Patients' experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck.
A temporary tracheostomy is commonly done in patients who have reconstruction after the ablation of advanced oral cancer to provide easy access to a secure airway in case a haematoma forms or the patient needs a return to theatre. Although relatively simple to do, we know little about the patients' experience, and to find out, we designed a three-stage study. First, we conducted semi-structured interviews to identify items related to the functional, emotional, and social impacts of the tracheostomy, on the ward and on removal (n=15 patients). Secondly, we used these items to develop a short, one-page questionnaire in collaboration with the Patient and Carer Support Group and Research Forum, and thirdly, we did a cross-sectional postal survey of 125 patients who had had a temporary tracheostomy as part of free tissue reconstruction between January 2013 and July 2015. Of them, 86 responded (69% response rate). Generally patients reported a negative experience. In the cross-sectional survey most responders (n=52, 60%) stated that they would "very much" avoid a tracheostomy if at all possible. The main problems concerned fear and communication, and between one-third and one-half stated that they had had "very much" or "quite a bit" of a problem in regard to choking, discomfort, attracting attention, sleeping, and general management (other than the suctioning). This feedback should form part of the information that is given to patients; it should also enable us to reflect on optimal perioperative care, and help to inform the debate about the selection criteria.
Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, L39 4QP; Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK. Electronic address: snrogers.aintree@gmail.com.
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Rogers
Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK. Electronic address: lukeerussell@googlemail.com.
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Russell
Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, L39 4QP; Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK. Electronic address: astraglobeltd@btconnect.com.
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D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000009:adverse effects / Q000523:psychology*
Head and neck cancer; Patient experience; Reconstruction; Tracheostomy