Patient communication following head and neck cancer surgery: A-pilot study using electronic speech-generating devices

Purpose/Objectives: To describe the communication of patients who received electronic speech-generating devices (SGDs) following surgical procedures for head or neck cancer. Design: Exploratory, complementary mixed methods. Setting: Otolaryngology surgical inpatient unit of an urban teaching hospital. Sample: 10 purposively selected patients with a mean age of 57.1 years (SD = 12.8 years) and moderately severe illness (Acute Physiology and Chronic Health Evaluation III score (X) over bar = 27.1 +/- 13.2) who had SGDs in their hospital rooms for 9.1 +/- 6.2 days. Methods: Observation, interviews, questionnaires, and clinical record review. Main Research Variables: Communication methods, communication content, SGD use, communication quality (i.e., ease and user satisfaction), barriers to SGD use, and patient clinical characteristics. Findings: SGCs were used in message construction in 8 (17%) out of 48 total observed communication events. Writing (31%) and nonverbal communication (46%) were the most frequently observed primary methods of communication used by patients with head and neck cancer postoperatively. Five patients demonstrated occasional SGD use with or without cuing, and one used the SGD as the dominant communication method. Ease of Communication Scale scores showed only slightly less difficulty with communication when compared to a historic control group. Patients initiated communications more often when SGDs were used in message construction. Poor device positioning, staff unfamiliarity with SGDs, and patient preference and ability for writing were barriers to SGD use. Conclusions: Although writing and making gestures were the most common communication methods, SGDs were used successfully by selected patients and may be particularly beneficial for constructing complex messages during conversation. Implications for Nursing: SGDs may be an appropriate assistive communication strategy for postoperative patients with head and neck cancer. Nurses can facilitate effective patient communication with SGDs by cuing patients on device options and positioning SGDs within easy reach.