Discussion:
Voice rehabilitation after TL is an important postoperative issue for
the patient quality of life [4,5]. In practice, the VP change is a
simple procedure that is usually performed by residents or
board-certified physicians. In this study, we reported adequate SLP and
patient-reported outcome perception about the SLP-related VP change. The
delegation of some clinical tasks from the otolaryngologist-head and
neck surgeon to the SLP is a current topical issue that may be
associated with many advantages.
First, it is commonly accepted that the development of post-TL
tracheoesophageal speech involves important speech rehabilitation work
and adequate follow-up for the management of VP leakage, which may be
time-consuming for the physician [4]. Currently, the number and the
availability of otolaryngologists in rural areas may be limited in some
European regions regarding some government hospital reforms that led to
significant reduction of medical centers and physicians [6,7]. In
our country, the shortage of otolaryngologists in rural regions may lead
to patient proposition of post-TL esophageal speech rather than
tracheoesophageal speech to limit the need of post-TL care [8]. In
that way, the availability of SLPs in the management of VP changes may,
therefore, be an advantage for the patient accessibility to health care
and follow-up.
Second, in some world regions, SLPs already perform routine
videolaryngostroboscopy, which was associated with enhancement of the
SLP role in the decision-making process in voice restoration [9].
According to the voice rehabilitation process, SLPs well-know their
patients, and a trusting relationship may develop throughout the
rehabilitation sessions. In the present study, more than 90% of
patients reported high rate of satisfaction outcomes about the SLP-VP
change procedure, which may be explained by the trusting relationship
between SLP and patient and the feasibility of the procedure.
The delegation of VP changes to SLP makes particularly sense in our
country because SLPs may prescribe respiratory or phonatory
rehabilitation equipment for TL patients for the last 4 years (March 30,
2017 law). Interestingly, a recent Italian study reported that
physicians were not opposed to the delegation of this task to other
health professionals, which strengthens the need of debate about this
task delegation issue [10].
The primary limitations of the present study were the low number of
procedures performed by the SLP (42 procedures) and the low number of
patients, which limited the realization of statistical analysis. The
lack of use of validated patient-reported outcome questionnaire
assessing the VP change procedure is an additional limitation. To the
best of our knowledge, there is no similar study available in the
literature, which is the main strength of this preliminary study.
Conclusion: The VP change is a feasible procedure for SLP
associated with few complications, rare need of physician intervention
and adequate patient-reported outcome perception. Future controlled
studies are needed to compare VP change outcomes between physicians and
SLPs and to evaluate its cost-effectiveness.
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