INTRODUCTION: People with advanced head and neck cancer face extensive and radical treatment with numerous negative functional, social and psychological consequences. Findings that focus on identifying positive outcomes and barriers to recovery from a lived experience perspective, have the potential to assist people in their earlier recovery process.

AIM: To explore the ‘lived’ patient experience of head and neck cancer surgery from admission to discharge home

METHOD: Using a prospective mixed-methods study design, we explored the patient experience of treatment and recovery in the acute recovery period. Adults planned for major head and neck cancer surgery at St. Vincent’s Hospital Melbourne, including a free flap reconstruction and tracheostomy, from July 2022 were invited to participate in the study. Participants completed the FACE-Q Head and Neck Cancer survey at days 10 and 21 post surgery. The survey included domains such as speaking, swallowing and appearance distress. Participants also completed a semi-structured interview at 2-weeks post discharge from hospital. Interview questions focused on preparedness for surgery and the recovery process.

RESULTS: Preliminary results from the study will be discussed. These include descriptive statistics analysis of demographic information and the FACE-Q surveys and inductive thematic analysis of the semi-structured interviews, following the six phases described by Braun and Clarke, 2006.

CONCLUSION: The findings from this study provide an understanding of the positive and negative aspects of each participants’ head and neck cancer journey. This information informs changes to the acute multidisciplinary team care approaches to support recovery and adjustment post surgery.

Introduction: Recently a range of “new generation” HME devices were designed to provide better humidification and less breathing resistance. The new range includes different HMEs specialized for different situational use during the day and night.

Aim: This study examined changes in post-laryngectomy pulmonary health following establishing an optimal Day/Night regimen using the new generation range of HME devices. Impacts to skin integrity, sleep, shortness of breath, quality of life and patient satisfaction were also examined.

Methods: The study involved a two-phase, prospective clinical trial. In Phase 1 (6 weeks) patients transitioned from their existing HME system to the new generation HMEs on a ‘like-for-like’ basis. In Phase 2 (6 weeks) an optimal Day/Night regimen was implemented with the full range of new generation HMEs and attachments. Pulmonary function, skin integrity, sleep, shortness of breath, quality of life and patient satisfaction was monitored at baseline, weeks 2 and 6 of Phase 1, and at weeks 2 and 6 of Phase 2.

Results: Forty-two post-laryngectomy HME users participated. By end of Phase 2, cough symptoms, cough impact, sputum symptoms, sputum impact, involuntary coughs, shortness of breath (walking) and total sleep score had significantly improved. By end of Phase 2 all had adopted using multiple HMEs in a day/night routine. The majority (95%) indicated they would continue using the device range in the future.

Conclusion: Results support positive pulmonary benefits following use of the new generation devices, with further pulmonary optimization achieved when adopting an optimal day/night regime using multiple HMEs.

Keywords: laryngectomy, HME, pulmonary, health, adherence, satisfaction

Submission Statement: Laryngectomy patients experience challenges wearing their HME all day/night. The current data confirms that the new generation HMEs improve HME use with corresponding pulmonary benefits. Using these findings, clinicians can respond and transition their patients to new generation HMEs to improve HME use and pulmonary health.

Introduction/rationale High-Flow-Nasal-Prongs (HFNP) are prescribed to deliver oxygen-therapy in patients requiring pulmonary support in the hospital environment. There is a paucity of evidence describing the impact of HFNP on swallowing. In 2017, a survey of Australian Speech Pathologists (SP) demonstrated variance in timing of swallowing assessment and consideration to FiO2 and flow rates, when managing patients with HFNP. Patient safety was reported as the primary concern driving clinical practice. To date, there is no literature describing the patient perspective.

Aim(s) To: (1) describe the patient perspective of swallowing function with HFNP, and (2) describe the relationship between patient-reported swallowing function with HFNP and SP swallowing assessment outcomes.

Methods 20 patients receiving oxygen-therapy via HFNP were recruited across 5 NSW tertiary teaching hospitals. Patient demographic data, HFNP FiO2 and flow rate parameters, and clinical swallowing outcomes (Functional-Oral-Intake-Scale, AusTOMs) were collected. Participants completed the Sydney Swallow Questionnaire and High-Flow Nasal Oxygen and Swallowing Questionnaire while HFNP was in situ. A subset underwent Flexible Endoscopic Evaluation of Swallowing, scored using validated outcome measures (Penetration-Aspiration-Scale, Yale-Pharyngeal-Residue-Severity-Rating-Scale, New-Zealand-Secretion-Scale, Dysphagia-Severity-Rating-Scale) to describe physiologic characteristics and severity of dysphagia.

