Communication Needs, Methods, and Perceived Voice Quality Following Head and Neck Surgery

Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.

VidaTalk™ patient communication application "opened up" communication between nonvocal ICU patients and their family

OBJECTIVES

To explore family members' perceptions of an electronic communication application, VidaTalk™, their communication experience, and emotional reactions to communication with mechanically ventilated patients in the intensive care units.

RESEARCH METHODOLOGY/DESIGN

Qualitative phase of a mixed-methods study nested within a randomised controlled trial. Family members in the intervention group received the VidaTalk™ app as a communication aid during their intensive care stay. Seven family members participated in 18 semi-structured email interviews after discharge between May and December 2018. Interviews were analysed using qualitative content analysis.

SETTING

Families were recruited in multiple intensive care units located in one university hospital.

MAIN OUTCOME MEASURES

Communication experience with the VidaTalk™ and emotions while communicating with the patient. Basic qualitative description and constant comparative techniques were used to code and analyse the text using ATLAS_ti (Version 7.5.18).

FINDINGS

The VidaTalk™ opened up family-patient communication by allowing clear communication and expanding communication content. Family members felt happy and thankful to communicate with the patient. They also expressed feelings of relief and less frustration and less stress while communicating with the patient.​ On the other hand, the patient's ability to express their worries or anxiety sometimes made families feel sad or distressed.

CONCLUSION

The VidaTalk™ was helpful for family-patient communication. The VidaTalk™ may help families reduce psychological distress. However, ​expanded communication with critically ill patients may cause other negative feelings.

Coping With Oral Tongue Cancer and COVID-19 Infection

To date, April 19, 2021, the coronavirus disease 2019 (COVID-19) caused about 140,886,773 confirmed cases and more than 3,000,000 deaths worldwide since the beginning of the pandemic. Oncology patients are usually frail due to the fear of prognosis, recurrence, and outcomes of treatments. Thus, coping with cancer is a complicated process that is necessary to overcome oncological challenge, even more in case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) disease. This is a brief case report on a middle-aged man affected by advanced oral tongue cancer and COVID-19, describing his experience of cancer diagnosis, surgical treatment, and rehabilitation during the hospital quarantine for COVID-19. Besides the traumatic experience due to the functional alteration in breathing, eating, and speaking caused by major surgery and the concurrent facial disfigurement, our patient had to face a COVID-19 diagnosis, which implied hospital and social isolation. The aim of this perspective work is to focus on the role of the psychological support in the management of hospital distress related to COVID-19 psychophysical loneliness or alienation. In our experience, such support should anticipate patients' oncological surgery or treatment and should be implemented through telemedicine in case of isolation or after hospital discharge.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

OBJECTIVE

To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.

DESIGN

Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017.

METHODS

Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified.

RESULTS

The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation.

CONCLUSIONS

We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.

A Guide of the Questionnaires Used in the Measurement of Health-Related Quality of Life in Head and Neck Oncology

Aims and background

There is a plethora of instruments which measure health-related quality of life (HRQOL), although only a fraction of these have been used in surgical studies and palliative care. Clinicians involved in the management of head and neck pathology face the difficult task of selecting the instrument most suited to the aspect of the patients’ perspective that they want to measure. The aim of this article is to guide head and neck trainees in deciding on the use of the appropriate instrument for evaluation of the patient's perspective.

Methods and study design

The two authors independently searched and scrutinized the literature. The ISI search engine with cross-reference using PubMed and Ovid was searched with the terms “quality of life”, “questionnaire” and specific specialty terms. Studies written in the English language were selected and the abstracts searched for evidence of patient self-completed questionnaires and HRQOL outcome.

Results

There are five broad category headings into which quality of life studies in head and neck oncology can be divided. These include: patient performance questionnaires, generic quality of life questionnaires, generic cancer questionnaires, head and neck cancer questionnaires, and head and neck functional questionnaires.

Conclusions

Patient perspective can be assessed using a number of instruments, including open interview, semi-structured interview, and the simple questionnaire. The choice of instrument depends somewhat on personal preference, the outcomes being measured, and available resources.

Using Technology to Give Patients a Voice After Surgery for Head and Neck Cancer

For patients with head and neck cancer, altered communication is a frequently occurring and highly upsetting issue that has been associated with psychological distress, fear, and anger among those with temporary or permanent speech impairment postsurgery. Many postoperative patients express that the most terrifying situation is to wake up from surgery and not be able to speak. Mobile devices have become part of everyday life, and augmentative and alternative communication mobile applications have the potential to enhance the healthcare journey of the patient and provider.


