Helping Patients With Head and Neck Cancer Understand Dysphagia: Exploring the Use of Video-Animation

Effectiveness of using an online instructional video for preventing infections among Thai patients with cancer: A quasi-experimental study

Background

Patients with cancer are more likely to develop infections from several factors, and an infectious complication is the leading cause of death in this population. Therefore, nurses should provide educational media to these patients for infection prevention.

Objective

This study aimed to examine the effectiveness of using an online instructional video to prevent infections among patients with cancer in Thailand.

Methods

A quasi-experimental design was conducted from May 2020 to March 2021 at a cancer hospital in northeast Thailand. The participants consisted of 54 patients with cancer (27 each in the experimental and control group). The experimental group participants received four weeks of online video instruction at home, while the control group received the usual education from nurses. The data collection instruments included a demographic data questionnaire, a knowledge test, an infection prevention practice questionnaire, and a video media satisfaction questionnaire. Statistical analyses included descriptive statistics, chi-square test, Fisher's exact test, paired t -test, and independent t -test.

Results

After receiving the online instruction video, the experimental group had a significantly higher score for infection prevention knowledge, increasing from 17.52 to 20.93 (t = -6.575, p <0.001), and infection prevention practice, rising from 52.07 to 61.33 (t = -3.954, p = 0.001). The control group had no significant increase in the knowledge score (17.04 to 18.04) (t = -1.328, p = 0.100) or practice score (53.41 to 54.44) (t = -0.797, p = 0.217). The experimental group showed a significantly higher mean knowledge score (t = 4.473, p <0.001, large effect size with a Cohen's d of 1.22) and practice score (t = 3.121, p = 0.002, large effect size with a Cohen's d of 0.85) during post-intervention than the control group.

Conclusion

The findings support the use of online video as instructional media to enhance knowledge and practices regarding infection prevention among patients with cancer. This online video should be implemented for nurses and healthcare providers to promote knowledge and practices in the prevention of infections among patients with cancer in other hospitals.

Trial Registry Number

Thai Clinical Trials Registry (TCTR20241030009).

Physiology and Execution of Swallowing Maneuvers in 3D Videos: Integrating the Technology into Patient Care

Educational technologies have proven to be an effective way to guide and educate patients, allowing them to increase awareness of their dysphagia condition and how treatment will help them. In this sense, this study aimed to develop and validate the content and appearance of 3D iconographic videos, which addressed the physiological demonstration and execution of protective and facilitating swallowing maneuvers, as well as verifying the feasibility of its use in teleconsultation, having adults and elderly people with oropharyngeal dysphagia as the main target audience. The development of the 3D videos was elaborated based on a guiding scientific script, constructed from an integrative literature review. After the development of the 3D videos by the digital designer, a committee of 12 expert judges evaluated the material produced to validate the content and appearance where a minimum agreement index of 0.8 among the judges was considered satisfactory. Subsequently with the validated material, the proof of concept was conducted together with the target population of 10 dysphagic patients through individual teleconsultation via Google Meet platform. After the teleconsultation, patients responded to a Google Forms questionnaire, analyzing the videos presented. From the integrative literature review, 29 studies that contained relevant information about the physiological effects caused by swallowing maneuvers were selected. Based on this information, the scientific script was created, allowing a detailed description of the physiological events that occurred during swallowing while executing the maneuvers. With the finished script, 3D videos of swallowing maneuvers were produced. After developing the material, the committee of expert judges validated the content and appearance. The twelve items that had an agreement index below 0.8 were adjusted. Once the adjustments were completed, the videos were analyzed again, obtaining approval from the judges, and ensuring the validation of content and appearance of the material developed. A proof of concept was conducted on ten dysphagic patients. The maneuver applied was chosen according to the patient's physiological changes, causing only 4 of the 9 maneuvers to be tested, as the patients did not demonstrate changes in swallowing that would justify the use of the other maneuvers. After this, patients answered a form in which all items covered received positive evaluations, related to both ease of understanding and learning. This study allowed the development of the 3D videos with a didactic demonstration of the physiology and execution of protective and facilitating swallowing maneuvers, in addition to having its content and appearance validity assured through analysis by the committee of expert judges.

