title: Patients using antifungals following laryngectomy: a qualitative study of community pharmacists in the North of England.
abstract: OBJECTIVE
  To explore community pharmacists' understanding and opinions in relation to the prevention of fungal colonisation of voice prostheses amongst laryngectomy patients.
  
  
  METHODS
  Semi-structured interviews were conducted on a purposive sample of 12 community pharmacists from the North of England. Interviews were undertaken until data saturation was reached and responses were transcribed verbatim and analysed using a thematic approach.
  
  
  RESULTS
  Six themes emerged from the data analysis. These were: terminology confusion about laryngectomy, stoma and voice prostheses; smoking as a risk factor for the development of laryngeal cancer; using nystatin to prevent biofilm formation; counselling information related to nystatin; prescription intervention and additional education in relation to laryngectomy. The theme of counselling information related to nystatin use and additional education was a key finding: our data show that when dispensing nystatin to patients with a voice prosthesis, community pharmacists would either give no advice related to medication use or would give incorrect advice that may lead to premature prosthesis failure amongst this patient group.
  
  
  CONCLUSIONS
  This study highlights that community pharmacists lack understanding in relation to laryngectomy and are unaware of the off-label doses and administration methods of the drugs (specifically nystatin) used to prevent fungal colonisation on voice prostheses. Additional information sources in the form of an educational leaflet, possibly obtained through the local department of speech and language therapy, would be perceived as a valuable resource to support community pharmacists who are required to manage these patients in the community.
authors.affiliation: Wolfson Research Institute, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK; Department of Pharmacy, Health and Well-being, Faculty of Applied Sciences, University of Sunderland, Sunderland, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Todd
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Husband
authors.forename: Anne
authors.initials: A
authors.lastname: Hurren
authors.forename: Simran
authors.initials: S
authors.lastname: Kler
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ling
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects; D003157:Community Pharmacy Services; D003376:Counseling; D004739:England; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000193:education; D008297:Male; D010595:Pharmacists; D036301:Qualitative Research
chemical_list: D000935:Antifungal Agents
keywords: community pharmacists; head and neck cancer; laryngectomy; off-label prescribing; voice prosthesis