Feasibility of an iPad to Facilitate Communication in Postoperative Patients With Head and Neck Cancer

PURPOSE

To measure the feasibility of a communication application and an iPad to facilitate communication in postoperative patients with head and neck cancer.

DESIGN

A prospective feasibility study.

METHODS

This IRB-approved study was conducted in the postanesthesia care unit at an urban comprehensive cancer center. The participants included patients with head and neck cancer who underwent surgery that resulted in altered communication. Questionnaires were developed and administered to measure feasibility and patient satisfaction at different time points (preoperative, postoperative, and 1 to 4 days postoperatively).

FINDINGS

Of 38 patients in the study, 25 (66%) were able to use the customized iPad. Of these 25 patients, 15 (60%) were satisfied or somewhat satisfied with it. 84% found the customized iPad to be very or somewhat helpful for communication after surgery.

CONCLUSIONS

Patients were satisfied with the customized iPad, and the study found that using technology such as this was feasible in the immediate postoperative period.

The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy

PURPOSE

The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy.

METHOD

An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized.

RESULTS

Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use.

CONCLUSIONS

There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.

Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues

The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.

A Phenomenologic Study of Family Caregivers of Patients With Head and Neck Cancers

PURPOSE/OBJECTIVES

To describe and understand the lived experience of family caregivers of patients with head and neck cancers (HNCs).

RESEARCH APPROACH

Phenomenology using van Manen's human science approach
.

SETTING

Two hospital systems providing regional cancer care in upstate New York. 
.

PARTICIPANTS

Nine family caregivers of patients with HNCs who had completed treatment
.

METHODOLOGIC APPROACH

Qualitative analysis of semi-structured, conversational interviews about the lived experience of family caregivers.

FINDINGS

Five major themes emerged related to the lived experiences of this sample of caregivers.

CONCLUSIONS

Family caregivers of patients with HNCs play a fundamental role in the post-treatment phase of care, including meeting specific physical and psychosocial needs. Further investigation should explore the relationship between information needs and the experience of vigilance and fear.

INTERPRETATION

Nurses must include caregivers in physical and psychosocial plans of care. Balancing and meeting information needs of caregivers to avoid undue emotional stress and recognizing their support needs are valuable components of care.

Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: a randomised controlled trial

OBJECTIVE

This study aims to assess the effect of voice rehabilitation on health-related quality of life (HRQL) and communication experience for laryngeal cancer patients treated with radiotherapy.

METHOD

This prospective randomised controlled trial included 74 patients with Tis-T4 laryngeal cancer treated curatively by radiotherapy, of which 37 constituted the intervention group receiving voice rehabilitation and 37 patients as a control group. Patients were followed at one and six months post-radiotherapy, with voice rehabilitation conducted between these time-points. Endpoints included patient reported outcomes, including HRQL as measured by European Organisation for Research and Treatment of Cancer (EORTC) Core30 (C30) and Head & Neck35 (H&N35) as well as communication function as measured by Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer (S-SECEL).

RESULTS

The intervention group reported statistically significant improvements in communication experience as measured by S-SECEL environmental, attitudinal and total score domains compared to the control group. Similar improvements were seen in EORTC H&N35 Speech domain and the EORTC C30 domain Global quality of life. Moderate correlations were noted (r = 0.51-0.59) between three of four S-SECEL domains and the EORTC domains Speech and Global quality of life.

CONCLUSION

Laryngeal cancer patients treated with radiotherapy who receive voice rehabilitation appear to experience beneficial effects on communication function and selected HRQL domains. Voice rehabilitation following radiotherapy is recommended but further research investigating potential target groups and long-term effects is required.

Communication dysfunction, body image, and symptom severity in postoperative head and neck cancer patients: factors associated with the amount of speaking after treatment

PURPOSE

The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs).

METHODS

This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment.

RESULTS

A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstructive surgery were more likely to have a negative body image.

CONCLUSIONS

Dissatisfaction with body image, greater symptom severity, and hypopharyngeal and laryngeal cancer are predictive of the amount HNC patients speak, as compared with the amount they spoke before having HNC. Clinicians should be aware of and systematically assess communication problems of HNC patients to promote their social function. Further research on interventions that facilitate the development of a positive body image and communication is strongly suggested.

Breast cancer awareness among Turkish nursing students

BACKGROUND

This study conducted to determine breast cancer awareness and influencing factors among nursing students in the West Black Sea Region in Turkey.

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted between April-May, 2014. The sample was 270 female nursing students. Data were collected by Personal Information Form and Champion's Health Belief Model Scale (CHBMS).

RESULTS

The students' mean age was 21.6±2.09 and 81.1% had knowledge about breast cancer from their academic education. It is found that 63.7% of the students performed Breast Self-Examination (BSE) and 11.1% had a family member diagnosed with breast cancer. The CHBMS mean score of the students was 117.7±14.5.

