Mahoney Janine, Vertigan Anne, Hew Mark, Oates Jennifer
Speech Pathology, La Trobe University, Melbourne, Victoria, Australia; Speech Pathology Department, The Alfred, Melbourne, Victoria, Australia.
Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
J Voice. 2024 Apr 1. doi: 10.1016/j.jvoice.2024.03.008.
Speech pathology is the first-line treatment for inducible laryngeal obstruction (ILO) and involves behavioral techniques to address symptoms and modify maladaptive laryngeal postures. Benefit from speech pathology is reliant on patients engaging in treatment sessions, regular home practice, and generalizing techniques to everyday activities. There is limited research exploring engagement in speech pathology treatment for ILO, particularly from the patient perspective. This study aimed to explore the experiences of living with ILO and how this experience may impact the way patients engage in speech pathology treatment.
Qualitative study.
Semistructured interviews were completed with seven participants exploring their experiences living with ILO, their diagnostic process and their experiences with speech pathology treatment. Data were analyzed using reflexive thematic analysis to determine shared meanings across participants and themes were developed.
Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Patients' reports of living with ILO and interacting with speech pathology suggested that these experiences impacted their readiness to start treatment and persist through the challenges of the treatment. Engagement appeared to be positively associated with significant ILO symptom burden and life impact, confidence in the diagnostic process, recommendation for speech pathology treatment, a tailored intervention by a patient-perceived expert in the field and working in a partnership with the speech pathologist to develop a sense of agency. Patients indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom burden and life impact.
The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient-centered approach to therapy may help to maximize engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximize engagement in treatment for people with ILO.
言语病理学是诱导性喉阻塞（ILO）的一线治疗方法，涉及行为技巧以解决症状并改变适应不良的喉部姿势。言语病理学的益处依赖于患者参与治疗课程、定期在家练习以及将技巧应用于日常活动。关于ILO患者参与言语病理学治疗的研究有限，尤其是从患者角度的研究。本研究旨在探索ILO患者的生活经历以及这种经历如何影响患者参与言语病理学治疗的方式。
定性研究。
对七名参与者进行了半结构化访谈，探讨他们的ILO生活经历、诊断过程以及言语病理学治疗经历。使用反思性主题分析法对数据进行分析，以确定参与者之间的共同意义并形成主题。
确定了三个主要主题——ILO生活、言语病理学治疗的挑战以及对我重要的事情。患者关于ILO生活以及与言语病理学互动的报告表明，这些经历影响了他们开始治疗的意愿以及在治疗挑战中坚持下去的能力。参与似乎与显著的ILO症状负担和生活影响、对诊断过程的信心、言语病理学治疗的推荐、由患者认可的该领域专家进行的量身定制干预以及与言语病理学家合作以培养自主意识呈正相关。患者表示他们的参与受到相互竞争的时间需求、使用症状缓解技巧和喉部练习时的社交尴尬以及较低的ILO症状负担和生活影响等因素的负面影响。
参与ILO言语病理学治疗背后的原因似乎是与ILO生活的先前经历（包括诊断过程）和言语病理学治疗经历之间的复杂相互作用。以患者为中心的治疗方法可能有助于通过探索治疗的准备情况和期望来最大限度地提高参与度。通过本研究对患者经历的更深入理解可能使言语病理学家设计出有意义的方法，以最大限度地提高ILO患者的治疗参与度。
