Dry mouth in palliative care: A systematic review of clinical practice guidelines around the world.

Abstract

Dry mouth is a disruptive symptom in patients with life-limiting illnesses. It has one of the highest symptom burdens in palliative care and a significant impact on quality of life. Nonetheless, dry mouth remains an underacknowledged and undertreated symptom with limited evidence-based interventions. To examine the quality and content of guidelines for the treatment of dry mouth in patients with life-limiting illnesses. A systematic review of clinical practice guidelines was conducted (preregistered in PROSPERO in 2023). PRISMA reporting guidelines were followed. The search strategy involved 4 scientific databases and 9 guideline databases, targeted searches and stakeholder outreach for 183 countries/regions. Quality and content were analysed using the AGREE II instrument and directed content analysis, respectively. Seventy-two clinical practice guidelines from 42 countries across 6 continents were included. Only two guidelines were recommended for use based on the AGREE II quality appraisal. Four main themes emerged from the content analysis: (1) Assessment of dry mouth by medical history, oral examination and measuring instruments (<i>n</i> = 32, <i>n</i> = 36 and <i>n</i> = 19 guidelines respectively); (2) Oral care (<i>n</i> = 68); (3) Management by treating causes (<i>n</i> = 40), saliva substitutes (<i>n</i> = 66) and stimulants (<i>n</i> = 62), diet (<i>n</i> = 45), and medication (<i>n</i> = 40); and (4) Patient and family involvement (<i>n</i> = 43). Despite differences in quality and comprehensiveness of guidelines for treatment of dry mouth in palliative care, many care practices are shared worldwide. This review highlights the need for methodologically robust guidelines with a strong evidence base that specifically focus on dry mouth.