc 2017;18:528-32.
20. Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare 2018;24:147-56.
21. Ogden G, Lewthwaite R, Shepherd SD. Early detection of oral cancer: how do I ensure I don’t miss a tumour? Dent Update 2013;40:462-5.
22. Pentapati KC, Siddiq H. Clinical applications of intraoral camera to increase patient compliance – current perspectives. Clin Cosmet Investig Dent 2019;23;11:267-78.
23. Pretty IA, Ekstrand KR. Detection and monitoring of early caries lesions: a review. Eur Arch Paediatr Dent 2016;17:13-25.
24. Pentapati KC, Mishra P, Damania M, Narayanan S, Sachdeva G, Bhalla G. Reliability of intra-oral camera using teledentistry in screening of oral diseases – pilot study. Saudi Dent J 2017;29:74-7.
25. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50.
26. Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health 2009;36:24-34.
27. Pbert L, Adams A, Quirk M, Hebert JR, Ockene JK, Luippold RS. The patient exit interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol 1999;18:183-8.