title: Evaluation of a weekly speech pathology/dietetic service model for providing supportive care intervention to head and neck cancer patients and their carers during (chemo)radiotherapy.
abstract: OBJECTIVE
  Dysphagia is a common and debilitating side effect for head and neck cancer (HNC) patients undergoing radiotherapy (RT) with or without chemotherapy ([C]RT) and is associated with nutritional and emotional comorbidities. Emotional sequelae and distress are also known to affect carers of HNC patients. A weekly, joint speech pathology/dietetic (SP/DN) service-delivery model has been employed to manage swallowing/nutritional and associated emotional issues during (C)RT. This study aimed to conduct a service evaluation of the weekly SP/DN clinical model.
  
  
  METHODS
  Cross-sectional sampling of core service metrics and perceptions of key stakeholders (70 HNC patients, 30 carers, and 10 clinicians) were collated from the Metro South Radiation Oncology Service in Brisbane, Australia. Data from each source was examined separately and then triangulated.
  
  
  RESULTS
  An average of 28 patients (SD = 5.54) attended SP/DN appointments per week, with 58% reporting swallowing and/or nutritional issues. Distress was reported by 27% of patients and 30% of carers. Clinicians felt able to adequately identify and manage swallowing and nutrition 90% of the time but only 10% of the time for distress. Seventy-six percent of scheduled SP/DN sessions were perceived as necessary by either patients, clinicians or both.
  
  
  CONCLUSIONS
  Findings demonstrated a third of patients and their carers had a high level of distress during HNC [C]RT, supporting need for the provision of a weekly SP/DN service in a select cohort. However, the routine weekly SP/DN assessment model for all patients undergoing HNC treatment demonstrates the potential for over-servicing. Alternative service-delivery models warrant further evaluation.
authors: Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia. l.wall@uq.edu.au.|School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. l.wall@uq.edu.au.|Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia. l.wall@uq.edu.au.
authors: Laurelie R
authors: http://orcid.org/0000-0002-9474-9121
authors: LR
authors: Wall
authors: Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia.|Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia.
authors: Bena
authors: B
authors: Cartmill
authors: Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia.|School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
authors: Elizabeth C
authors: EC
authors: Ward
authors: School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.|Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Australia.
authors: Anne J
authors: AJ
authors: Hill
authors: Dietetics Department, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia.|Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.
authors: Elizabeth
authors: E
authors: Isenring
authors: Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia.|School of Medicine, The University of Queensland, Brisbane, Australia.
authors: Sandro V
authors: SV
authors: Porceddu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017028:Caregivers; D003430:Cross-Sectional Studies; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000473:pathology*; D004046:Dietetics / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D013066:Speech-Language Pathology / Q000379:methods*; D055815:Young Adult
keywords: Head and neck cancer; Service evaluation; Service-delivery; Supportive care intervention