Sparks Freya, Dipper Lucy, Coffey Margaret, Hilari Katerina
Department of Language and Communication Sciences, City, University of London, London, UK.
Barts Health NHS Trust, London, UK.
Int J Lang Commun Disord. 2023 Sep-Oct;58(5):1481-1495. doi: 10.1111/1460-6984.12873. Epub 2023 Apr 3.
After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context.
(1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy.
METHODS & PROCEDURES: A self-administered 10-min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post-registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis.
OUTCOMES & RESULTS: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general.
CONCLUSIONS & IMPLICATIONS: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under-resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring-fenced for therapy are available for tracheoesophageal speakers to receive the support they require.
What is already known on this subject Total laryngectomy results in life-altering changes to communication. Clinical guidelines advocate for speech and language therapy intervention; however, there is no clear information on what SLTs should do to optimize tracheoesophageal voice and the evidence base to support practice is lacking. What this study adds to existing knowledge This survey identifies what interventions SLTs provide in clinical practice to rehabilitate tracheoesophageal voice; and it explores the barriers and facilitators that influence the provision of tracheoesophageal voice therapy. What are the potential or actual clinical implications of this work? Specific training, clinical guidelines, increased research and audit are required to support clinical practice in laryngectomy rehabilitation. Service planning should address the under-resourcing of staff, expert practitioners and therapy allocated time.
全喉切除术后，手术语音恢复用于通过气管食管语音假体建立交流。一旦建立了语音，关于言语和语言治疗师（SLTs）应采取何种措施来改善气管食管语音质量以确保功能性交流的信息却很少。现有的调查或研究均未探讨这个具体问题。此外，指南、知识与临床实践之间也存在脱节，临床指南规定了SLT干预的要求，但未详细说明在康复背景下这具体包括哪些内容。
（1）加深对当前语音假体管理和护理之外临床实践的理解。（2）探讨英国和爱尔兰共和国在临床实践中用于恢复气管食管语音的方法。（3）调查提供气管食管语音治疗的障碍和促进因素。
使用Qualtrics软件开发了一份10分钟的在线自填式调查问卷，并在分发前进行了预试验。调查问卷的制定参考了行为改变轮，以确定影响SLTs为气管食管语音使用者提供语音治疗的障碍、促进因素和其他因素。该调查问卷通过社交媒体和专业网络进行分发。入选标准包括注册后至少有一年工作经验且在过去5年中有喉切除手术工作经验的SLTs。使用描述性统计分析封闭式答案问题。使用内容分析法分析开放式问题的回答。
该调查共收到147份回复。参与者代表了头颈癌SLT工作群体。SLTs认为气管食管语音治疗是喉切除术后康复的一个重要方面；然而，他们对治疗方法缺乏了解，且实施治疗的资源不足。SLTs表示希望获得更多培训、具体指南以及更强有力的证据基础来指导临床实践。一些SLTs对进行喉切除术后康复和一般气管食管工作所需的专业技能感到沮丧且未得到认可。
该调查表明需要一种完善的培训方法和详细的临床指南，以促进整个行业的一致实践。该临床领域的证据基础刚刚出现，因此需要增加研究和临床审计以指导实践。突出了资源不足的问题，在服务规划中应予以考虑，以确保有足够的工作人员、获得专家从业者的机会或为气管食管语音使用者预留治疗时间，使他们能够得到所需的支持。
关于该主题的已知信息全喉切除术会导致交流方式发生改变人生的变化。临床指南提倡言语和语言治疗干预；然而，关于SLTs应如何优化气管食管语音且缺乏支持实践的证据基础，尚无明确信息。本研究对现有知识的补充该调查确定了SLTs在临床实践中为恢复气管食管语音所提供的干预措施；并探讨了影响气管食管语音治疗提供的障碍和促进因素。这项工作的潜在或实际临床意义是什么？需要特定培训、临床指南、更多研究和审计来支持喉切除术后康复的临床实践。服务规划应解决工作人员、专家从业者和分配的治疗时间资源不足的问题。
