Defense Date

4-1-2019

Graduation Date

Spring 5-10-2019

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Joan Such Lockhart

Committee Member

Lenore K. Resick

Committee Member

Umamaheswar Duvvuri

Keywords

Head and Neck Cancer, phenomenology, hermeneutics

Abstract

Abstract

Ongoing advances in minimally invasive surgical techniques, such as transoral robotic surgery (TORS), has enabled select patients with head and neck cancer to receive treatment that results in less disfigurement and dysfunction compared with traditional approaches. While TORS research has focused mainly on functional surgical outcomes, a need exists to understand recovery following TORS from the patient perspective. A hermeneutic phenomenological approach was used to recruit patients who had recently undergone TORS at a major academic health system in northeastern US. Data were collected using audio-recorded telephone interviews and field notes and analyzed concurrently. Participants included 17 HNCS (12 men; 5 women), aged 43-78 years, and diagnosed with oropharyngeal (n=15) and/or laryngeal cancer (n=2). Six major themes with multiple subthemes were identified: 1) Something is not right; 2) Importance of trust/faith in the doctor and health system; 3) Reflections on the TORS experience and recovery; 4) Getting through this; 5) Concerns about chemotherapy and radiation therapy; and 5) Returning to (the new) normal- markers of success. Findings provide insight into the lived experience of TORS from a patient perspective and include: importance of early diagnosis; benefit of a sound therapeutic relationship; management of postoperative pain in light of the opioid crisis; and value of spirituality/prayer through recovery. While undergoing TORS allowed some HNCSs to forego adjuvant treatment, many expressed negative opinions of chemotherapy and radiation therapy. Functional benchmarks, such as being cancer-free, returning to work, and hope for recovery were seen as markers of success. Effective pain management and returning to (the new) normal were new to TORS literature. Findings suggest areas for further exploration to facilitate recovery: encouraging prescribed pain medications; using realistic goal-setting; and ensuring patient understanding of ongoing swallowing rehabilitation. Nursing education regarding HNCS care should include the use of goal-setting (with attainable short/long-term goals) and the use of anticipatory guidance. Policy implications include strengthening public awareness of cancer screening, using strategies that promote HNCS and public understanding, emphasizing pain management, and increasing the availability and participation in HNCS support groups. Future research includes understanding patient-provider trust, supporting hope for recovery, and investigating the effect of context (setting).

Language

English

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