Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Theurer, Julie A., Doyle, Philip. C.

Abstract

Introduction: Potential reductions in perceived quality of life (QoL) are associated with the diagnosis of head and neck cancer (HNCa) and the consequences of its treatment. HNCa survivorship care is intended to address the challenges experienced in biopsychosocial domains of functioning that influence perceived QoL. However, owing to the conventionally medicalized provision of HNCa survivorship care, comprehensive consideration of QoL may be excluded and ultimately restricted to the provision of palliative care. If principles of palliative care are included throughout HNCa survivorship care they may serve to bolster the focus on QoL. The purpose of this study centred on the identification and description of laryngectomees’ and physicians’ perceptions of the inclusion of principles of palliative care that may support QoL in HNCa survivorship care.

Methods: A web-based questionnaire was developed to collect data pertaining to laryngectomees’ and physicians’ perceptions of principles of palliative care in the context of HNCa survivorship care both under ideal circumstances and in actual practice. Descriptive and inferential statistics were used to summarize and analyze the laryngectomees’ and physicians’ responses. Correlational analyses also were completed to identify relationships among participants’ perceptions.

Results: Data indicated that the laryngectomees and physicians believed that the principles of palliative care should be regularly included in HNCa survivorship care. However, the laryngectomees’ and physicians’ responses suggested that the inclusion of these principles in HNCa survivorship care in actual practice is more limited and quite variable in nature. As such, significant differences were identified between the participants’ perceptions within the context of ideal circumstances and actual practice.

Conclusions: The findings of the present study provide insights into laryngectomees’ and physicians’ perspectives of the principles of palliative care in the context of HNCa survivorship care. A commonality among these foundational principles is their role in enhancing QoL. Thus, the findings of the present study provide information that may promote the inclusion of aspects of care that bolster the focus on QoL in HNCa survivorship care.

Summary for Lay Audience

Individuals who are diagnosed with head and neck cancer (HNCa) are likely to experience substantial reductions in their quality of life (QoL) even after the completion of their cancer treatment. However, the care provided to these individuals tends to be aimed at treating the disease itself and is commonly limited in its capacity to fully address QoL issues. Care that is targeted to fully address QoL issues is commonly provided only in the end-of-life context when the medical subspeciality of palliative care often becomes involved. To increase the focus on the QoL of individuals who have completed treatment for HNCa, the principles of palliative care may be included in the care that is delivered outside of the end-of-life context. This study sought to gather information on the perceptions of individuals who have completed treatment for HNCa, specifically those who have undergone total laryngectomy (i.e., removal of the voice box), and the physicians who provide care for HNCa survivors. These individuals were asked about their opinions regarding whether certain principles of palliative care that support QoL should be present in the posttreatment care received by HNCa survivors under ideal circumstances, and whether these principles are actually present in HNCa survivors’ posttreatment care.

The information gathered indicated that HNCa survivors and physicians believed that the principles of palliative care should be regularly included in HNCa survivors’ posttreatment care. However, the HNCa survivors and physicians also believed that in actual practice the inclusion of these principles in HNCa survivors’ posttreatment care is more limited and variable. A commonality among these principles of palliative care is their role in supporting and enhancing QoL. Therefore, this information may inform how the focus on HNCa survivors’ QoL could be increased in the care they receive after treatment completion.

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