Evaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC

Introduction of a speech-language pathology assistant role for swallow screening in a head and neck radiotherapy clinic

PURPOSE

Optimal care suggests that all moderate-high risk head and neck (H&N) cancer patients should receive speech pathology assessment, education and management when commencing radiotherapy. However this is not always feasible due to high patient numbers and limited staffing. The aim of this study was to investigate the implementation of a speech-language pathology assistant (SLP-A) role for swallowing screening and education in a multidisciplinary H&N treatment clinic.

METHOD

A detailed model of care and training module were developed to up-skill the SLP-A in the screening and education to be undertaken. A pre-test post-test design compared outcomes in two separate groups prior to and following SLP-A role implementation. Outcomes included: optimal care compliance, speech-language pathology time spent with complex patients, swallowing-related admissions and patient satisfaction.

RESULT

Twenty-six patients were included pre-implementation and 35 post-implementation, with 16 (46%) patients receiving SLP-A screening/education post-implementation. The proportion of eligible patients seen by speech-language pathology pre-implementation was 62%, compared to 94% seen by speech-language pathology or SLP-A post-implementation (p = 0.002). There was a (non-significant) increase in speech-language pathology time spent with complex patients post-implementation (total minutes per patient: mean 252, SD = 144 vs. 279, SD = 115). There was no increase in swallowing-related admissions, and a (non-significant) increase in patient satisfaction post-implementation, indicating no compromise to patient safety or satisfaction.

CONCLUSION

Implementing a speech-language pathology assistant role for screening patients within the H&N treatment clinic allowed delivery of optimal care and increased time for speech-language pathologists to spend with complex patients, without compromising patient safety or satisfaction.

Head and Neck Cancer in a Rural U.S. Population: Quality of Life, Coping, Health Care Literacy, and Access to Services

Purpose The aim of this study was to explore the beliefs, access, and motivations of individuals with head and neck cancer (HNC) living in a rural community in the United States, regarding their speech and swallowing deficits. Method A convenience sample of nine patient participants with HNC and nine caregiver participants completed in-depth, semistructured interviews regarding their experiences with HNC diagnosis and treatment. The researchers utilized a thematic networks approach to analyze the qualitative data obtained. Results Primary results of the study were a set of common themes emerging from 735 units for analysis, arranged into 34 basic themes, nine organizing themes, and four global themes. The resulting networks centered around quality of life impact, coping, health literacy, and access. Direct quotes from the participants are utilized to illustrate response categories. Conclusions Individuals with HNC and their caregivers living in rural communities in the United States appear to represent a unique subset of the HNC population. While they present similarly in most areas, they display unique tendencies in the areas of psychological coping, health literacy, and access. Provision of practical, pertinent information that can be accessed by patients and caregivers alike outside the hospital is suggested to better serve this community.