CONCLUSIONS

Breast cancer awareness of nursing students is on a good level and was affected by family history of breast cancer and health beliefs.

Shoulder pain, functional status, and health-related quality of life after head and neck cancer surgery

Head and neck cancer (HNC) patients experience treatment-related complications that may interfere with health-related quality of life (HRQOL). The purpose of this study was to describe the symptom experience (shoulder pain) and functional status factors that are related to global and domain-specific HRQOL at one month after HNC surgery. In this exploratory study, we examined 29 patients. The outcome variables included global HRQOL as well as physical, functional, emotional, and social well-being. Symptom experience and functional status factors were the independent variables. In the symptom experience variables, shoulder pain distress was negatively associated with physical well-being (R (2) = 0.24). Among the functional status variables, eating impairment was negatively related to global HRQOL (R (2) = 0.18) and physical well-being (R (2) = 0.21). Speaking impairment and impaired body image explained a large amount of the variance in functional well-being (R (2) = 0.45). This study provided initial results regarding symptom experience and functional status factors related to poor HRQOL in the early postoperative period for HNC patients.

The psychometric properties of the Greek version of Champion's Health Belief Model Scale

BACKGROUND AND PURPOSE

Breast cancer is the leading female type of cancer in Cyprus. Therefore, there is a need for a valid and reliable tool to examine beliefs or practices about breast cancer and breast self-examination (BSE). The objective of this study was to translate the widely used Champion's Health Belief Model Scale into Greek and validate the tool among Cypriot women.

METHODS

Data analysis included descriptive statistics, reliability estimates, and confirmatory factor analysis with fit indexes for construct validity. Multiple regression, with dependent variables "frequency of practice of BSE in the previous year" and "intended frequency of BSE," was used to examine predictive validity. Ninety-four women were surveyed.

RESULTS

The six-subscale structure (confidence, benefits, susceptibility, barriers, seriousness, motivation) of the Greek version was verified, with a good model fit. Alpha coefficients ranged from .66 to .88, indicating internal consistency reliability of the tool. Regression analysis provided evidence of predictive validity, with barriers and confidence being significant predictors of BSE practice.

CONCLUSIONS

The Greek version of Champion's Health Belief Model Scale is a valid and reliable tool for use among Cypriot women that can be used to evaluate their beliefs about breast cancer and BSE and for planning interventions to improve these beliefs.

Determination of the breast cancer risk levels and health beliefs of women with and without previous mammography in the eastern part of Turkey

OBJECTIVE

This research was conducted to determine the breast cancer risk levels of women with and without previous mammography and their beliefs on breast cancer and mammography.

METHODS

The sample for this descriptive research consisted of women aged 50 years or older who were registered at the Family Health Center in the city center of Erzurum. The research was conducted with a total of 420 women with at least one mammography (210) and without mammography (210) who presented to the center on Wednesdays and Thursdays for any reason between 1 January 2010 and 1 January 2011. Research data were collected using the personal information "Breast Cancer Risk Assessment Form" accepted and recommended by the Turkish Ministry of Health, and the Champion's Health Belief Model Scale for Breast Cancer and Screening (CHBMS). Data were evaluated using percentages and means with the t-test.

RESULTS

According to the research data, 89.8% of the women were found to be in the low risk group, 87.6% with and 91.9% without mammography. When the health beliefs of women with and without mammography were compared, it was found that susceptibility, seriousness, motivation, mammography benefit scores were higher among those with mammography (p<0.01). The mammography barrier score average was higher in the group without mammography (p<0.01).

CONCLUSION

Knowing women's health beliefs, which have positive and negative effects on participating in mammography screening, may increase the rate of mammography uptake among women. Moreover, women with high breast cancer risk may be determined by increasing society's level of knowledge on breast cancer and risk factors.

Experiences of patients with laryngectomies as they reintegrate into their community

BACKGROUND

The purpose of this qualitative study is to describe the patient's experiences as they reintegrate into the community following laryngectomy surgery and identify their perceived support and barriers within this transition.

METHODS

Using Thorne's interpretive descriptive approach, purposeful sampling was used to recruit participants from two large urban hospitals. In-depth, audio-taped interviews were conducted with nine participants 6-12 months following surgery.

RESULTS

Enveloped under an overarching theme of a "Constant Accommodation to Life with a Laryngectomy," were three main themes: (1) "Impact of Cancer Diagnosis," (2) "Coping with Illness: Trying to Live Life like Before," and (3) "Transitions in Recovery." Subthemes further illuminated the constant accommodation participants had to make following cancer recurrence, surgery, and returning home.

