Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

Julie Cowie, Sally Boa, Emma King, Mary Wells, David Cairns

Research output: Contribution to journalArticle

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Abstract

Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work.

Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer.

Methods: The study was conducted using a recognised mobile health (mHealth) development and evaluation framework and involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data.

Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use.

Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises.
Original languageEnglish
JournalJournal of Medical Internet Research - Formative Research
Volume2
Issue number2
DOIs
Publication statusPublished - 17 Aug 2018

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Feasibility Studies
Deglutition
Head and Neck Neoplasms
Focus Groups
Exercise
Radiotherapy
Interviews
Patient Care
Health
Group Processes
Telemedicine
Caregivers
Consensus
Quality of Life
Delivery of Health Care

Keywords

  • head and neck cancer; ehealth; self-management

Cite this

Cowie, Julie ; Boa, Sally ; King, Emma ; Wells, Mary ; Cairns, David. / Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study. In: Journal of Medical Internet Research - Formative Research. 2018 ; Vol. 2, No. 2.
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abstract = "Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemo-radiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work.Objective: To develop and conduct preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for head and neck cancer. Methods: The study was conducted using a recognised mobile health (mHealth) development and evaluation framework and involved health professionals and patients who were undergoing CRT for head and neck cancer. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as a means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SIP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype which was then evaluated using a series of steering group meetings, semi-structured interviews with both patients and health care professionals, and analysis of e-SiP log data.Results: Feedback from focus groups and health professional interviews was very positive and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the ten patients offered e-SIP, only two opted to use it. For these patients, aspects of the e-SIP application were considered useful, in particular the ease of keeping a diary of exercises performed. Interviews with users and non-users suggested significant barriers to its use. Most significantly the lack of flexibility of platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: Results suggest a need for further research to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care, and through patient training and staff engagement, can be seen as a beneficial tool to help support patients in conducting swallowing exercises.",
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Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study. / Cowie, Julie; Boa, Sally; King, Emma; Wells, Mary; Cairns, David.

In: Journal of Medical Internet Research - Formative Research, Vol. 2, No. 2, 17.08.2018.

Research output: Contribution to journalArticle

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T1 - Electronic swallowing intervention package to support swallowing function in patients with head and neck cancer: development and feasibility study

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N1 - Acceptance in SAN Published version title different from AAM; updated title to match the VoR. ET 23/1/19

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