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Abstract

BACKGROUND:

Laryngectomy is a surgical procedure which results in the permanent removal of the larynx. Laryngectomy has a devastating impact on communication; and it is no longer possible to produce voice in a conventional manner. Surgical voice restoration is an alternative communication modality offered to people with laryngectomy (PWL), which is consistently shown to give favourable outcomes for quality of life and satisfaction when compared with other post-laryngectomy communication methods. However, whilst surgical voice restoration enables PWL to produce an alternative voice, called tracheoesophageal voice, quality varies significantly and may be difficult to establish. There is an absence of communication interventions for PWL and limited literature to inform clinical practice. Furthermore, PWL have not been included in research or intervention development as stakeholders. This study encompassed aspects of the preliminary development phase of a novel voice therapy intervention for tracheoesophageal speakers.

AIMS:

1. To establish current knowledge, identify and evaluate existing evidence on tracheoesophageal voice rehabilitation
2. To understand what approaches SLTs currently use in clinical practice, and to identify barriers and facilitators to implementation of tracheoesophageal voice therapy
3. To establish the views, experiences and priorities of PWL regarding tracheoesophageal voice rehabilitation
4. To identify the potential components of a novel tracheoesophageal voice therapy

METHODS:

Intervention development aligned to the Medical Research Council framework for developing and evaluating complex interventions. Patient and diversity advisory groups informed the study design. The following methodologies were used to meet the corresponding aims above:

1. Systematic literature review of behavioural interventions for tracheoesophageal voice
2. A survey of UK and Irish SLTs’ clinical practice and beliefs
3. Qualitative study using focus group methodology with PWL
4. Co-design study with PWL and SLT stakeholders; and a small study testing the feasibility of Expiratory Muscle Strength Training with PWL

OUTCOMES:

The study found existing evidence for tracheoesophageal voice rehabilitation is insufficient to inform clinical practice. SLTs were motivated to provide intervention, however, the lack of
evidence and clinical guidelines, and insufficient resourcing were barriers to implementation. Qualitative, feasibility and co-design studies established that PWL want a personalised,
collaborative intervention that embeds impairment-based voice interventions in a holistic framework to support activity and participation.

CONCLUSIONS:

The study has identified the components of an acceptable intervention through stakeholder co-design and feasibility study. This has culminated in a preliminary theory, informed by stakeholder partnership. The findings will guide further development and refinement of the intervention, leading towards feasibility testing of a novel tracheoesophageal voice therapy intervention, which is acceptable and meaningful to PWL.

Publication Type:	Thesis (Doctoral)
Subjects:	P Language and Literature > P Philology. Linguistics
Departments:	School of Health & Medical Sciences > Language & Communication Science School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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