Factors influencing clinical consistency and variability in voice prosthesis management

Abstract

Purpose: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability.

Method: A national survey was completed by SLP’s from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site.

Result: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice.

Conclusion: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.

Keywords:

• voice prosthesis
• tracheoesophageal speech
• speech language pathologist
• clinical practices
• service variability
• laryngectomy

Acknowledgements

We wish to acknowledge and thank all of the study participants. We also wish to thank Professor Anne Hill, from The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia, for her assistance as PhD supervisor for Kelli Hancock.

Supplementary material

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17549507.2017.1353133