Results Preliminary results indicate patients report a change in swallowing function during application of HFNP. Variability in the relationship between patient reports of swallowing ability and SP outcomes on clinical and instrumental assessment exists.

Conclusions: This study contributes new clinical knowledge by providing an understanding of the patients’ perspective of swallowing whilst receiving HFNP. Associations between patient reports and clinical and instrumental swallow assessment outcomes are described.

Keywords: High-Flow-Nasal-Prongs, swallowing, patient perspective, oxygen-therapy.

Submission statement: Reflecting on variability in SP practice when managing patients receiving oxygen via HFNP, and respecting the value of the patient experience, we have responded by representing the patient perspective of eating and drinking with HFNP in situ and comparing this with clinician rated measures to inform future clinical practice.

Background:
The inability of ventilated patients to communicate effectively has been shown to have a significant impact on their mental health. In addition, ineffective communication has been shown to negatively impact on overall health outcomes. Ventilator Associated Speech (VAS) methods have the potential to restore speech in ventilated, tracheostomised patients. Despite this, their routine use in Intensive Care Units (ICUs) within Australia is prevented due to reports that there is poor acceptability amongst healthcare professionals. This is despite the absence of any evidence to support this theory.

Aim(s):
To explore the perceptions of healthcare professionals working in a metropolitan hospital ICU with regards to: (i) The comparative and overall acceptability of three different VAS methods, and (ii) perceived barriers to and enablers of the use of three different VAS methods in the ICU setting.

Method:
Outcomes will be collected via use of an online questionnaire and semi-structured interviews. Relevant statistics and framework analysis will be used to interpret the questionnaire and interview data (respectively).

Result(s):
Results will be discussed with reference to the project aims.

Conclusion:
It is hoped that explicit consideration of the comparative acceptability of three different VAS methods will assist Speech Pathologists working in Critical Care settings to make choices regarding the use of individual VAS methods, and the manner in which they are used so as to facilitate their acceptability within the broader Critical Care team.

Keywords - Ventilation, Tracheostomy, Communication, Speech, Acceptability

Submission Statement:
It is hoped that the outcomes of this study will facilitate the routine introduction of VAS methods that will respect the contribution that critically ill patients can make to their medical management plans; and respond to their need to have access to effective communication options.

Introduction/rationale: For a Speech Pathologist to competently manage a tracheostomised patient, further skill and knowledge development is required beyond graduation. Learning Pathways are a developmental approach to building performance through clinical supervision, support and self-reflection, and incorporate learning as a continuous process. With an increase in tracheostomy presentations in the setting of COVID-19, a new method to support learning, and an efficient training model was required in the Eastern Health (EH) Speech Pathology (SP) department.

Aim(s): To develop and maintain learning in the management of tracheostomised patients and instigate a training solution to meet the demand on Speech Pathology services.

Methods: Benchmarking with other health services and agencies about how they foster learning and performance was conducted. The EH SP Tracheostomy Learning Pathway and its associated guidance was produced and Speech Pathologists were identified to commence the pathway and participate in training. An expert facilitator was employed to embed the Learning Pathway and undertake individual and group training sessions. The Learning Pathway and training model was evaluated through satisfaction survey.

Results: All (4/4) participants had varying levels of skills and knowledge in tracheostomy management. They found the new Tracheostomy Learning Pathway and training solution to be beneficial to their learning, allowing them to consolidate, reflect and regain confidence.

Conclusions: The development and implementation of a Tracheostomy Learning Pathway and training model at a time of increased tracheostomy presentations, allowed for efficient, collaborative and reflective learning while meeting the demands on the EH SP service.

Keywords: Learning, performance, tracheostomy, training, skill development, knowledge development.

Submission statement: The COVID-19 pandemic caused us to reflect on how Speech Pathologists operate in the acute environment. With an increase in patients being tracheostomised across our health service, we had to respond through instigation of a new Learning Pathway and employment of an efficient training model.

Introduction/Rationale: Critically ill patients with an artificial airway have difficulty communicating. There is no internationally agreed upon definition of effective communication nor consensus on the key elements that determine the effectiveness of communication for this patient population. Overall, the outcome measurement tools that have been used to assess communication outcomes in the ICU do not have robust clinimetric properties.

