TY - JOUR
T1 - Determining the Prevalence, Implementation Approaches, and Opinions of Above Cuff Vocalization
T2 - A Survey of Health Care Professionals
AU - Mills, Claire S.
AU - Michou, Emilia
AU - Bellamy, Mark C.
AU - Siddle, Heidi J.
AU - Brennan, Cathy A.
AU - Bojke, Chris
N1 - Funding Information:
Supported by the National Institute for Health Research (NIHR) as part of an HEE/NIHR ICA Programme. Claire S. Mills is funded by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-036). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
We acknowledge the support of the project advisory group: Esther Beaumont, Frank Beaumont, Sarah Brown, Nicki Credland, Gary Masterson, Elankumaran Paramasivam, Maureen Twiddy, Simon Walker, Sarah Wallace, and Karen Woodford. We thank our patient, carer, and public involvement group for their valued input into this project. We also thank the following societies and professional networks for supporting the dissemination of our survey: the Association of Chartered Physiotherapists in Respiratory Care, the British Association of Critical Care Nurses, the Critical Care Leadership Forum, the European Society for Swallowing Disorders, the ICU Recovery Network, the Intensive Care Society, Members of Special Interest Group 3 and 13, American Speech-Language-Hearing Association, the NIHR Critical Care Specialty Group, the Royal College of Speech and Language Therapists (RCSLT), the RCSLT Tracheostomy Clinical Excellence Network, the Scottish Intensive Care Society, Speech Language and Audiology Canada, the UK Allied Health Professional and Nurses Network for Critical Care Research, the UK Critical Care Nursing Alliance, the UK Critical Care Research Forum, the Welsh Intensive Care Society, and the World Federation of Critical Care Nurses. We thank all the individuals who took the time to complete the survey and the clinicians who helped to pilot and develop the survey questions. Supported by the National Institute for Health Research (NIHR) as part of an HEE/NIHR ICA Programme. Claire S. Mills is funded by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-036). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2021 The Authors
PY - 2021/9/22
Y1 - 2021/9/22
N2 - Objective: To conduct an international survey to investigate the use of above cuff vocalization (ACV) and how practice and opinion differs. Design: Observational, cross-sectional online survey. Setting: Critical care, acute, rehabilitation, long-term care, and community. Participants: Health care professionals involved in tracheostomy care or weaning (N=243). Interventions: Not applicable. Main Outcome Measures: Tracheostomy management, prevalence, personal experiences and opinions, and barriers to use. Quantitative data were reported descriptively, and content analysis was conducted with qualitative data. Results: The survey was completed by 243 health care professionals from 9 professional groups and 25 countries, with most responses from the United Kingdom (54%) and speech and language therapists (55%). ACV was used in 39% of services (n=93). Sixty percent (n=50/83) of health care professionals with direct experience of ACV had used it with <10 people. Implementation of ACV varied widely concerning procedures, contraindications, safety processes, professionals involved, competencies, staff training, delivery, and outcome measures. The top benefits were communication (n=76/93; 82%), mood (n=62/93; 67%), and laryngeal sensation (n=49/93; 53%). Complications included discomfort (n=54/93; 58%) and strained vocal quality (n=39/93; 42%). Barriers to ACV implementation included lack of knowledgeable staff (n=92/238; 39%) and lack of access to training (n=73/238; 31%). Conclusions: ACV uptake varies internationally with no standardized approach to ACV delivery. Diversity of opinions on approaches and benefits exist. Serious complications are infrequent, but minor complications are common. Future research is needed to establish optimal ACV implementation to maximize benefits and minimize risks.
AB - Objective: To conduct an international survey to investigate the use of above cuff vocalization (ACV) and how practice and opinion differs. Design: Observational, cross-sectional online survey. Setting: Critical care, acute, rehabilitation, long-term care, and community. Participants: Health care professionals involved in tracheostomy care or weaning (N=243). Interventions: Not applicable. Main Outcome Measures: Tracheostomy management, prevalence, personal experiences and opinions, and barriers to use. Quantitative data were reported descriptively, and content analysis was conducted with qualitative data. Results: The survey was completed by 243 health care professionals from 9 professional groups and 25 countries, with most responses from the United Kingdom (54%) and speech and language therapists (55%). ACV was used in 39% of services (n=93). Sixty percent (n=50/83) of health care professionals with direct experience of ACV had used it with <10 people. Implementation of ACV varied widely concerning procedures, contraindications, safety processes, professionals involved, competencies, staff training, delivery, and outcome measures. The top benefits were communication (n=76/93; 82%), mood (n=62/93; 67%), and laryngeal sensation (n=49/93; 53%). Complications included discomfort (n=54/93; 58%) and strained vocal quality (n=39/93; 42%). Barriers to ACV implementation included lack of knowledgeable staff (n=92/238; 39%) and lack of access to training (n=73/238; 31%). Conclusions: ACV uptake varies internationally with no standardized approach to ACV delivery. Diversity of opinions on approaches and benefits exist. Serious complications are infrequent, but minor complications are common. Future research is needed to establish optimal ACV implementation to maximize benefits and minimize risks.
KW - Communication
KW - Critical care
KW - Deglutition
KW - Rehabilitation
KW - Surveys and questionnaires
KW - Tracheostomy
KW - Voice
U2 - 10.1016/j.apmr.2021.08.016
DO - 10.1016/j.apmr.2021.08.016
M3 - Article
C2 - 34562433
AN - SCOPUS:85118552148
SN - 0003-9993
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
ER -