Preoperative Counseling in Salvage Total Laryngectomy: Content Analysis of Electronic Medical Records

Otolaryngol Head Neck Surg. 2017 Oct;157(4):641-647. doi: 10.1177/0194599817726769. Epub 2017 Aug 22.


Objective To study preoperative counseling in patients undergoing salvage total laryngectomy (STL). Study Design Case series with chart review. Setting Tertiary care academic hospital. Subjects and Methods We reviewed charts of patients ≥18 years undergoing STL between 2005 and 2015. Fifty-eight patients were identified. Notes written within 2 months prior to surgery by head and neck surgical oncologists, radiation oncologists, medical oncologists, speech-language pathologists, social workers, and nurse practitioners were extracted and coded into 4 categories. Coded content was then analyzed using a simple tally within content areas. Results Nonphysicians documented patient values and priorities, exclusive of treatment desires, more frequently. These topics included apprehension about family obligations, fear about communication, questions regarding quality of life, and anxiety regarding job continuation. Physician notes documented priorities regarding preferences for surgical treatment. No patients were seen by palliative care preoperatively, and only 14% (n = 8) patients had documentation of an end-of-life discussion. Conclusions Preoperative counseling for STL patients that included nonphysicians had a higher frequency of discussion of patients' priorities. This suggests including these types of providers may lead to more patient-centered care. A prospective study evaluating patient and physician perceptions of preoperative counseling can better identify where discrepancies exists and help conceptualize a framework for preoperative counseling in STL patients and other patients undergoing high-risk surgery.

Keywords: preoperative counseling; recurrent head and neck cancer; salvage laryngectomy.

MeSH terms

  • Aged
  • Counseling / methods*
  • Electronic Health Records*
  • Female
  • Follow-Up Studies
  • Humans
  • Laryngeal Neoplasms / psychology
  • Laryngeal Neoplasms / surgery*
  • Laryngectomy / methods*
  • Male
  • Middle Aged
  • Preoperative Care / methods*
  • Quality of Life*
  • Retrospective Studies
  • Salvage Therapy / methods*
  • Time Factors