Aim(s): 1) To define effective communication and it’s key elements 2) Develop and pilot an outcome measurement tool underpinned by the consensus-outputs.

Methods: An international multi-professional panel of experts was convened, and a modified Consensus Development Panel methodology applied. Two consumers with recent lived experience were invited to review the consensus outputs. An outcome measurement tool was developed and piloted at The Austin Hospital.

Results: Seven out of eight (87.5%) participants voted in agreement of the definition and list of key elements of effective communication, respectively. The panel agreed that communication occurs on a continuum from ineffective to effective for basic and complex communication. Descriptors of what constitutes basic versus complex communication were developed. One consumer with recent lived experience provided feedback on the CDP outputs. The tool was piloted with fifteen patients, finding feasibility and identification of need to revise several rating items.

Conclusions: The consensus agreed definition and list of key elements with constitute effective communication for critically ill patients with an artificial airway can be used as the basis of standard terminology to support future research in this population. The tool will require a larger external validation study.

Keywords: Critical illness, artificial airway, communication, consensus, outcome measurement tool

Submission statement: Delegates will reflect on the unique communication challenges for critically ill patients with an artificial airway, and respond to the current gap in standard terminology and both clinician and patient-reported outcome measures in this setting.

Introduction: In the years following radiotherapy for head and neck cancer (HNC), patients can experience further slow, progressive decline of swallowing function. Currently there are challenges detecting this late-stage decline, leading to delays referring patients to speech pathology (SP) services.

Aim: To examine the feasibility of implementing a SP led Flexible Endoscopic Evaluation of Swallow (FEES) screening protocol to identify late-onset dysphagia as part of annual medical oncological surveillance visits for patients ≥2 years post HNC treatment.

Methods: SPs screened all HNC patients ≥2 years post-radiation therapy attending routine oncological surveillance appointments. The SP attended the oncology appointment and conducted the FEES once the radiation oncologist completed their nasendoscopic assessment. FEES was analysed using the DIGEST-FEES, NZSS, and Revised Patterson Edema Scale. Patients and clinical staff completed post-session surveys.

Results: There were 71 eligible patients and FEES was completed with 70% (21 not assessed due to non-consent, missed appointments, difficulty scoping). Eighty-six percent (n=43) were identified with dysphagia: with 44% exhibiting mild dysphagia, 36% moderate and 6% severe dysphagia. Internal lymphoedema was identified in 90%. Radiation oncologists indicated the addition of the FEES assessment had minimal impact on clinical time. Patients found the process worthwhile and would value FEES as part of their annual review. SPs reported gaining valuable information impacting clinical management.

Conclusion: Speech pathology led FEES, conducted as part of annual oncological review appointments, was found to be an efficient and effective approach to assist identification of late-onset dysphagia in the HNC population, facilitating timely SP support.

Keywords: cancer, dysphagia, late-effects, screening, FEES, feasibility

Submission Statement: Reflecting on the current clinical challenge identifying late dysphagia occurring post HNC treatment, we designed and evaluated the feasibility of a late-dysphagia screening service. The data confirms this model is feasible and can help SP services identify and provide timely response for patients with late-onset dysphagia.

Introduction: Dysphagia is a common sequel following an oesophagectomy. Clinical anecdotal evidence suggests significant, and often long term swallow compromise may result following the invasive removal of the oesophagus and surgical reconstruction of the swallowing tract. There is currently limited literature to support causal understanding or preventative measures to manage dysphagia post oesophagectomy.
Aim: To evaluate the impact of a speech pathology pathway on swallowing and health outcomes following a 3-stage oesophagectomy.
Methods: A before and after study was conducted at a single tertiary public hospital in Sydney. Files were retrospectively audited (n=41) who met the inclusion criteria and had undergone an oesophagectomy between 2014-2021. The sample was divided into two groups, those who received usual care (2014-2019) and those who received perioperative speech pathology intervention with data collected across five key outcomes. The primary outcome was the between group difference in incidence of aspiration on the post-operative leak test.
Results: There was no statistically significant difference found between groups in rates of aspiration on the post operative leak test. Participants who received pre-operative speech pathology intervention commenced oral intake in a shorter timeframe post operatively (pre-pathway group mean 10.45 days compared to the post pathway group mean 6.56 days). No statistically significant differences were found between the two groups in length of hospital length of stay or number of medical images required.
Conclusions: Perioperative speech pathology intervention appears promising in addressing dysphagia management in this complex patient population.

