Dobbins M, Gunson J, Bale S, Neary M, Ingrams D, Brown M
ENT Department, Royal Gwent Hospital, Newport, South Wales.
Br J Nurs. 2005;14(12):634-40. doi: 10.12968/bjon.2005.14.12.18283.
Patients undergoing total laryngectomy/glossectomy are left without a voice at least temporarily in the early postoperative stage, since their larynx and/or tongue has been removed. Those patients rendered permanently speechless usually acquire a form of mechanical speech through electronic devices. However, the life-changing nature of this surgery should not be underrated as effectively these people have lost their normal voice. It can be argued that this patient group is also without a voice in a political sense - theirs seems to be a forgotten cancer, as other forms of cancer appear to attract greater attention for research priorities and funding. In some ways this research attempts to redress the balance through exploring the patient experience postoperatively, in particular the issues related to communication for this patient group. The results also highlight the emotional trauma experienced by patients and the mechanisms healthcare staff employ to support these patients. This research is multidisciplinary, involving patients and all those health workers that come into contact with them on the ward. The patient experience forms a major part of this article, allowing their stories to form much of the content. The results draw attention to deficiencies in service delivery that, as a direct result of this research, have been and are being addressed so that patients' care is improved and their quality of life is restored. Such change has been driven by patient comment such as: 'But then when you wake up after that operation that's the pits when you are laying there and you think "I'm dead". And then when you wake up properly that's the bit I always say you wish you were dead. That's when you wish you had died.'
接受全喉切除术/舌切除术的患者在术后早期至少会暂时失去发声能力，因为他们的喉部和/或舌头已被切除。那些永久性失声的患者通常会通过电子设备获得一种机械发声方式。然而，这种手术对生活的改变程度不应被低估，因为实际上这些人已经失去了正常的声音。可以说，从政治意义上讲，这个患者群体也处于无声状态——他们所患的癌症似乎被遗忘了，因为其他形式的癌症似乎在研究重点和资金方面吸引了更多关注。在某些方面，这项研究试图通过探索患者术后的经历来纠正这种平衡，特别是与该患者群体沟通相关的问题。研究结果还凸显了患者所经历的情感创伤以及医护人员用来支持这些患者的机制。这项研究是多学科的，涉及患者以及在病房中与他们接触的所有医护人员。患者的经历构成了本文的主要部分，他们的故事构成了大部分内容。研究结果指出了服务提供方面的不足，由于这项研究，这些不足已经并正在得到解决，从而改善了患者的护理并恢复了他们的生活质量。这种改变是由患者的评论推动的，比如：“但手术后醒来的时候太糟糕了，你躺在那里，会想‘我死了’。然后当你完全清醒过来，我总是说那时候你真希望自己已经死了。就是在那个时候，你希望自己已经死了。”
