Ward Elizabeth C, Wall Laurelie R, Burns Clare L, Cartmill Bena, Hill Anne J
aCentre for Functioning and Health Research, Queensland Health bCentre for Research in Telerehabilitation, School of Health and Rehabilitation Sciences cCentre for Research Excellence in Telehealth, University of Queensland dSpeech Pathology and Audiology Department, Royal Brisbane and Women's Hospital eSpeech Pathology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Curr Opin Otolaryngol Head Neck Surg. 2017 Jun;25(3):169-174. doi: 10.1097/MOO.0000000000000357.
Head and neck cancer (HNC) is a complex and heterogeneous disease, requiring specialist intervention from a multidisciplinary team including speech language pathology (SLP). Unfortunately, multiple patient and service-related challenges exist which currently limit equitable access to SLP support for all individuals. This review highlights the existing evidence for different telepractice models designed to help patients and services optimize management of swallowing and communication disorders arising from HNC.
Emerging evidence exists for using computerized screening to enhance the identification of treatment-related toxicities and assist referrals to services, including SLP. Asynchronous telepractice applications are being used to assist delivery of intensive home-based dysphagia therapy, whereas videoconferencing can offer a feasible and effective method to support ongoing management for patients with limited access to local specialist SLP services. Patient and clinician satisfaction with all models has been high.
SLP services can be redesigned to incorporate a range of telepractice models to optimize clinical care at different stages of the HNC survivorship pathway. Early evidence supports telepractice can improve patient access to services, enhance outcomes, and optimize health service efficiency; however, further systematic research is needed into these models, particularly relating to large-scale implementation and costs/economic analyses.
头颈癌（HNC）是一种复杂的异质性疾病，需要包括言语语言病理学（SLP）在内的多学科团队进行专业干预。不幸的是，目前存在多种与患者和服务相关的挑战，限制了所有人公平获得SLP支持。本综述强调了不同远程医疗模式的现有证据，这些模式旨在帮助患者和服务机构优化对HNC引起的吞咽和沟通障碍的管理。
有新证据表明，使用计算机化筛查可加强对治疗相关毒性的识别，并协助转诊至包括SLP在内的服务机构。异步远程医疗应用正被用于协助提供强化的家庭吞咽困难治疗，而视频会议可为难以获得当地专业SLP服务的患者提供一种可行且有效的持续管理方法。患者和临床医生对所有模式的满意度都很高。
SLP服务可重新设计，纳入一系列远程医疗模式，以优化HNC生存路径不同阶段的临床护理。早期证据支持远程医疗可改善患者获得服务的机会、提高治疗效果并优化医疗服务效率；然而，需要对这些模式进行进一步的系统研究，特别是与大规模实施以及成本/经济分析相关的研究。
