Center for Outcomes Research and Education, Providence St Joseph Health, Portland, Oregon.
Loma Linda University School of Medicine, Loma Linda, California.
JAMA Otolaryngol Head Neck Surg. 2023 Jun 1;149(6):485-492. doi: 10.1001/jamaoto.2023.0371.
The management of vestibular schwannoma may include observation, microsurgical resection, or radiation of a tumor near the facial nerve. Injury to the facial nerve can result in facial paralysis with major functional, social, and psychological sequelae, and the experiences of patients after paralysis are not well studied.
To (1) identify patient preparedness for developing facial paralysis and how well their care is coordinated following its development and (2) present in their own words outcomes of facial paralysis in terms of physical health, emotional health, self-perception, and social interactions.
DESIGN, SETTING, AND PARTICIPANTS: A qualitative observational study was performed using semistructured interviews at a tertiary care academic medical center. Semistructured interviews were conducted between January 1, 2018, and June 30, 2019, with adults aged 25 to 70 years who developed facial paralysis after treatment for vestibular schwannoma. Data were analyzed from July 2019 to June 2020.
Perceptions of the educational and emotional experiences of individuals who developed complete facial paralysis after surgical treatment of vestibular schwannoma.
Overall, 12 participants were interviewed (median age, 54 years [range, 25-70 years]; 11 were female). Saturation was achieved after 12 interviews, indicating that no further information could be elicited from additional interviews. Four major themes were identified: (1) lack of sufficient patient education about the diagnosis of facial paralysis; (2) lack of appropriate care coordination related to facial paralysis; (3) changes in physical and emotional health following facial paralysis; and (4) changes in social interactions and external support following facial paralysis.
It is well-known that patients with facial paralysis have reduced quality of life, severe psychological and emotional sequelae. However, little is currently done to help prepare patients for this undesirable outcome. In this qualitative study of facial paralysis, patients express, in their own words, their feeling that the education and management of facial paralysis by their clinicians was inadequate. Before patients undergo surgery, and certainly after injury to the facial nerve, clinicians should consider the patient's goals, preferences, and values to ensure that a comprehensive educational program and psychosocial support system are implemented. Facial reanimation research has not adequately captured these key patient factors associated with the quality of communication.
听神经鞘瘤的治疗管理可能包括观察、显微外科切除或面神经附近肿瘤的放射治疗。面神经损伤可导致面瘫，从而导致严重的功能、社会和心理后遗症，而面瘫后患者的经历并未得到很好的研究。
（1）确定患者对面瘫发展的准备情况，以及在面瘫发展后其护理的协调情况；（2）以自身的语言描述面瘫在身体健康、心理健康、自我认知和社会交往方面的结果。
设计、设置和参与者：一项定性观察性研究在一家三级保健学术医疗中心使用半结构式访谈进行。2018 年 1 月 1 日至 2019 年 6 月 30 日，对接受听神经鞘瘤治疗后出现面瘫的 25 至 70 岁成年人进行了半结构式访谈。数据分析于 2019 年 7 月至 2020 年 6 月进行。
对面神经完全麻痹患者的教育和情感体验的个体感知。
总体而言，共访谈了 12 名参与者（中位年龄 54 岁[范围 25-70 岁]；11 名女性）。12 次访谈后达到饱和，表明从额外访谈中无法得出更多信息。确定了四个主要主题：（1）缺乏关于面瘫诊断的充分患者教育；（2）面瘫相关护理协调不当；（3）面瘫后身体健康和心理健康的变化；（4）面瘫后社会交往和外部支持的变化。
众所周知，面瘫患者的生活质量降低，存在严重的心理和情感后遗症。然而，目前几乎没有采取任何措施来帮助患者做好应对这种不良后果的准备。在这项关于面瘫的定性研究中，患者用自己的语言表达了他们的感受，即他们认为临床医生对面瘫的教育和管理是不充分的。在患者接受手术之前，当然在面神经损伤之后，临床医生应该考虑患者的目标、偏好和价值观，以确保实施全面的教育计划和社会心理支持系统。面神经再兴奋研究尚未充分捕捉到与沟通质量相关的这些关键患者因素。
