Effect of Augmentative Technology on Communication and Quality of Life After Tracheostomy or Total Laryngectomy

Abstract

Objective Surgical procedures that render patients acutely aphonic can cause them to experience significant anxiety and distress. We queried patient perceptions after tracheostomy or laryngectomy and investigated whether introducing augmentative technology was associated with improvement in patient-reported outcomes. Methods Participants included hospitalized patients who acutely lost the ability to speak due to tracheostomy or total laryngectomy from April 2018 to December 2019. We distributed questions regarding the patient communication experience and relevant questions from the validated V-RQOL questionnaire (Voice-Related Quality of Life). Patients were offered a tablet with the electronic communication application Verbally. Pre- and postintervention groups were compared with chi-square analyses. Results Surveys were completed by 35 patients (n = 18, preintervention; n = 17, postintervention). Prior to using augmentative technology, 89% of patients who were aphonic reported difficulty communicating, specifically noting breathing or suctioning (56%), treatment and discharge plans (78%), or immediate needs, such as pain and using the bathroom (39%). Communication difficulties caused anxiety (55%), depression (44%), or frustration (62%), and 92% of patients were interested in using an electronic communication device. Patients reported less trouble communicating after the intervention versus before (53% vs 89%, P = .03), including less difficulty communicating about treatment or discharge plans (35% vs 78%, P < .01). V-RQOL scores were unchanged. Discussion Acute loss of phonation arising from surgery can be highly distressing for patients, and use of augmentative technology may alleviate some of these challenges by improving communication. Further studies are needed to identify what additional strategies may improve overall well-being. Implications for Practice Electronic communication devices may benefit patients with acute aphonia.

Improving airway management and tracheostomy care through interprofessional collaboration: aligning timing, technique, and teamwork

“…Interprofessional teamwork also has an essential role in humanizing care. Doing so involves engaging patients, families, and caregivers to promote successful recovery (4) care can be fostered by using eye contact, augmentative and alternative communication systems, and therapeutic touch (34,35). Patients with tracheostomy are susceptible to feelings of isolation and stigma; therefore, welcoming family members to engage in tracheostomy hygiene, tube feeding, swallowing, or other aspects of rehabilitation can promote recovery.…”

“…A cohesive team provides not only technically sound care but also makes effective use of interprofessional communication systems to avoid inconsistent messages or fragmented care. Engaging patients as partners in care can be fostered by using eye contact, augmentative and alternative communication systems, and therapeutic touch ( 34 , 35 ). Patients with tracheostomy are susceptible to feelings of isolation and stigma; therefore, welcoming family members to engage in tracheostomy hygiene, tube feeding, swallowing, or other aspects of rehabilitation can promote recovery.…”

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection

“…Few populations are more susceptible to harm than individuals with a tracheostomy, whose risk of severe course of illness and complications during the pandemic has been magnified by impaired communication, limited access to care, and comorbidities [9] , [11] , [12] , [13] , [14] , [15] , [16] . Tracheostomy is most often construed as a procedure, a medical device, or an artificial airway with a defined function [17] . However, the framing for a patient or family is very different, often construed as part of identity, communication, and survival [18] .…”