Patient Experience of Head and Neck Surgery With Free Flap Reconstruction.

Autor:	Dattilo LW; Harvard Medical School, Boston, Massachusetts.; Department of Otolaryngology, Massachusetts Eye & Ear, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Russell TI; Harvard Medical School, Boston, Massachusetts., Warinner CB; Harvard Medical School, Boston, Massachusetts.; Department of Otolaryngology, Massachusetts Eye & Ear, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Starmer H; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California., Annino DJ Jr; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Goguen LA; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Sethi RKV; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Uppaluri R; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Windon MJ; Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington., Bergmark RW; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Rettig EM; Harvard Medical School, Boston, Massachusetts.; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.; Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2024 Apr 01; Vol. 150 (4), pp. 311-317.
DOI:	10.1001/jamaoto.2023.4750
Abstrakt:	Importance: Major head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients' experiences, including decision-making prior to, and regret following, free flap surgery. Objective: To characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery. Design, Setting, and Participants: This mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to 4 years). Interview transcripts were qualitatively analyzed for themes. Participants also completed a Decision Regret Scale questionnaire. Exposure: Microvascular free flap surgery for head and neck reconstruction. Main Outcomes and Measures: Thematic analysis of interviews, decision regret score. Results: Seventeen participants were interviewed. Median (IQR) age was 61 (52-70) years. Overall, 7 participants were women (49%), and 10 of 17 were men (59%). The most common free flap was fibula (8/17, 47%). Three major themes with 9 subthemes were identified: theme 1 was the tremendous effect of preoperative counseling on surgical decision-making and satisfaction, with subthemes including (1) importance of clinical care team counseling on decision to have surgery; (2) emotional context colors preoperative understanding and retention of information; (3) expectation-setting affects satisfaction with preoperative counseling; and (4) desire for diversified delivery of preoperative information. Theme 2 was coexisting and often conflicting priorities, including (1) desire to survive above all else, and (2) desire for quality of life. Theme 3 was perception of surgery as momentous and distressing, including (1) surgery as a traumatic event; (2) centrality of mental health, emotional resolve, and gratitude to enduring surgery and recovery; and (3) sense of accomplishment in recovery. On the Decision Regret Scale, most participants had no regret (n = 8, 47%) or mild regret (n = 5, 29%); 4 had moderate-to-severe regret (24%). Conclusions and Relevance: In this mixed-methods cohort study, patient experiences surrounding major head and neck reconstructive free flap surgery were described. Opportunities to improve support for this complex and vulnerable population, and to mitigate decision regret, were identified.
Databáze:	MEDLINE
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