Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
Dysphagia. 2019 Feb;34(1):89-104. doi: 10.1007/s00455-018-9917-4. Epub 2018 Jun 19.
Head and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n = 63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to implementing and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (< 15%) to 24 months. Collection of clinician/patient outcome tools was good during treatment, but lower post-treatment. Dysphagia outcomes were good and comparable to prior published data. The pathway provided patients with access to regular supportive care and provided staff opportunities to provide early and ongoing dysphagia monitoring and management. However, implementing and sustaining a HNC pathway is complex, requiring significant staff resources, financial investment, and perseverance. Regular audits are necessary to monitor the quality of the pathway.
头颈部癌症（HNC）指南建议定期进行多学科团队（MDT）监测和早期干预，以优化吞咽障碍的治疗效果；然而，许多因素会影响实现这些目标的能力。本研究的目的是探讨建立和维持头颈部癌症 MDT 治疗路径的障碍/促进因素，并研究该路径中的吞咽障碍相关言语治疗（SLP）和饮食学成分。本研究采用了综合实施研究框架（CFIR），采用混合方法研究设计来评估已建立的头颈部癌症 MDT 治疗路径。10 名 MDT 成员提供了对实施和维持该路径的障碍/促进因素的看法。对 2013 年至 2014 年间接受 SLP 和饮食学成分治疗的患者进行了审核，以评估其就诊情况、每次就诊时的结果数据以及治疗后 24 个月的吞咽结果。将吞咽障碍结果与接受强化预防性吞咽障碍管理的已发表队列进行了比较。确定了多个 CFIR 结构对实施和维持该路径至关重要。复杂性是一个障碍。在治疗期间，患者的就诊率很高，24 个月内的不依从率（<15%）很低。在治疗期间，临床医生/患者结果工具的收集情况良好，但治疗后则较低。吞咽障碍结果良好，与之前发表的数据相当。该路径为患者提供了定期的支持性护理机会，并为工作人员提供了提供早期和持续的吞咽障碍监测和管理的机会。然而，建立和维持头颈部癌症路径是复杂的，需要大量的人力、财务投资和毅力。需要定期进行审核，以监测路径的质量。
