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A questionnaire was sent to 380 members of the Laryngectomy Association of Queensland and their spouses to examine the nature of the information given and professionals involved in pre-and post-operative counselling and information dissemination. From a total of137 responses, the questionnaires of 41 spouses/carers and 77 patients who underwent surgical removal of the larynx in public hospitals between 1990 and 2000 were analysed. The results indicated that over80(~of surgical patients reported satisfllction with the nature and extent of information provided pre and post-operatively. Respondents indicated receiving information from a multidisciplinary team, encompassing £1 diversity of topics relating to the surgical procedure and subsequent consequences. Only 16(~of respondents felt they were not told enough information pre-operatively and 12(X)felt there were inadequate services prOVided post-operatively. Approximately 80% of spouses/carers reported satisfaction with pre-and post-operative counselling; however, only 57.5% of spouses/carers felt they were given enough information prior to surgery or received enough post-surgical support (55.3(~). More discussion of associated consequences following surgery and an increase in 'contact with certain professionals/support staff' were identified as areas for further improvement by a proportion of surgical respondents. The results of the present study highlight some aspects of information dissemination practices that can be filrther optimized for the population of patients undergoing laryngeal surgery. In particular, the need for increased support 'and .counselling for their~pouses/carers is indicated.

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Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.