Exploring the Acceptability of Behavioral Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study of Patients' Experience

The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy namely: reactive, proactive low- ("EAT-RT" only), and high-intensity ("EAT-RT + exercises"). Understanding the perceived acceptability of these interventions is important to inform eventual implementation into clinical practice. This study explored patients' perspectives using qualitative methodology. At 2 Canadian PRO-ACTIVE trial sites, 24 trial participants were recruited for individual semi-structured interviews, representing each of the 3 trial arms. Data collection and thematic analysis were guided by the Theoretical Framework of Acceptability (TFA). Member checking was conducted through follow-up focus groups. Seven themes were derived reflecting the TFA constructs. Overall, regardless of trial arm, patients reported a positive experience with therapy. Patients identified benefits of EAT-RT therapy, reporting that it provided meaningful feedback on diet progress and supported goal setting for oral intake. Patients who received proactive therapies valued the opportunity to set expectations early, build mealtime routine iteratively over time, and have an extended engagement with the SLP. Regardless of trial arm, patients agreed proactive therapy aligned with what they think is best and that therapy intensity should accommodate individual needs. This study identified the value to HNC patients of receiving swallowing interventions during RT and setting realistic expectations around swallowing. Compared to reactive care, proactive therapies were perceived helpful in consolidating habits early, establishing realistic expectations around swallowing and building an extended rapport with the SLP. These findings will inform the implementation of proactive versus reactive swallowing therapies in clinical practice.

Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial

BACKGROUND

Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer.

OBJECTIVE

This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction.

METHODS

This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0.

RESULTS

The IED significantly reduced the occurrence of aspiration pneumonia ( P = .012), delayed the onset of aspiration pneumonia ( P = .005), and extended the survival time ( P = .007) in the experimental group.

CONCLUSION

For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia.

IMPLICATION FOR PRACTICE

The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Evaluation of the understandability, actionability and reliability of YouTube videos for brain, head, and neck cancer information

PURPOSE

Online videos accessed via YouTube are a popular method to provide health education. Videos need to be critically evaluated for educational qualities as the information could influence health outcomes. The present study aimed to evaluate the understandability, actionability and reliability of videos available on YouTube regarding brain, head, and neck cancer information.

METHODS

A scoping review was conducted with a specific search strategy and inclusion/exclusion criteria based on previous studies. For each video, video characteristics and user engagement activities were recorded. Videos were evaluated using the PEMAT-A/V and modified DISCERN criteria. Spearman's rank correlation, Kruskal-Wallis test and Mann-Whitney U test were used for analysis.

RESULTS

Out of 200 retrieved videos, 37 were included and analysed. The median length of the video was 3 min and 33 s. The majority of videos were published by health institutional and private channels (43.2%, n = 16). Health institutional channels received the highest actionability (Md = 37.5, p = 0.049), while private channels resulted in lower views/day (Md = 0.46, p = 0.001) and likes/day (Md = 0.01, p = 0.002). Animated and narrated videos acquired the highest understandability score (Md = 92.31, p < 0.001). Videos with professional transcripts reported higher actionability (Md = 62.5, p = 0.004), reliability (Md = 3.33, p = 0.028), views/day (Md = 29.31, p = 0.026), and likes/day (Md = 0.272, p = 0.023).

CONCLUSION

YouTube videos pertaining to brain and head and neck cancer have low understandability, low actionability and moderate reliability. It is beneficial to have a stronger representation of trustworthy and credible organisations for sharing essential health information via YouTube. Including animations and professional video transcripts may improve their overall quality and consumer engagement.

