Factors Influencing Likelihood of Voice Therapy Attendance: Report from the CHEER Network

Abstract

Objective To identify factors associated with the likelihood of attending voice therapy among patients referred for it in the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure. Study Design Prospectively enrolled cross-sectional study. Setting CHEER network of community and academic sites. Methods Data were collected on patient-reported demographics, voice-related diagnoses, voice-related handicap (Voice Handicap Index–10), likelihood of attending voice therapy (VT), and opinions on factors influencing likelihood of attending VT. The relationships between patient characteristics/opinions and likelihood of attending VT were investigated. Results A total of 170 patients with various voice-related diagnoses reported receiving a recommendation for VT. Of those, 85% indicated that they were likely to attend it, regardless of voice-related handicap severity. The most common factors influencing likelihood of VT attendance were insurance/copay, relief that it was not cancer, and travel. Those who were not likely to attend VT identified, as important factors, unclear potential improvement, not understanding the purpose of therapy, and concern that it would be too hard. In multivariate analysis, factors associated with greater likelihood of attending VT included shorter travel distance, age (40-59 years), and being seen in an academic practice. Conclusions Most patients reported plans to attend VT as recommended. Patients who intended to attend VT reported different considerations in their decision making from those who did not plan to attend. These findings may inform patient counseling and efforts to increase access to voice care.

Health disparities among adults with voice problems in the United States

“…This study also demonstrated that, among those with voice problems in the last year, delay of care due to cost was more common among those without health insurance or with lower annual income levels. This is consistent with previous studies identifying concerns with cost of voice therapy as a barrier to seeking voice care . A survey of contemporary commercial music performers found that 37% indicated they do not seek help for vocal problems due to lack of adequate health coverage .…”

“…We could not find any studies in the literature that assessed the impact of race and ethnicity in adults with voice disorders. However, the voice disorder population has traditionally been described as predominantly white, wealthier, and educated . The difference in self‐reported voice outcomes among racial and ethnic groups may be secondary to cultural bias.…”

“…However, the voice disorder population has traditionally been described as predominantly white, wealthier, and educated. 20 The difference in self-reported voice outcomes among racial and ethnic groups may be secondary to cultural bias. Yiu et al reported that the impact of voice disorders may differ across cultural backgrounds after comparing qualityof-life surveys between Chinese and American dysphonic subjects.…”

“…This is consistent with previous studies identifying concerns with cost of voice therapy as a barrier to seeking voice care. 17,20 A survey of contemporary commercial music performers found that 37% indicated they do not seek help for vocal problems due to lack of adequate health coverage. 17 It is logical to conclude that patients who experience a greater burden in healthcare costs or experience lack of health insurance will be less likely to seek care for their voice problems.…”

Association of voice and mental health diagnoses with differences in voice‐related care utilization

“…Lack of follow-through could potentially be related to concerns that may be exacerbated by MH comorbidities, including unclear potential improvement, not understanding the purpose of therapy, or concerns that it would be too hard. 18 Insurance is another potential contributing factor because patients with both MH and voice diagnoses were more likely to have Medicaid. Although this was mitigated by inclusion of insurance status as a covariate in all regression analyses, it is possible there may be more subtle impacts that remain to be observed.…”