None listed
Conditions
Brief summary
The aim of this study is to look at how a speech language pathology (SLP) telehealth assessment contributes to diagnosis and if it can be used to prioritise people with vocal symptoms to urgent or routine visualisation of the voice box for diagnosis. A range of clinical tests are used to assess a voice problem including a detailed symptom case history, listening and analysing the voice quality, and looking at the voice box using a camera inserted in the nose or throat (laryngoscopy with stroboscopy). Some of these are typically completed by an Ear Nose and Throat (ENT) specialist and then an SLP, either in a combined clinic (with both professional’s present) or separate clinics (where one professional makes a referral to another after assessment). Laryngoscopy is the only assessment that cannot be performed in a telehealth appointment but is still important to complete diagnosis. Considering the current global pandemic, many face-to-face assessments have transitioned to a telehealth model to help reduce the risk of virus transmission. In addition, laryngoscopy is being prioritised for urgent patients because it requires additional personal protective equipment (PPE), due to a risk of viral transmission from the nose and throat in patients who may have a contagious virus. Past research has shown that an SLPPC face to face assessment can reduce waiting times for patients, and in most cases, enable them to commence treatment with the SLP without needing ENT treatment. In this model, the SLP sees the patient first and an ENT is still involved in confirming the diagnosis and ensuring the most appropriate treatment pathway has been offered. In this study participants we will use a combination of written information about symptoms provided by the patient and voice assessments completed in a telehealth model to predict how quickly patients need to attend hospital for a laryngoscopy and an ENT diagnosis. We will measure what parts of the SLP assessment help to predict the voice diagnosis, the cost-benefit of the alternative pathway and what consumers think about the alternative model of providing care. We hope to demonstrate that telehealth assessment with a SLP can help to prioritise how urgently a laryngoscopy is needed, whilst also providing strategies to manage symptoms while waiting for this assessment and diagnosis. In addition, we hope this research will help us to understand which parts of the SLP voice assessment can be used to contribute to a diagnosis before laryngoscopy.
Interventions
Participants will be asked to complete a pre assessment written case history information questionnaire, patient reported outcome measures (Voice Handicap Index-10, Reflux Symptom Index, Newcastle Laryngeal Hypersensitivity Questionnaire) and a quality of life instrument (AQoL-6D). Blank copies of these forms will be sent to patients by email 2 weeks in advance of their appointment. Participants will be asked to return completed pre-assessment forms using an electronic secure file transfer servi
Participants will be asked to complete a pre assessment written case history information questionnaire, patient reported outcome measures (Voice Handicap Index-10, Reflux Symptom Index, Newcastle Laryngeal Hypersensitivity Questionnaire) and a quality of life instrument (AQoL-6D). Blank copies of these forms will be sent to patients by email 2 weeks in advance of their appointment. Participants will be asked to return completed pre-assessment forms using an electronic secure file transfer service (KiteWorks) 2-3 days prior to their telehealth appointment. Participants without access to email can complete and return the pre-assessment forms by post. The anticipated duration to complete the pre-assessment questionnaires is 30 minutes. The telehealth voice assessment with a Speech Language Pathologist (SLP) will consist of multiple parts designed to collect information relevant to the patients presenting vocal symptoms including: socio-demographic information; personal and family medical history; key symptoms; onset and variability of symptoms; red-flag signs or symptoms for laryngeal malignancy; clinical voice assessment data for auditory-perceptual and acoustic analysis. These assessments make up the usual care voice assessment protocol during a in-person voice assessment. The duration of the telehealth assessment will be 45 minutes including 15 minutes for the collection of case history information, 20 minutes for the clinical voice assessment and 10 minutes for education. The participant will be guided by the SLP to record a standardised voice sample using their home computer/tablet/smart phone for auditory-perceptual and acoustic analysis. The audio file can be sent securely to the clinician for analysis using an electronic secure file transfer service (KiteWorks). The SLP will then triage the patient for an in-person laryngoscopy assessment which will include diagnosis from an Ear, Nose and throat medical officer. Priority for diagnostic laryngoscopy will be categorised as emergent time sensitive, urgent or routine. This appointment will take approximately 20-30 minutes. Participants will be observed from the telehealth assessment session until the in-person out-patient laryngoscopy assessment The overall duration of observation for each participant will depend on the urgency of laryngoscopy determined by the telehealth assessment, this is anticipated to take between 2 and 8 weeks from enrolment. Participants who decline or are unable to participate in the telehealth assessment for any reason (e.g. access to telehealth equipment, patient preference, language/communication barriers) will be offered a face to face clinic appointment. These participants will still be invited to take part in the study and if they consent their data will be used for a sub-analysis. If participants choose not to enroll in this study, or if they do not meet the study eligibility criteria, they will be offered the same assessment pathway in accordance with the usual care for this service.
Sponsors
Gold Coast Hospital and Health Service
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
New patients referred for initial ENT evaluation who are triaged by the ENT Surgical team as category 2 (complex care, assess <90 days) or 3 (non-urgent, delayed assessment unlikely to lead to deterioration or a need for more complex care, assess <365 days) on the ENT waitlist, in accordance with the Queensland Health Clinical Prioritisation Criteria (CPC), and then referred to the SLPPC service. - Adults aged over 18. - Referral symptoms of episodes of hoarseness or altered voice in patients with no risk factors for malignancy identified on written referral. - Patients who can provide informed consent and complete a telehealth case history and assessment in English.
Exclusion criteria
- Patients whose referrals are triaged by ENT as Category-1 based on written referral information, as defined by the Queensland Health Clinical Prioritisation Criteria. - Any significant medical comorbidities identified on written referral (i.e., previous head and neck cancer, previous laryngeal surgery, neuromuscular disease affecting the larynx).
Outcome results
None listed