The effects of Phoniatric PREhabilitation in Head and Neck Cancer patients on Aspiration and Preservation of Swallowing (PREHAPS): study protocol of a monocentric prospective randomized interventional outcome-blinded trial

BACKGROUND

Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head and Neck Cancer Center, more than half of patients are affected. Improving treatment, and ideally prevention respectively prehabilitation, therefore seems more than desirable.

METHODS

The study is planned as a monocentric, prospective, outcome-blinded, randomized interventional study comparing an advanced phoniatric-logopedic prehabilitation with a control (standard of care). Seventy patients (30 control group, 30 intervention group, 10 drop-out rate of 15%) with an initial diagnosis of invasive HNSCC and curative treatment intention will be included over a period of 17 months. In addition to the previous standard, both groups will undergo both detailed subjective assessment of swallowing function and quality of life by means of various questionnaires and objective analyses by bioelectrical impedance measurements and phoniatric endoscopic swallowing examinations. In the intervention group, risk-related nutritional counseling (face-to-face) and phoniatric-logopedic prehabilitation are provided: detailed counseling with video demonstration and exercises to strengthen and improve the range of motion of the oral, pharyngeal, and laryngeal muscles (guided by exercise diary). Controls are performed at 6 weeks, 3 and 6 months, and 9 or 12 months after the end of therapy during the regular tumor follow-up. Primary study endpoints are swallowing function and emotional distress at 6 weeks of control visit.

DISCUSSION

Prehabilitation measures have already proven successful in other patient groups, e.g., transplant patients. In the field of head and neck oncology, interest in such concepts has increased significantly in recent years. However, usually, only subgroups, e.g., patients with swallowing problems after radiochemotherapy alone, are in focus. Our study aims to investigate the general benefit of prehabilitation with regard to swallowing function, which is so important for protection of aspiration and quality of life.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00029676 . International Clinical Trials Registry Platform DRKS00029676 . Registered on 19 July 2022.

Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures

BACKGROUND

Video health education has been increasingly adopted in the clinic to expand patient guidance and improve perioperative outcomes. To date, however, it is unclear whether the use of short-form videos and web-based clinician-created forums actually improve the perioperative experience of patients.

OBJECTIVE

To evaluate the effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures.

METHODS

This study is a quasi experimental study, using convenient sampling method and grouping according to historical control., one hundred and twenty-two patients admitted with lower limb fractures to the orthopedic ward of a tertiary first-class general hospital in Fujian, China were enrolled in this study. Based on their admission order, patients admitted from September 2021 to November 2021 were enrolled into the control group (n = 61) and patients admitted from December 2021 to March 2022 were enrolled in the intervention group (n = 61). Both groups received identical admission-based patient education, perioperative care, and discharge rehabilitation instructions. The control group received the traditional education method while the intervention group received a short-form educational video in addition to the traditional education method. Patient perioperative health knowledge and patient satisfaction with nursing care during treatment of lower limb fractures were compared across the two groups.

RESULTS

Preoperative health knowledge in the intervention group was 95.1%, compared to 82.0% in the control group (χ2 = 3.954, P<0.05). The Newcastle satisfaction with nursing scales score in the intervention group was (80.902 ± 7.016) points, compared to (78.131 ± 8.213) points in the control group. These group differences were statistically significant (P < 0.05).

CONCLUSION

The application of a short-form educational video during the perioperative care of patients with lower limb fractures may improve patients' understanding of perioperative health and increase satisfaction with nursing care.

Animated educational video using health belief model on the knowledge of anemia prevention among female adolescents: An intervention study

Introduction

As the younger female generation, female adolescents should understand anaemia prevention. This study examined the effects of animated educational videos on the knowledge of anaemia prevention among female adolescents using the Health Belief Model (HBM).

Method

A quasi-experimental method with a randomised pre-test and post-test control group design was applied. Animated educational videos about anaemia prevention were used as the intervention. One hundred sixty-one female adolescents were recruited through multistage random sampling and divided into intervention (n=78) and control (n=83) groups. The intervention group received education via animated educational videos. The HBM questionnaire was used to measure the nine HBM indicators (r=0.8); the item categories were valid and reliable. Descriptive analyses, independent t-tests and repeated-measures ANOVA were used to analyse the data.

