Patient Satisfaction With the Head and Neck Cancer Telephone Triage Service During the COVID-19 Pandemic.

Background A telephone triage consultation, as part of the two-week wait head and neck cancer referral pathway, was implemented nationally in March 2020. This was in response to the COVID-19 pandemic to stream cancer referrals to minimize unnecessary interactions and appointments with health services. The aim of this study is to assess patient satisfaction with this novel telephone triage system in the setting of a district general hospital. Methods A custom designed patient satisfaction questionnaire covering different facets of the patient experience was used. These questions were adapted from several internally validated questionnaires. A retrospective telephone survey was conducted by interviewers for all continuous new head and neck cancer referrals over two 4-week periods in 2020. Questionnaire responses to the initial modality of consult (either telephone triage or face to face) were collected, and data were analysed both qualitatively and quantitatively. Results Seventy-five responses were received, with 51 patients providing feedback on an initial telephone triage consultation. Patients rated the telephone triage consultation to be between satisfied and very satisfied across most domains, with an overall score of 4.29 out of 5. Accessibility and efficiency of the telephone triage were the domains with the least satisfaction. Fifty-five percent of patients would be happy to receive a similar telephone triage consultation beyond the pandemic. Qualitative analysis showed praise for the safety and convenience of the telephone triage consultation during the pandemic but highlighted a general preference for a face-to-face consultation and dissatisfaction regarding a lack of physical examination. Conclusions Overall, patients are satisfied with the telephone triage consultation employed in the pandemic, with high satisfaction rates for multiple aspects of care. However, there were concerns regarding the accessibility and inefficiency associated with a lack of/delayed physical examination and inability to adequately address the fear and anxiety associated with the referral. A mixed response is obtained on whether the telephone triage system should stay for the long run.

Incidence and predictive features of pharyngeal pouch in a dysphagic population.

Pharyngeal pouch patients often present with dysphagia and risk perforation when undergoing gastroscopy. Knowledge of pharyngeal pouch incidence and predictive demographic features in patients referred for dysphagia would help determine those patients who should have barium swallow as an initial investigation. The prospectively collected data of 2,797 consecutive referrals were analysed. Logistic regression determined significant variables for predicting pharyngeal pouches. Of the 2,430 patients investigated [mean age = 67.7 years, range 17-103; 48.2 % male], 49 (2.0 %) had a pharyngeal pouch [mean age = 79.8 years (range 58-93); 53.1 % male]. Significant predictors of pharyngeal pouch were pharyngeal level dysphagia (odds ratio [OR] 3.8-19.2), age over 65 years (OR 2.2-14.1), symptom duration over 12 weeks (OR 1.1-3.9), and no weight loss (OR 1.1-5.5). Only 18 patients (36.7 %) underwent surgery for their pouch. Midsternal dysphagia alone occurred in 16 % of all patients with pouches. From our results we conclude that pharyngeal pouches in a dysphagic population are more common than previously recognised. Patients aged over 65 years with pharyngeal level dysphagia for more than 12 weeks should have a barium swallow as their initial investigation.