目的:全喉切除术(PTL)的患者面临与气道解剖结构改变相关的安全威胁,在医疗保健危机期间,不良事件的风险被放大。以COVID-19大流行为例。了解这些挑战,它们是如何被PTL导航的,以及可以部署哪些资源来减轻风险可以改善言语语言病理学家(SLP)的跨专业护理,耳鼻喉科医师,和其他专业人士。
方法:在COVID-19大流行期间,一项在线调查被传播到美国的PTL,向参与者询问有关安全问题和访问以解决护理问题的信息来源。描述性统计和卡方用于分析气管食管消耗的信息源,食道,和喉部电扬声器。完成了内容分析,以确定主题并按次主题量化答复。
结果:在173名受访者PTL中,气管食管说话者优先寻求耳鼻喉科医生的输入,而食管和喉电扬声器更经常选择SLP(p<.01)。总的来说,气管食管说话者有更多的SLP或耳鼻喉科医师接触.许多PTL报道了严格的洗手,颈部清洁,和卫生风险缓解策略。内容分析中出现了涉及感染/传播风险的六个主题,提高警惕,改变了咽喉的沟通,改良的气管造口覆盖率,诊断测试,以及来自合并症的风险。有限的提供者联系表明,大流行阻碍了医疗保健的获得。
结论:PTL具有一系列针对喉切除术的特定需求和关注点,并且鼻咽沟通的类型与所寻求的信息来源相关.需要优化医疗保健专业人员之间的合作,以改善患者导航和获得专业护理的整体机会。
OBJECTIVE: People with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals.
METHODS: An online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme.
RESULTS: Among 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access.
CONCLUSIONS: PTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.