Results

The animated educational videos played thrice significantly increased the knowledge of the intervention group (mean score: pre-test, 94; post-test one, 99; post-test two, 102). The scores for anaemia examination barriers (P=0.001), anaemia susceptibility (P=0.001), anaemia severity (P=0.001), anaemia prevention benefits (P=0.001), anaemia examination benefits (P=0.001), self-efficacy for obtaining iron tablets (P=0.001), self-recognition of anaemia signs and symptoms (P=0.001), signs of anaemia prevention (P=0.001) and health motivation (P=0.001) significantly changed. Meanwhile, the knowledge of the control group did not significantly increase (pre-test, 93; post-test one, 94; post-test two, 97). The intervention group had significantly higher mean scores in both the first and second measurements than the control group (P=0.05).

Conclusion

Animated educational videos significantly increased the knowledge of anaemia prevention, including the nine HBM indicators.

Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era

BACKGROUND

Total laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post-surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID-19 has placed significant pressures on acute services, requiring rapid service changes for TL patients.

AIMS

To understand the acute patient experience of having a TL both before and during COVID-19.

METHODS & PROCEDURES

Semi-structured interviews using a pre-designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data.

OUTCOMES & RESULTS

Thematic analysis identified four main themes: (1) pre-operative information-giving: 'it was just words'; (2) decision-making influences: 'I just wanted them to get it all out and get it over with'; (3) coping with adjustment to the new normal: 'this is part of me now'; and (4) the importance of relationship-building: 'when you've had something like this, you need some care and understanding'.

CONCLUSIONS & IMPLICATIONS

The need for an individualized approach to TL intervention which incorporates medical and psycho-social approaches from pre-treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID-19 did not contribute any major changes to the acute patient-reported experience.

WHAT THIS PAPER ADDS

What is already known on the subject We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre-treatment and early discharge home period. Overall, the gaps identified were from a more psycho-social need suggesting that future ERAS models of care should consider both medical and psycho-social principles to enhance patient experience and outcome. What are the potential or actual clinical implications of this work? Pre-treatment services provided to people who have a TL could be reviewed to help maximize long-term adjustment to life. Areas which could be reviewed include the method and mode of information delivery. Further work needs to be done in partnership with community services to improve the immediate discharge home experience.

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

Purpose

In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs).

Methods

We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority.

Results

Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority.

Conclusion

This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.

The care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping review

INTRODUCTION

Besides affecting physical health, Oropharyngeal Dysphagia (OD) entails limitations in daily activities and social participation for both patients and their informal caregivers. The identification of OD-related needs is crucial for designing appropriate person-centered interventions.

AIMS

To explore and map the literature investigating the care needs related to OD management of adult persons with OD and their informal caregivers during the last 20 years.

METHODS

A scoping review was conducted and reported following PRISMA guidelines. Five electronic databases and reference lists of eligible publications were searched for original works in English or Italian, published between January 2000 and February 2021. Two independent raters assessed studies' eligibility and extracted data; a third rater resolved disagreements. Extracted care needs were analyzed using a Best fit framework synthesis approach.

RESULTS

Out of 2,534 records preliminarily identified, 15 studies were included in the review and 266 care needs were extracted. All studies were conducted in Western countries. Research methods primarily consisted of qualitative interviews and focus groups (14 studies, 93.3%); head and neck cancer was the most frequent cause of patients' dysphagia (8 studies, 53.3%); caregivers' perspective was seldom investigated (5 studies, 33.3%). Both patients and caregivers primarily reported social (N = 77; 28.9%) and practical (N = 67; 25.2%) needs, followed by informational (N = 55; 20.7%) and psychological (N = 54; 20.3%) ones. Only patients reported physical needs (N = 13; 4.9%), while spiritual needs were not cited.

