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Validating the Changes to Self-identity After Total Laryngectomy

Bickford, Jane, PhD; Coveney, John, PhD; Baker, Janet, PhD; Hersh, Deborah, PhD

doi: 10.1097/NCC.0000000000000610
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Background A total laryngectomy often prolongs life but results in long-term disablement, disfigurement, and complex care needs. Current clinical practice addresses the surgical options, procedures, and immediate recovery. Less support is available longer-term despite significant changes to aspects of personhood and ongoing medical needs.

Objective The aim of this study was to explore the experience of living with and/or supporting individuals with a laryngectomy at least 1 year after surgery.

Methods Constructivist grounded theory methods and symbolic interactionism were used to guide collection and analysis of interview data from 28 participants (12 individuals with a laryngectomy, 9 primary supporters, and 7 health professionals).

Results The phenomena of “validating the altered self after total laryngectomy” highlighted how individuals, postlaryngectomy, navigate and negotiate interactions due to the disruption of their self-expression, related competencies, and roles. Several reframing patterns representing validation of the self emerged from the narratives. They were as follows: destabilized, resigned, resolute, and transformed. The data describe the influence of the processes of developing competence and building resilience, combined with contextual factors, for example, timing and turning points; being supported; and personal factors on these reframing patterns.

Conclusion The findings further our understanding of the long-term subjective experience of identity change after laryngectomy and call attention to the persisting need for psychosocial support.

Implications for Practice This research provides important evidence for evaluating and strengthening the continuum of services (specialist to community) and supporting social participation, regardless of communication method, and for competency training for all involved to optimize person-centered practices.

Authors Affiliations: College of Nursing and Health Sciences, Flinders University, Adelaide (Dr Bickford and Adjunct Associate Professor Baker and Professor Coveney); and School of Medicine and Health Sciences, Edith Cowan University, Western Australia (Associate Professor Hersh).

The first author received an annual research maintenance grant of A$1000 from the Faculty of Medicine, Nursing and Health Sciences, flinders University during her doctorate, and some of these funds were used to support data collection and analysis of this study.

The first author is a current employee of Flinders University and was an employee of the university while completing her doctoral studies. The remaining authors have no conflicts of interest to disclose.

Correspondence: Jane Bickford, PhD, Department of Speech Pathology and Audiology, College of Nursing and Health Sciences, Flinders University South Australia, GPO Box 2100, Adelaide, SA 5001, Australia (jane.bickford@flinders.edu.au).

Accepted for publication February 21, 2018.

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