Govender, Roganie; (2018) Development and feasibility testing of a pre-treatment swallowing intervention package for patients with head and neck cancer. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Dysphagia is a highly prevalent and significant problem affecting function and quality of life in patients treated for cancers of the mouth or throat. Based on available evidence, pre-treatment swallowing exercise interventions show promise in improving post-treatment swallowing outcomes for patients. Poor patient adherence undermines clinical trials of swallowing exercises. However, this behavioural issue has not been fully acknowledged in the design of previous interventions. This research aimed to devise an optimized pre-treatment swallowing intervention package, which was subsequently tested in a feasibility trial. A series of five sequential studies was undertaken to inform the development and feasibility of the new intervention. State-of-the-art behaviour change methods were employed to determine best strategies to improve patient adherence. Study 1, a systematic review, was conducted to identify the behavioural strategies used in swallowing exercise interventions and their association, if any, with intervention efficacy. In addition to core strategies used in most swallowing interventions, self-monitoring, social support, behavioural practice and delivery by a credible source were more prevalent in effective interventions. Study 2, a patient interview study, highlighted the key barriers and facilitators to patient adherence. Psychological capability was the greatest barrier, evidenced by patient reports of not fully understanding reasons for the exercises, forgetting, and not having a system to keep track. Social support, having a routine or trigger for exercises, and the desire to avoid tube feeds were key facilitators. Study 3, a think-aloud study, indicated that a swallowing video-animation was useful and acceptable to patients in improving understanding about swallowing, thus potentially beneficial for the new intervention. In Study 4, findings and insights from these studies were synthesized and combined with other essential components such as a swallowing assessment, to model the pre-treatment swallowing intervention package. Feedback from patients and clinicians informed the final content of the new intervention prior to its use in the feasibility randomized trial (Study 5). Key success criteria for feasibility were achieved. It is anticipated that the new intervention will proceed to testing in a small multi-centre pilot study.

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