CONCLUSIONS

The recurrence of personal and social needs besides physical ones highlighted the manifold impact of OD on patients' and caregivers' lives. Larger and more focused studies are required in order to design tools and interventions tailored to patients' and caregivers' needs.

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.

Informal caregivers' quality of life and management strategies following the transformation of their cancer caregiving role: A qualitative systematic review

Objectives

Globally, informal caregivers caring for cancer patients meet challenges within their caregiving role, which significantly influence their quality of life. This qualitative systematic review aimed to analyze how cancer caregiving influence the quality of life of informal caregivers and the management strategies of informal caregivers for their role as cancer caregivers.

Methods

Following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement, Wanfang database, the China National Knowledge Infrastructure (CNKI), CINAHL, MEDLINE, PubMed, Cochrane Library, PsycARTICLES and PsycINFO, and grey literature in English and Chinese from 1 May 2009 to 31 December 2019 were searched. Quality of included studies was assessed by the Critical Appraisal Skills Programme (2018) Qualitative Checklist and thematic synthesis was conducted.

Results

Of the 8,945 studies identified, 6 studies met the inclusion criteria. One analytical theme relating to the QoL of informal caregivers following cancer caregiving was identified: "challenges of caregiving". In terms of the management strategies to the role of cancer caregivers, two analytical themes were identified: "self-adjustment" and "seeking for formal and informal support".

Conclusions

Cancer caregiving influences informal caregivers' QoL significantly and informal caregivers develop diverse coping strategies to deal with the difficulties occurred while balancing the relationship between their own lives and caregiving. However, professional and policy support remain inadequate for informal caregivers that require the need for improvement in terms of health care professionals and policymakers.

SIP SMART: a parallel group randomised feasibility trial of a tailored pre-treatment swallowing intervention package compared with usual care for patients with head and neck cancer

BACKGROUND

Dysphagia or difficulty in swallowing affects quality of life for most patients with head and neck cancer. SIP SMART - [Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training] aims to improve post-treatment swallowing outcomes through a targeted and tailored pre-treatment intervention. This feasibility study assessed 1) recruitment and retention, 2) patient acceptability of randomisation and participation, 3) patient adherence, and 4) sought to identify a suitable primary outcome for a definitive trial, including sample size estimation.

METHODS

This two-arm parallel group non-blinded randomised feasibility trial took place within a head and neck centre at a teaching hospital in London, UK. Patients newly diagnosed with stage III/IV head and neck cancer were recruited and underwent 6-month follow-up. Patients were randomised to SIP-SMART or usual care via an online web-based system. SIP SMART comprised two 45-min consultations including a baseline clinical and instrumental swallowing assessment, relevant educational information, targeted swallowing exercises, and specific behaviour change strategies to increase exercise adherence. Usual care comprised a single session including a baseline clinical assessment and generic information about the likely impact of treatment on swallowing.

RESULTS

A total of 106 patients were identified at pre-screening, 70 were assessed for eligibility. Twenty-six patients did not meet eligibility criteria [0.37, 95% CI 0.27 to 0.49]. Five of 44 [0.11, 95% CI 0.05 to 0.24] eligible patients were not approached by researchers during clinic. Seven [0.18, 95% CI 0.08 to 0.33] of the 39 approached declined participation. Target recruitment (32 consented patients) was achieved within the timeframe. At 6-months 29/32 [0.91, 95% CI 0.76 to 0.97] patients remained in the trial. Acceptability of randomisation and participation in the intervention was favourable, and adherence to the exercises exceeded the pre-defined 35% minimum criterion. The MD Anderson Dysphagia Inventory swallow related quality of life measure was selected as the most suitable primary outcome for sample size estimation. No adverse effects arose from the intervention, or study participation.

CONCLUSIONS

A definitive trial of the SIP SMART intervention compared to usual care is feasible and can be undertaken with patients with head and neck cancer treated within the NHS.

TRIAL REGISTRATION

ISRCTN40215425, registered retrospectively.