Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era.
Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era.
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COVID-19期间全喉切除术后急性术后期的患者经验。
DOI：
10.1111/1460-6984.12709
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发表时间：
2022-07
影响因子：
2.4
通讯作者：
Patterson, Joanne M.
中科院分区：
文献类型：
--
作者：
Watson, Laura-Jayne;Hamilton, David;Patterson, Joanne M.
全喉切除术（TL）导致永久性的功能改变，需要快速发展复杂的新技能。这种学习的重要部分发生在急性手术后阶段。有越来越多的兴趣在TL手术后增强恢复（ERAS）协议，然而，实施一直很困难。COVID-19给急性服务带来了巨大压力，需要为TL患者快速改变服务。了解在COVID-19之前和期间发生TL的急性患者经历。使用预先设计的主题指南对10名在过去2年内接受过TL的人进行了半结构化访谈。参与者由他们的言语和语言治疗师使用目的抽样招募。Braun和Clarke的数据收集和专题分析迭代方法被用于从数据中生成关键主题。主题分析确定了四个主要主题：（1）术前信息提供：“这只是言语”;（2）决策影响：“我只是希望他们把一切都说出来并结束它”;（3）应对适应新常态：“这是我现在的一部分”;和（4）建立关系的重要性：“当你有这样的事情，你需要一些照顾和理解”。需要一种个性化的TL干预方法，包括从治疗前到急性出院的医学和心理社会方法，这是至关重要的。应审查ERAS模式，使其不仅仅局限于医疗模式。COVID-19导致的快速服务变化并未对急性患者报告的经验造成任何重大变化。我们知道ERAS方案有可能改善TL后的患者结局。然而，该研究并没有考虑任何其他比早期口服喂养的辩论，因此，它一直难以实现ERAS协议在目前的服务模式。COVID 19要求头颈部癌症服务部门迅速改变手术路径，这可能导致一些ERAS协议被无意中采用。为了了解这一影响，我们需要了解COVID 19之前和期间TL后的患者经历。本文使用定性访谈来了解COVID 19期间和之前TL后的急性患者经历。这些采访的结果强调，人们在大多数情况下，为手术后他们将经历的功能变化做好了充分的准备。然而，人们认为在治疗前和早期出院期间提供的服务存在差距。总体而言，所确定的差距来自更多的心理社会需求，这表明未来的ERAS护理模式应考虑医疗和心理社会原则，以改善患者体验和结局。可以审查为TL患者提供的治疗前服务，以帮助最大限度地长期适应生活。可以审查的领域包括提供信息的方法和方式。需要与社区服务合作开展进一步的工作，以改善立即出院回家的体验。
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. To understand the acute patient experience of having a TL both before and during COVID‐19. 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. 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’. 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. 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. 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. 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.
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发表时间：
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