Establishing a Multidisciplinary Head and Neck Clinical Pathway: An Implementation Evaluation and Audit of Dysphagia-Related Services and Outcomes

AbstractHead and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n  =  63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to imple menting and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (
Source: Dysphagia - Category: Speech-Language Pathology Source Type: research

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ConclusionThe translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.ResumoIntroduçãoO linfedema interno é uma das sequelas do tratamento para o câncer de cabeça e pescoço, podendo levar a alterações de grau variado na deglutição, voz e respiração. A Escala do Edema da Radioterapia (Radiotherapy Edema Rating Scale), elaborada por Patterson et al., é uma ferramenta de avaliação do edema de faringe e laringe.ObjetivoTraduzir, par...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
Abstract Purpose: The purpose of the current project was to explore the feasibility for subtyping dysphagia traits or patterns of scores in a subset of data from the Modified Barium Swallow Impairment Profile global registry in patients referred to videofluoroscopic swallowing studies across 5 common medical categories: (a) cardiothoracic, (b) gastroenterology, (c) head and neck cancer, (d) neurology, and (e) pulmonary. Method: Videofluoroscopic swallowing study imaging and Modified Barium Swallow Impairment Profile metrics were used to evaluate 235 patients with dysphagia grouped into 1 of the 5 categories. ...
Source: American Journal of Speech-Language Pathology - Category: Speech-Language Pathology Authors: Tags: Am J Speech Lang Pathol Source Type: research
“When I was in graduate school, we didn’t even have a class on dysphagia,” I sometimes tell my students. But before you hold this against me, I did realize this gap in my education during my clinical fellowship back in 1993, so I attended a course taught by Jeri Logemann. The course helped me connect the dots, but I did my fellowship in an outpatient department for a children’s hospital, so I needed to learn quickly. Fortunately, Joan Arvedson, Bob Beecher and Monica Wojcik continued to shape my pediatric dysphagia knowledge. Now I’m a clinical instructor and guest lecturer teaching a pediatri...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - Category: Speech-Language Pathology Authors: Tags: Academia & Research Health Care Slider Speech-Language Pathology Dysphagia Feeding Disorders NICU Swallowing Disorders Source Type: blogs
Advances in technology have improved survival rates for patients with head and neck cancer; however, the medical profession continues to pursue opportunities to improve quality of life for survivors. Advances in organ preservation therapies, such as intensity-modulated radiation therapy and proton therapy, are encouraging. However, preservation of swallowing-related quality of life remains challenging. For the past decade, speech-language pathologists (SLPs) have applied neuroplasticity principles to exercise-based swallowing treatment for patients undergoing chemoradiation therapy for head and neck cancer. This intensive ...
Source: JAMA Otolaryngology - Head and Neck Surgery - Category: ENT & OMF Source Type: research
Patients undergoing radiotherapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function; however, it is unclear which interventions have the greatest benefit.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Source Type: research
Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL).
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Clinical Investigation Source Type: research
Conclusions: We demonstrated the feasibility of comparing health and economic outcomes in patients receiving and not receiving early slp dysphagia intervention. These preliminary findings suggest that early slp dysphagia intervention for hnc patients might reduce peg dependency despite worsening health. Findings also highlight effects on financial security for these patients and their caregivers. PMID: 29270055 [PubMed]
Source: Current Oncology - Category: Cancer & Oncology Tags: Curr Oncol Source Type: research
Caption: Gary Altobella, owner of The Synapse Health Group, LLC, talks to Private Practice Connect participants about aligning clinical and business approaches. Juliane Pearson took the leap from working as a school-based speech-language pathologist to opening her own private practice a year ago. So she came to ASHA’s Private Practice Connect to get some ideas and strategies—and she was not disappointed. “I’m lucky I’m still small,” she said after attending a presentation on the importance of tracking patient and practice-pattern data by Shannon Butkus. “I can put the tracking syst...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - Category: Speech-Language Pathology Authors: Tags: Speech-Language Pathology Practice Management private practice Professional Development Source Type: blogs
With increases in survivorship for patients with head and neck cancer, attention is turning to quality-of-life issues for survivors. Care for these patients is multifaceted. Dysphagia and issues of voice/speech, airway obstruction, neck and shoulder dysfunction, lymphedema, and pain control are important to address. Rehabilitation interventions are patient-specific and aim to prevent, restore, compensate, and palliate symptoms and sequelae of treatment for optimal functioning. Central to providing comprehensive interdisciplinary care are the head and neck surgeon, laryngologist, and speech-language pathologist. Routine fun...
Source: Otolaryngologic clinics of North America - Category: ENT & OMF Authors: Source Type: research
Conclusion: The translation and cultural adaptation of the PCI into Brazilian Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use among the Brazilian head and neck cancer population.Resumo Objetivo: O objetivo deste estudo foi traduzir, adaptar culturalmente e avaliar o Invent ário de Preocupações dos Pacientes - Cabeça e Pescoço (IPP-CP) em uma série consecutiva de pacientes brasileiros. Método: Este estudo incluiu pacientes adultos tratados por câncer do trato aerodigestivo superior (TADS...
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
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