Undergoing head and neck cancer surgery: A grounded theory

Abstract

Surgery is the treatment of choice in most head and neck cancers. Very often, the surgery is radical with high impact on the psychosocial, functional and aesthetic fields. The aim of this study is to gain a deeper understanding of the patient's, clinician's and key informant's point of view when surgery is proposed, to improve the quality of pathways in terms of patients’ practical, psychological and relational needs. We followed a Grounded Theory approach with semi‐structured interviews. Seventeen participants (six patients, nine healthcare professionals and two volunteers) were interviewed immediately before surgery. The study generated a process of “persuading the patient of an obligation” as the core category. The other principal categories that emerged highlighted the patients’ doubts and fears regarding the surgery consequences and, in parallel, strategies employed by the healthcare professionals to rebut hindering issues impeding surgery. In particular, healthcare professionals involved patients in an affiliation process through simplified communication to sustain the choice of surgery; the family plays a supportive role in this process. The interplay between the organisational process and patients’ experience results in “I will let you convince me” at the end of the decision‐making process, where the main aim was to save and be saved.

Voice reacquisition after total laryngectomy via tracheoesophageal speech in patients with head and neck cancer: A qualitative study

“…Patients even consider sacri cing their lives [39] due to the combined impact of the cancer diagnosis [38] and voice loss. Additionally, physicians often focus their efforts on convincing patients of treatment [40],…”

An attempt to analyze the longitudinal psychological state of cancer patients in the active treatment stage

“…interpreting the emotions in context. Although there are several previous studies of the psychological state of cancer patients (1,19,(21)(22)(23)(24)(25)34), all of them used a one-time assessment through semi-structured interviews. In the present study, since documents based on the "psychological interview records" described in the medical record in the past were used, it became possible to find the change in psychological state from several months to more than a year.…”

“…Previous case studies focused on the psychology of cancer patients examined through a case study (6,7), psychological tests (8,9), interviews (10) and literature surveys (11)(12)(13), most of which targeted terminally ill patients (14)(15)(16)(17)(18). Conversely, previous studies on the psychological state of cancer patients during active treatment in Europe and the United States have examined changes after diagnosis and initial treatment (19)(20)(21), surgical decision-making (22), the relationship between positive emotions and depression (23,24), and fear of hematopoietic stem cell transplantation (25). In Japan, studies on the psychological responses related to early-stage lung cancer (26) and outpatient chemotherapy (13,27,28) were examined, all of which were involved the use of questionnaires or one-off interviews.…”

Health professionals learning qualitative research in their workplace: a focused ethnography

“…The three generative questions were: a) what is going on from patients, clinicians and other key-informants' point of view when HPs propose surgery to a head and neck cancer patient?, b) what happens when hospital HPs accompany for the first time a patient to death?, c) what is the hospital assistance of migrant cancer patients? To date, the group dealing with the first research question published the study [23], while the other two groups submitted the manuscripts only recently.…”