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Background <p>Accurate diagnosis of oral mucositis (OM) is essential for effective management and plays a critical role in ensuring reliable outcomes in clinical trials evaluating OM-prevention and treatment strategies. Currently, no evidence-based guidelines specify which clinical profession should be primarily responsible for OM assessments in patients undergoing high-dose chemotherapy. In most Scandinavian countries, nurses perform daily OM assessments, while dentists specialized in orofacial medicine (considered the gold standard) conduct supplementary evaluations several times per week. However, the concordance between nurses’ assessments and those conducted by dentists specialized in orofacial medicine remains unclear. Therefore, this study aimed to evaluate the interrater reliability in of OM assessments between these two professions.</p> Methods <p>This study utilized data from a randomized, blinded, multicenter, parallel-group, phase 3 trial conducted at five university hospitals in Sweden and Norway. A total of 127 patients aged 18 years or older, diagnosed with multiple myeloma or lymphoma, and scheduled to receive high-dose conditioning chemotherapy in preparation for hematopoietic stem cell transplantation, were included. The primary objective was to evaluate the interrater reliability of OM assessments across all severity grades using the World Health Organization (WHO) oral toxicity scale (grades 0–4). The secondary objective was to evaluate the interrater reliability of OM assessments across all severity grades at each individual study site.</p> Results <p>Overall interrater reliability between nurses and dentists specialized in orofacial was found to be fair for OM of any grade (κ = 0.211, <i>p</i> &lt; 0.001). However, agreement levels at individual study sites ranged from no agreement to fair agreement.</p> Conclusion <p>The interrater reliability in the assessment of oral mucositis between dentists specialized in orofacial medicine and nurses ranged from no-, to fair agreement. This highlights the need for targeted interventions to improve nurses' assessment skills or to integrate a specialized dentist as a permanent member of the multidisciplinary team in oncology and hematology settings.</p> <p><b>Trial registration</b> This study is based on data from a previously registered clinical trial (ClinicalTrials.gov; Identifier: NCT03203733, Registered on November 20, 2020).</p>

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Interrater reliability in the assessment of oral mucositis among patients receiving high-dose chemotherapy: a multicenter comparison between specialized dentists and registered nurses

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  • 发表日期：

    2025年12月17日

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  • Aram Ibrahim,
  • Dilav Mahmoud,
  • Hanna Mavandadipur,
  • Java Walladbegi

摘要

Background

Accurate diagnosis of oral mucositis (OM) is essential for effective management and plays a critical role in ensuring reliable outcomes in clinical trials evaluating OM-prevention and treatment strategies. Currently, no evidence-based guidelines specify which clinical profession should be primarily responsible for OM assessments in patients undergoing high-dose chemotherapy. In most Scandinavian countries, nurses perform daily OM assessments, while dentists specialized in orofacial medicine (considered the gold standard) conduct supplementary evaluations several times per week. However, the concordance between nurses’ assessments and those conducted by dentists specialized in orofacial medicine remains unclear. Therefore, this study aimed to evaluate the interrater reliability in of OM assessments between these two professions.

Methods

This study utilized data from a randomized, blinded, multicenter, parallel-group, phase 3 trial conducted at five university hospitals in Sweden and Norway. A total of 127 patients aged 18 years or older, diagnosed with multiple myeloma or lymphoma, and scheduled to receive high-dose conditioning chemotherapy in preparation for hematopoietic stem cell transplantation, were included. The primary objective was to evaluate the interrater reliability of OM assessments across all severity grades using the World Health Organization (WHO) oral toxicity scale (grades 0–4). The secondary objective was to evaluate the interrater reliability of OM assessments across all severity grades at each individual study site.

Results

Overall interrater reliability between nurses and dentists specialized in orofacial was found to be fair for OM of any grade (κ = 0.211, p < 0.001). However, agreement levels at individual study sites ranged from no agreement to fair agreement.

Conclusion

The interrater reliability in the assessment of oral mucositis between dentists specialized in orofacial medicine and nurses ranged from no-, to fair agreement. This highlights the need for targeted interventions to improve nurses' assessment skills or to integrate a specialized dentist as a permanent member of the multidisciplinary team in oncology and hematology settings.

Trial registration This study is based on data from a previously registered clinical trial (ClinicalTrials.gov; Identifier: NCT03203733, Registered on November 20, 2020).