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Exploring the Acceptability of Behavioral Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study of Patients’ Experience

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Abstract

The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy namely: reactive, proactive low- (“EAT-RT” only), and high-intensity (“EAT-RT + exercises”). Understanding the perceived acceptability of these interventions is important to inform eventual implementation into clinical practice. This study explored patients’ perspectives using qualitative methodology. At 2 Canadian PRO-ACTIVE trial sites, 24 trial participants were recruited for individual semi-structured interviews, representing each of the 3 trial arms. Data collection and thematic analysis were guided by the Theoretical Framework of Acceptability (TFA). Member checking was conducted through follow-up focus groups. Seven themes were derived reflecting the TFA constructs. Overall, regardless of trial arm, patients reported a positive experience with therapy. Patients identified benefits of EAT-RT therapy, reporting that it provided meaningful feedback on diet progress and supported goal setting for oral intake. Patients who received proactive therapies valued the opportunity to set expectations early, build mealtime routine iteratively over time, and have an extended engagement with the SLP. Regardless of trial arm, patients agreed proactive therapy aligned with what they think is best and that therapy intensity should accommodate individual needs. This study identified the value to HNC patients of receiving swallowing interventions during RT and setting realistic expectations around swallowing. Compared to reactive care, proactive therapies were perceived helpful in consolidating habits early, establishing realistic expectations around swallowing and building an extended rapport with the SLP. These findings will inform the implementation of proactive versus reactive swallowing therapies in clinical practice.

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Data Availability

The qualitative data generated during the current study are available from the corresponding author on reasonable request.

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Funding

Beatrice Manduchi is supported by her studentship from the Swallowing Lab, Department of Speech-Language Pathology (Rehabilitation Sciences Institute, University of Toronto), and by the 2022–2023 Peterborough K. M. Hunter Charitable Foundation Graduate Award. Rosemary Martino is supported by her Canada Research Chair (Tier II) in Swallowing Disorders. The remaining authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Beatrice Manduchi & Rosemary Martino

  2. Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada

    Beatrice Manduchi & Rosemary Martino

  3. The Swallowing Lab, University of Toronto, Toronto, ON, Canada

    Beatrice Manduchi & Rosemary Martino

  4. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Margaret I. Fitch

  5. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Jolie G. Ringash

  6. Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    Jolie G. Ringash & Rosemary Martino

  7. Princess Margaret Cancer Centre, Toronto, ON, Canada

    Doris Howell

  8. Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Doris Howell

  9. Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Katherine A. Hutcheson

  10. Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Katherine A. Hutcheson

  11. Krembil Research Institute, University Health Network, Toronto, ON, Canada

    Rosemary Martino

Authors
  1. Beatrice Manduchi
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  2. Margaret I. Fitch
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  3. Jolie G. Ringash
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  4. Doris Howell
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  5. Katherine A. Hutcheson
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  6. Rosemary Martino
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BM, MIF and RM. The first draft of the manuscript was written by BM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Beatrice Manduchi.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

The study received ethical approval from each of the 3 participating sites in Canada: the Ontario Cancer Research Ethics Board (CTO Project #1363) and CIUSSS West-Central Montreal REB (Project 2021-2503).

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Manduchi, B., Fitch, M.I., Ringash, J.G. et al. Exploring the Acceptability of Behavioral Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study of Patients’ Experience. Dysphagia (2023). https://doi.org/10.1007/s00455-023-10640-8

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