CONCLUSIONS

Patients with laryngectomies face major changes in lifestyle related to altered airway, loss of voice, body image concerns, and challenges with eating. Support of family, friends, and health care professionals is critical for successful transition during this stressful period. Instant messaging, email, Web-based support groups, and video messaging can contribute to a great improvement in communication and engagement for this population.

Palliative treatment of dysphonia and dysarthria

The focus of this article is the palliative treatment of a variety of dysphonic conditions. Symptomatic relief of hoarseness can be achieved by voice therapy, augmentative alternative communication modalities, and surgery. The causes of dysphonia addressed herein include amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, stroke, head and neck cancers requiring glossectomy or laryngectomy, unilateral vocal fold paralysis, and presbyphonia. Palliative treatment of dysphonia and voice disorders provides symptomatic relief but not a cure of the underlying disease state. For these patients there are a number of palliative interventions that can greatly improve their quality of life.

Psychosocial determinants of successful voice rehabilitation after laryngectomy

This study gives an overview of publications on factors that are associated with the outcome of voice rehabilitation after laryngectomy. A systematic literature review was conducted. Fifty-six manuscripts were analyzed regarding the parameters investigated, the number of participants included, the study designs used, the assessment instruments, and the results. A broad range of factors were considered to contribute to successful voice rehabilitation, whereby psychosocial attributes related to success are mentioned as often as medical and treatment-related characteristics. The results of the studies are mostly inconsistent. It can be concluded, however, that active communication behavior, employment status, type of alaryngeal speech and the general physical condition are associated with rehabilitation outcomes, whereas alcohol consumption is not. More comprehensive prospective studies are needed which analyze the impact of psychosocial factors with validated and standardized instruments. A large sample size would be necessary to calculate all possibly relevant factors and their interaction. Clinicians should be careful about considering their patients to be "unmotivated" if the rehabilitation fails; instead, they should encourage them to communicate actively and take part in social activities.

Patient communication following head and neck cancer surgery: a pilot study using electronic speech-generating devices

PURPOSE/OBJECTIVES

To describe the communication of patients who received electronic speech-generating devices (SGDs) following surgical procedures for head or neck cancer.

DESIGN

Exploratory, complementary mixed methods.

SETTING

Otolaryngology surgical inpatient unit of an urban teaching hospital.

SAMPLE

10 purposively selected patients with a mean age of 57.1 years (SD = 12.8 years) and moderately severe illness (Acute Physiology and Chronic Health Evaluation III score mean = 27.1 + 13.2) who had SGDs in their hospital rooms for 9.1 + 6.2 days.

METHODS

Observation, interviews, questionnaires, and clinical record review.

MAIN RESEARCH VARIABLES

Communication methods, communication content, SGD use, communication quality (i.e., ease and user satisfaction), barriers to SGD use, and patient clinical characteristics.

FINDINGS

SGDs were used in message construction in 8 (17%) out of 48 total observed communication events. Writing (31%) and nonverbal communication (46%) were the most frequently observed primary methods of communication used by patients with head and neck cancer postoperatively. Five patients demonstrated occasional SGD use with or without cuing, and one used the SGD as the dominant communication method. Ease of Communication Scale scores showed only slightly less difficulty with communication when compared to a historic control group. Patients initiated communications more often when SGDs were used in message construction. Poor device positioning, staff unfamiliarity with SGDs, and patient preference and ability for writing were barriers to SGD use.

CONCLUSIONS

Although writing and making gestures were the most common communication methods, SGDs were used successfully by selected patients and may be particularly beneficial for constructing complex messages during conversation.

IMPLICATIONS FOR NURSING

SGDs may be an appropriate assistive communication strategy for postoperative patients with head and neck cancer. Nurses can facilitate effective patient communication with SGDs by cuing patients on device options and positioning SGDs within easy reach.

Head and neck cancer patient and family member interest in and use of E-mail to communicate with clinicians

BACKGROUND

E-mail is actively discussed as a promising method for clinical communication, but little study of patient and family preferences regarding its use has been done. This study aimed to describe patients' and family members' interest in and use of E-mail with their surgeons and nurses after head and neck cancer surgery.

METHODS

Surveys were distributed to patients and family members attending postoperative clinic visits. Seventy-four patients and 35 caregivers completed the surveys.

RESULTS

Although one in three patients expressed interest in E-mailing their clinicians, only 9.5% reported actually doing so. Symptom management and prescription refills were the most common issues addressed by E-mail. Few family members expressed any interest in using E-mail.

CONCLUSIONS

The findings suggest that E-mail communication between patients with head and neck cancer or their family members with surgeons and nurses is not common. Interest in using E-mail tends to be stronger among patients than family members.