Perspectives of Maryland adult and family practice nurse practitioners on oral cancer.

OBJECTIVES: Because oral and pharyngeal cancer mortality in Maryland ranks seventh among states and sixth for black males, a statewide oral cancer needs assessment was conducted. The purposes of this qualitative descriptive study were to obtain indepth information on nurse practitioners' awareness and opinions of oral cancer, oral cancer examinations, and related factors. These findings were intended to supplement a previous survey conducted among Maryland nurse practitioners. METHODS: A professional focus group moderator conducted one face-to-face focus group with 11 nurse practitioners and one telephone focus group with eight nurse practitioners. Criterion-purposeful sampling and qualitative content analysis were employed. RESULTS: Findings showed that oral cancer is a neglected public health problem and, based on their formal training, not one considered by nurse practitioners to be their responsibility. Although aware of other cancers, none of the nurse practitioners recognized that oral cancer was a public health problem in the state. Numerous barriers were cited for this neglect, including their lack of training and, in one case, unpleasant feelings about examining the mouth. Participants concluded that oral cancer is part of their responsibilities and that they are interested in related continuing education courses. CONCLUSIONS: The focus groups of nurse practitioners provided rich and insightful suggestions for future strategies to help solve the oral cancer problem in Maryland, which supplemented the quantitative mail survey conducted earlier.

Oral cancer knowledge and opinions among Maryland nurse practitioners.

OBJECTIVES: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. METHODS: Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. RESULTS: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. CONCLUSIONS: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.

Oral cancer educational materials for the general public: 1998.

OBJECTIVES: Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination. METHODS: Letters requesting copies of oral cancer educational materials produced by the organization or agency--leaflets, fact sheets, pamphlets, videos, posters--were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items. RESULTS: Seventy-seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade. CONCLUSIONS: This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.

Perspectives of Maryland dentists on oral cancer.

BACKGROUND: Maryland's mortality rate for oral and pharyngeal cancer is seventh highest overall in the United States, sixth highest for men and third highest for African-American men. As part of a statewide needs assessment and in follow-up to a mail survey of Maryland general dentists, focus groups were conducted to obtain more in-depth information about why dentists do not provide a comprehensive oral cancer examination for most of their patients and how to solve this problem from a dentist's perspective. METHODS: A trained focus group moderator conducted two focus groups of general practice dentists in two locations in Maryland. Five major themes emerged from the two focus groups: inaccurate knowledge about oral cancer; inconsistency in oral cancer examinations; lack of confidence in when and how to palpate for abnormalities; lack of time to routinely provide oral cancer examinations; and recommendations to help resolve these issues. CONCLUSIONS: The focus groups provided a rich source of ideas on how to best provide dentists with continuing education about oral cancer prevention and early detection. Participants also provided opinions about the need to improve the public's awareness of oral cancer and its prevention. CLINICAL IMPLICATIONS: Dentists need to include comprehensive oral cancer examinations as part of their routine oral examinations for all appropriate patients.