Bridging the Gap

The goal of the research project was to identity the differences between desired and actual practice conditions, including service delivery and quality patient outcomes as measured against evidence-based benchmarks while incorporating key stakeholder concerns and expectations to improve quality of interventions and maximize the coordination of care.

The research included a gap analysis that comprised of a literature review to determine bestresized pauly practice in the management of head and neck cancer patients and data collection on the care provided at a cancer center. The team collected a clinician survey, a process map, and a patient satisfaction survey, and baseline data from 2013. A SWOT (strengths, weaknesses, opportunities, threats) analysis was conducted, followed with quality improvement interventions.

In addition to being part of the research team, Tiffany and Meredith were part of the clinician survey.

“We were 2 of the 25 clinicians surveyed to share their perspective on the quality of care for head and neck patients, representing outpatient speech language pathology,” shares Pauly. “Over a process of several months, I offered my outpatient speech language pathology experience in treating head and neck cancer patients.”

“And through my work as an inpatient speech pathologist, I was able to identify gaps in acute care which I shared with the nursing student lead on this project,” says Hogan.

The results from their participation have led to new quality initiative projects, care team roles and insights on how to improve the continuum of care for patients. This project highlighted a need for pre-treatment instrumental assessment of swallowing function.  Currently Hogan and Pauly are exploring ways to improve the patient experience by participating in two quality improvement projects at Pennsylvania Hospital. First is a continuation of the gap analysis project by looking at data results since the addition of a head and neck cancer-specific nurse navigator in 2016. The second is the creation of a risk-stratification tool for identification of patients in our program who are at risk for feeding tube use during chemo radiation treatment.

HoganPAHThis research and the information gathered has allowed the program to re-assess our performance and make addition the head and neck cancer services in order to continue to enhance the impact of patient care,” shares Pauly.

In an acute setting, Hogan noted that the benefit  of pre-operative education resulting in a change practice to include a speech consult with all patients in for their pre-TORS (transoral robotic surgery) neck dissection, including what they can expect after their TORS. Outpatient speech therapy follow-up appointments are now scheduled before discharge, creating one less thing a patient has to worry about during their recovery.

“The most rewarding thing about being a speech language pathologist is having the privilege to watch someone’s confidence grow, make someone smile, or witness someone say “I love you” to their spouse for the first time after a total laryngectomy and voice restoration. Through my clinical skills, I have the ability to increase independence and empower people to be confident when they communicate or eat,” shares Pauly. “One of the greatest rewards of working with individuals dealing with head and neck cancer is helping them accomplish their goals to that they can find joy in eating again. As James Beard said, food is a universal experience. People with dysphagia miss out on their favorite foods as well as the significant social experience of mealtime with their loved ones.”

The Gap Analysis paper was published in the February 2017 The Journal of Community and Supportive Oncology. Additionally, the research was presented at the Oncology Nursing Society meeting in May 2017 by Dr. Clara Granda-Cameron. Click here to read the Gap Analysis paper. 

About the Therapists

Tiffany Hogan, MA, CCC-SLP received her degree in Communication Sciences and Disorders from Temple University in 2009.  Her clinical expertise is dysphagia and neonatal feeding disorders.  Tiffany is an active member of the American Speech-Language-Hearing Association.

Meredith Pauly, MA CCC-SLP received her Master’s Degree in Speech Language Pathology from Temple University in 2003. She is a member of the American Speech Language Hearing Association (ASHA) and has maintained the ASHA certificate of clinical competency since 2004. She is an advanced clinician specializing in speech, voice, and swallowing rehabilitation for people with movement disorders and head and neck cancer including voice rehabilitation after total laryngectomy. She is a certified LSVT LOUD and VitalStim provider.