title: Adherence to a Prophylactic Swallowing Therapy Program During (Chemo) Radiotherapy: Impact of Service-Delivery Model and Patient Factors.
abstract: Intensive, prophylactic swallowing therapy programs have been developed to improve dysphagia outcomes for patients with head/neck cancer (HNC) receiving (chemo)radiotherapy ([C]RT). Across studies, variable therapy adherence rates have been reported. Preliminary research suggests that service-delivery mode and demographic factors may influence adherence. This study examined patient adherence to a prophylactic swallowing therapy protocol across three service-delivery models: (1) clinician-directed face-to-face therapy, (2) technology-assisted therapy using the telepractice application, SwallowIT and (3) independent patient-directed therapy. The secondary aim explored the impact of patient factors on adherence. Patients with oropharyngeal HNC receiving definitive (C)RT were randomised to receive the Pharyngocise exercise protocol via clinician-directed (n = 26), patient-directed (n = 27) or SwallowIT-assisted (n = 26) models. Adherence was calculated as the percentage of prescribed exercise completed. Multiple patient factors were recorded at baseline. Adherence across the 6 weeks in all groups was low (27%), and declined from week 4 of (C)RT. The clinician-directed model yielded significantly (p = 0.014) better adherence than patient-directed therapy in weeks 1-3. There was also a trend for higher adherence in the SwallowIT group compared to patient-directed in weeks 1-3 (p = 0.064). Multivariable linear modelling identified active smoking at baseline (p < 0.001) and concomitant chemotherapy (p = 0.040) as significant negative predictors of adherence, with baseline reduced motivation trending towards significance. Although (C)RT-related toxicities will impact adherence, adopting service-delivery models with greater structure/support and providing extra assistance to patients with known risk factors may help optimise therapy adherence to prophylactic therapy programs. Telepractice may provide an alternate model to support adherence where service constraints limit intensive clinician-directed therapy.
authors.affiliation: Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Ipswich Rd, Buranda, QLD, 4102, Australia. l.wall@uq.edu.au.|Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia. l.wall@uq.edu.au.|Centre for Research Excellence in Telehealth, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia. l.wall@uq.edu.au.
authors.forename: Laurelie R
authors.initials: LR
authors.lastname: Wall
authors.affiliation: Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Ipswich Rd, Buranda, QLD, 4102, Australia.|Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.affiliation: Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Ipswich Rd, Buranda, QLD, 4102, Australia.|Speech Pathology Department, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, 4102, Australia.
authors.forename: Bena
authors.initials: B
authors.lastname: Cartmill
authors.affiliation: Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Hill
authors.affiliation: Radiation Oncology Department, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, 4102, Australia.|School of Medicine, The University of Queensland, St Lucia, QLD, 4072, Australia.
authors.forename: Sandro V
authors.initials: SV
authors.lastname: Porceddu
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D010349:Patient Compliance; D010819:Physician's Role; D012648:Self Care; D017216:Telemedicine
keywords: Adherence; Deglutition; Deglutition disorders; Dysphagia; Exercise; Head and neck cancer; Prophylactic swallowing therapy; Service-delivery