Keywords - speech pathology, oesophagectomy, 3-stage, dysphagia, swallowing, cancer
Submission Statement: Specialists in the diagnosis and evaluation of dysphagia and rehabilitation of swallowing disorders, SP's have traditionally played a limited role in surgical caseloads. This study aims to demonstrate evidence in practice to bridge the gap in this often lacking involvement in dysphagia management pre and post oesophagectomy.

Introduction
The Grampians Health Ballarat campus speech pathology voice, swallow, airways (VSA) clinic provides rapid assessment and diagnosis for individuals presenting with voice, swallowing, and airways-related issues. Multiple inefficiencies in managing referrals, administration time, and access existed. These included wait times averaging 145 days for dysphagia clinic and 151 days for voice clinic. Furthermore, work practices were inconsistent, poorly documented, and failed to align with the Victorian specialist outpatient clinic (SOC) guidelines.

Aim
To reduce the time from receipt of referral to time of initial assessment for patients referred to speech pathology adult specialist outpatient clinics by reducing the time taken for clinicians to manage referral and ensure a more consistent, streamlined process within the next four months.

Methods
Key stakeholders were engaged in collecting baseline data, including process mapping, waitlist data review, administration time audits, and patient journeys. Several solutions were co-designed with the team. These solutions were then tested and iterated using a series of Plan, Do, Study, Act (PDSA) cycles.

Results
Key outcomes included reduced waste (Time – 8.5hr reduction in administration/fortnight), reduced clinical risk, increased access (average wait time 18 days for dysphagia and 0 days for voice), increased clinician consistency, and improved job satisfaction.

Conclusions
This work has taken a PDSA approach to improve access for patients to the speech pathology VSA clinic. In achieving alignment with the key performance indicators of the Victorian SOC access policy, it has further paved the way for ongoing iteration and quality initiative offshoots. These include the opportunity to engage patients in co-designing clinic resources and models of care such as telehealth.

Background: Dysphagia is a consequence of advanced tongue cancer (ATC). Surgical resection via mandibular lingual release approach (MLRA) may present a risk for complex and severe dysphagia. Rehabilitation studies show positive findings for EMST and sEMG, however evidence in ATC remains limited.

Aim: Examine the feasibility and effectiveness of exercise-based swallow rehabilitation for severe dysphagia post-treatment involving MLRA for ATC.

Methods: Case study design. A 47-year-old male commenced therapy 4-weeks post-treatment (MLRA, flap, and chemoradiotherapy) for ATC. The exercise-based program involved combined swallow (using sEMG) and pulmonary (EMST) exercises, performed 5-days a week. Sessions were speech pathology led for 2-weeks, then weekly telehealth with independent home practice. Treatment efficiency was monitored for 6-months. Endpoints included functional swallowing via clinical swallow examination (FOIS, MDADI), physiological functioning via videofluoroscopy (DIGEST, PAS, BRS, MBSImp), nutritional data (BMI, SGA, enteral feeding), respiratory function (PEF, MEP), and feasibility (sessions offered/attended, number exercises completed).

Results: Interim results at 12 weeks show improved tongue function, reduced trismus (30mm=moderate to 37mm=mild), markedly improved functional swallow (severe: FOIS=3 to mild: FOIS=5), and patient-perceived impairment improved (MDADI=36.84 to 49.47). Swallow severity on VFSS also improved (severe: DIGEST=3 to moderate: DIGEST=2). BMI returned to the healthy range (17.9=underweight to 19.1=healthy) and the patient progressed from non-oral to 100% oral nutrition. Respiratory function improved (70% predicted PEF [age-height norm] to 82%). Feasibility was excellent (95% SLP session, 100% home, 100% exercises). All were maintained at six months.

Conclusions: Successful rehabilitation of severe dysphagia in ATC can be achieved through exercise-based therapy.

Keywords:
Dysphagia, tongue cancer, rehabilitation

Submission Statement:
Dysphagia rehabilitation in the setting of advanced tongue cancer is challenging, requiring an individualised response to target physiological deficits and patient goals. This research reflects on a combined swallow and pulmonary program and provides evidence of the effectiveness of this approach in a clinical outpatient setting.