Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Communication of Voice-Related Complications in Thyroidectomy: A Qualitative Analysis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kao Derek D, Jensen Catherine B, Bacon Elizabeth, Hogikyan Norman D, Roman Benjamin R, Pitt Susan C
Аннотация
OBJECTIVE: This study aims to characterize patient-surgeon discussions of voice-related complications during thyroidectomy for low-risk thyroid cancer.
STUDY DESIGN: A qualitative study.
SETTING: Three academic medical centers.
METHODS: Pre-operative clinic visits between 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 49 patients with low-risk (cT1-2, N0) thyroid cancer were audio-recorded and transcribed. Qualitative analysis was used to evaluate surgeon counseling strategies and patient concerns related to voice.
RESULTS: Patients aged from 20 to 77 years old were predominantly female (77.6%) and white (89.9%). Surgeons presented risk with negative framing and numerical percentages (1%-4%) and/or qualified the risk as "low" or "small" for a lobectomy, but a "much bigger deal" for bilateral nerve injury in total thyroidectomy. At a minimum, surgeons referred to voice dysfunction as "voice change." Some further described "hoarseness" or the "inability to project voice." Other surgeons imitated what voice dysfunction would sound like. A few surgeons probed the importance of voice to a patient's life. One surgeon imparted that having a voice-related complication "can be really emotional." Patients responded with varying degrees of concern about voice changes after surgery, from feeling "super concerned … about losing [their] voice" to feeling "ok" with it "as long as [they're] around to deal with it."
CONCLUSION: Significant variability exists in how surgeons describe and set expectations about voice-related complications. The degree to which patients value voice-related outcomes differed based on their occupation and hobbies, but this was tempered by their cancer diagnosis. Further research is needed to identify optimal disclosure of voice-related risks and expectations.
STUDY DESIGN: A qualitative study.
SETTING: Three academic medical centers.
METHODS: Pre-operative clinic visits between 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 49 patients with low-risk (cT1-2, N0) thyroid cancer were audio-recorded and transcribed. Qualitative analysis was used to evaluate surgeon counseling strategies and patient concerns related to voice.
RESULTS: Patients aged from 20 to 77 years old were predominantly female (77.6%) and white (89.9%). Surgeons presented risk with negative framing and numerical percentages (1%-4%) and/or qualified the risk as "low" or "small" for a lobectomy, but a "much bigger deal" for bilateral nerve injury in total thyroidectomy. At a minimum, surgeons referred to voice dysfunction as "voice change." Some further described "hoarseness" or the "inability to project voice." Other surgeons imitated what voice dysfunction would sound like. A few surgeons probed the importance of voice to a patient's life. One surgeon imparted that having a voice-related complication "can be really emotional." Patients responded with varying degrees of concern about voice changes after surgery, from feeling "super concerned … about losing [their] voice" to feeling "ok" with it "as long as [they're] around to deal with it."
CONCLUSION: Significant variability exists in how surgeons describe and set expectations about voice-related complications. The degree to which patients value voice-related outcomes differed based on their occupation and hobbies, but this was tempered by their cancer diagnosis. Further research is needed to identify optimal disclosure of voice-related risks and expectations.