The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 “interim-care solution”. Rather, we encourage clinicians, services, and researchers to embrace a future of “integrated care”, where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.

Introduction: Research has shown that electronic platforms can assist data capture of patient-reported outcome measures (PROMs) to guide clinical care. In comparison, routine collection of carer-reported outcome measures (CROMs) to support the patient-carer dyad during cancer treatment has had limited attention. The current study utilised a novel electronic CROM (eCROM) system, ScreenIT Carer, to monitor the prevalence and nature of distress in carers of patients undergoing (chemo)radiotherapy ((C)RT) for head/neck cancer (HNC), and explore factors associated with carer distress. Methods: Carers completed ScreenIT Carer weekly when attending patients' (C) RT treatment sessions from planning to 2 weeks post-treatment. ScreenIT Carer included the Distress Thermometer (DT) and Problem List, and a purposebuilt Mealtime-Specific DT and Problem list. Data were first examined descriptively, then associations between demographic/treatment-related factors and distress severity were analysed using mixed-effects general linear modelling. Results: 135 carers provided 434 ScreenIT Carer entries during the study period (mean entries = three/carer; yielding average adherence rate of 41% (range 11-100%)). A high prevalence of general (59%) and mealtime-specific distress (46%) was reported by carers. Nature of distress was multifactorial, with emotional problems and the patients' physical condition/symptoms common contributing factors. Based on multivariate analysis, tumour site, geographical location of residence and time during (C)RT when ScreenIT Carer was completed were significant predictors of carer distress severity. Conclusions: Carer distress is prevalent and multifactorial during (C)RT. This study highlights the feasibility of utilising eCROM platforms such as ScreenIT Carer, to monitor carer wellbeing and guide supportive care services as part of a holistic care pathway.

Background Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach. Methods Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change. Results Between the two participating health services, 30 actionable goals were identified within the “green‐zone” on the go‐zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills. Conclusions This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.

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Objective: Individuals with head and neck cancer residing in rural areas face numerous challenges accessing post-acute rehabilitation services, including speech pathology services. In order to inform future service enhancements, the key issues impacting access to, and the provision of, speech pathology head and neck cancer services in rural areas was explored through the perspectives of patients, carers, speech pathology clinicians and service managers. Setting: A rural health referral network in Queensland consisting of tertiary, regional and remote hospitals.Participants: Twenty-eight participants, including 12 speech pathology staff/ managers and 16 consumers (people with head and neck cancer/carers).Design: Qualitative methodology using semi-structured interviews was analysed using content analysis. Results: Two themes were identified from the consumer group including (a) navigating health services for head and neck cancer management and (b) burden of accessing head and neck cancer care. Speech pathology staff/managers interviews raised 3 themes: (a) transfer of care and access to local services, (b) workforce and workload and (c) travelling impacts the service our patients can receive. An integrative theme across both groups highlighted the perceived disparity in health care access that existed for people with head and neck cancer in rural areas. How to cite this article: Foley J, Nund RL, Ward EC, et al. Clinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery.

Background: People with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post-discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas. Methods: Health care appointments and services accessed by people with HNC were collated for 6-month post-treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery.Results: The 6-month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs.

ObjectiveCollaborative practice is critical to optimising patient outcomes in contemporary healthcare settings. Evidence suggests interprofessional learning is an effective way to develop teamwork capabilities, yet these skills are traditionally developed in professional silos, or not at all. This study evaluated the implementation of a team development program, the Team Management Systems (TMS) program, for allied health staff within a large metropolitan health service. MethodsA mixed-methods audit–quality improvement study was conducted, using Kirkpatrick’s four-level evaluation model to structure evaluation of the program. Semistructured questionnaire and workforce survey data were retrieved immediately, 6 months and 1–2 years after training and applied to each level of the model (Reaction, Learning, Behaviour, Results). ResultsIn all, 886 staff participated in the TMS program from 2014 to 2018. High satisfaction with the program was observed. Knowledge of what constitutes effective teamwork improved significantly (P=0.008) in TMS participants compared with a matched untrained cohort. Participants reported positive behaviour change and continued engagement with TMS principles 6 months after training. Perceived impact of the program on patient and/or organisational outcomes was evident, although less compelling than the changes to knowledge and behaviour. ConclusionsThe TMS program yielded positive effects on staff satisfaction, knowledge, team dynamics and team behaviours. These findings demonstrate the significant value of such initiatives to enhance the capability and effectiveness of interdisciplinary healthcare teams. What is known about the topic?Complex conditions, increasing comorbidities, specialisation and scarcity of resources mean healthcare workers need to work effectively in teams to achieve quality, safe, person centred patient care. There is some evidence of the effect of teamwork initiatives on knowledge or behaviour in specific clinical specialities, single services or single professions, but limited research is available regarding the effects of teamwork programs across multiple professions, including allied health professions, and on patient and organisational outcomes. What does this paper add?This paper describes the effect of a large-scale teamwork program implemented across multiple professions, including enablers and barriers. It presents outcomes at all four levels of Kirkpatrick’s evaluation model, including the less studied behaviour and results levels. What are the implications for practitioners?This paper supports health service leaders to consider developing and implementing interprofessional teamwork programs to foster essential teamwork capabilities. Learning together about teamwork, across professional silos, will lead to collaborative, patient-centred care, which leads to safe, quality patient outcomes.

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