Laurelie R. Wall

Examining user perceptions of SwallowIT: A pilot study of a new telepractice application for delivering intensive swallowing therapy to head and neck cancer patients.

Consumer feedback and end-user perceptions provide important information regarding the clinical acceptability of new telepractice systems. This pilot investigation aimed to evaluate end-user perceptions of a new asynchronous telepractice application, ‘SwallowIT’, designed to support patients to remotely complete intensive swallowing therapy during curative chemoradiotherapy (CRT) treatment for head and neck cancer (HNC). Insights were sought from 15 patients with oropharyngeal cancer who used SwallowIT to complete supported home swallowing therapy. Perceptions were evaluated via structured questionnaires, completed following initial orientation to SwallowIT and on completion of CRT. Semi-structured phone interviews were conducted ≥3 months post-treatment. The majority of patients reported positive initial perceptions towards SwallowIT for comfort (87%), confidence (87%), motivation (73%) and support (87%). No statistically significant change in perceptions was observed from baseline to end of CRT (p > 0.05). Thematic analysis of interviews revealed four main themes: the ease of use of SwallowIT, motivating factors, circumstances which made therapy difficult, and personal preferences for service-delivery models. These preliminary findings demonstrate that SwallowIT was well-perceived by the current group of HNC consumers and suggest that SwallowIT may be well-accepted as an alternate service-delivery model for delivering intensive swallowing therapy during CRT.

“ScreenIT”: Computerized screening of swallowing, nutrition and distress in head and neck cancer patients during (chemo)radiotherapy

BACKGROUND In light of growing service demands, the use of computerized screening processes have been proposed to optimize patient triage and enhance the efficiency and synergy of multidisciplinary care practices. This study evaluated the accuracy of a novel system, ScreenIT, to detect swallowing, nutrition and distress status in HNC patients receiving (chemo)radiotherapy ([C]RT), and facilitate appropriate referrals for MDT management. MATERIALS AND METHODS Patient-reported data obtained from ScreenIT was compared to blinded face-to-face assessment by speech pathology/dietetic clinicians across five domains: side-effects, swallowing/oral intake, nutrition, distress, and need for supportive care services. Agreement was analysed using percent exact and close agreement (PEA/PCA) and kappa statistics. RESULTS Clinically acceptable agreement (PEA/PCA 80% or higher) was achieved for the majority of domains. In areas of discordance, ScreenIT demonstrated a higher sensitivity to patient-perceived concerns, particularly regarding distress. Management pathways generated by ScreenIT initiated clinically appropriate referrals for high and medium-risk patients for swallowing/nutrition and distress. CONCLUSION Findings suggest that ScreenIT may provide an effective and efficient means of monitoring swallowing, nutrition and distress status during (C)RT, and facilitate clinically appropriate prioritization of MDT supportive care intervention.

Use of simulation technology for clinical skills development in tracheostomy management

Dysphagia Research Society Annual Meeting and Post-Graduate Course March 7–12, 2012 The Ritz-Carlton Toronto, Ontario, Canada Springer Science+Business Media New York 2012

UK Survey of Clinical Consistency in Tracheostomy Management.

BACKGROUND Many speech and language therapists (SLTs) work with patients who have a tracheostomy. There is limited information about their working practices and the extent to which recent publications and research have influenced the speech and language therapy management of the tracheostomized patient. AIMS This study reviews the current patterns of clinical practice for SLTs in the management of adult tracheostomized patients in the UK. METHODS & PROCEDURES An online questionnaire was completed by 106 SLTs with prior experience in tracheostomy management. The information from this was explored to determine patterns of practice across various areas of speech and language therapy tracheostomy management including clinical roles and responsibilities, management of communication disorders, and assessment and management of dysphagia and decannulation. These clinical patterns were then examined with respect to the current literature, emerging patterns in evidence-based practice and national practice guidelines. OUTCOMES & RESULTS The results indicate a moderate to high level of clinical consistency in the majority of areas evaluated across the scope of tracheostomy management in speech and language therapy. Consistency in practice areas such as increased utilization of instrumental assessments and conservative use of the Modified Evans Blue Dye Test indicate clinical application in line with current research. Limited clinical consensus or inconsistencies in evidence-based services were identified in aspects of practice that are supported by conflicting or emerging research evidence. Such areas include involvement in cuff deflation regimes, adoption of specific decannulation procedures and participation in multidisciplinary team management. CONCLUSIONS & IMPLICATIONS SLTs in the UK provide a moderate to high level of consistent practice in tracheostomy management. This study identifies areas of tracheostomy management that require further research in order to establish clinical practice guidelines and to address discrepancies between research evidence and clinical implementation.

Computer Literacy and Health Locus of Control as Determinants for Readiness and Acceptability of Telepractice in a Head and Neck Cancer Population

Understanding end-user populations is required in designing telepractice applications. This study explored computer literacy and health locus of control in head/neck cancer (HNC) patients to inform suitability for telerehabilitation. Sixty individuals with oropharygneal cancer were recruited. Computer literacy was examined using a 10-question survey. The Multidimensional Health Locus of Control Scale Form C (MHLC-C) examined perceptions of health “control”. Participants were mostly middle-aged males, from high socioeconomic backgrounds. Only 10% were non-computer users. Of the computers users, 91% reported daily use, 66% used multiple devices and over 75% rated themselves as “confident” users. More than half were open to using technology for health-related activities. High internal scores (MHLC-C) signified a belief that own behaviour influenced health status. HNC patients have high computer literacy and an internal health locus of control, both are positive factors to support telepractice models of care. This may include asynchronous models requiring heightened capacity for self-management.

Technology-assisted screening of patient-reported functional outcomes in the head and neck cancer population: what’s the evidence?

Abstract Introduction There is growing recognition that patient-reported outcome assessment tools are important components in the holistic clinical management of patients with head and neck cancer. Single administration of such tools can provide insight into the inci -dence and prevalence of the many multifaceted and debilitating func-tional deficits experienced by this population, while routine screening using patient-reported outcomes can assist in the early detection of cancer care. “at-risk” patients and serve as a pro-cess for monitoring functional status over time. To assist the implementation of routine patient-reported outcome screening in clinical practice, an tations that currently restrict the emerging body of literature has begun to explore the use of technology to help collect and summarise data in real-time for clinical use. The pur-pose of this review is to appraise the current evidence-base for the use of technology-assisted screening of functional patient-reported out-comes in the head and neck cancer population and to identify areas of future research need.

Application of telepractice for head and neck cancer management: a review of speech language pathology service models

Purpose of review Head and neck cancer (HNC) is a complex and heterogeneous disease, requiring specialist intervention from a multidisciplinary team including speech language pathology (SLP). Unfortunately, multiple patient and service-related challenges exist which currently limit equitable access to SLP support for all individuals. This review highlights the existing evidence for different telepractice models designed to help patients and services optimize management of swallowing and communication disorders arising from HNC. Recent findings Emerging evidence exists for using computerized screening to enhance the identification of treatment-related toxicities and assist referrals to services, including SLP. Asynchronous telepractice applications are being used to assist delivery of intensive home-based dysphagia therapy, whereas videoconferencing can offer a feasible and effective method to support ongoing management for patients with limited access to local specialist SLP services. Patient and clinician satisfaction with all models has been high. Summary SLP services can be redesigned to incorporate a range of telepractice models to optimize clinical care at different stages of the HNC survivorship pathway. Early evidence supports telepractice can improve patient access to services, enhance outcomes, and optimize health service efficiency; however, further systematic research is needed into these models, particularly relating to large-scale implementation and costs/economic analyses.