Klaske van Sluis

Life after total laryngectomy 135 The interview data were analysed following the six phases described in the method of thematic analysis [17], while also taking interpretative phenomeno- logical analysis as a lead [18]. This method for the analysis of interviews empha- sizes how respondents make sense of their own subjective experiences, in partic- ular those following a life-changing event. In accordance with both methodolog- ical approaches, the first step includes familiarization with the data by repeat- edly reading the transcriptions. In addition, the interviewers all wrote short reflection reports following each interview (phase 1, [17]). Coding and analysis were initiated by highlighting potential codes together. Weekly meetings were held to discuss project’s progress, initial coding, and the analysis (phase 2, [17]). Next, members of the project team each coded a share of the interviews, while also regularly discussing the coding process together. After going through the first two interviews by hand, NVivo software (v11) was used to structure the coding process, creating a long list of codes along the data set. Inter-coder reliability was monitored by keeping a master list of all codes, tracking all changes, and regularly discussing these. Next, in an iterative process encom- passing several joint sessions, codes were sorted into potential themes (phase 3, [17]). To visualize relationships between codes and themes, a ‘mind map’ was created (phase 4, [17]). This process resulted in a set of three fully worked-out themes, each encompassing three sub-themes (see Figure 8.1) (phase 5, [17]). Themes cover recurring issues, as well as issues that respondents indicated were meaningful to them. The themes and categories were checked against the entire data set by AK. The report of the analysis served as a basis for the present article (phase 6, [17]). After finishing the first draft of the report, a two-page summary was created to perform participant checking. The participants re- ceived this summary by mail and were invited to respond via a response form or telephone. No comments were provided by the participants. 8.4 Results Three main themes were identified: “Disease and treatment as a turning point”, “Re-establishing meaningful everyday activities”, and “Persistent vulnerability” (visualized in Figure 8.1). This section discusses each theme. The first theme is presented more briefly due to overlap with existing qualitative literature on the experiences of individuals undergoing total laryngectomy [12, 13, 15]. 8.4.1 Disease and treatment as a turning point This first theme highlights the fact that respondents experienced their disease and its treatment as a turning point in their lives. This shift already started before the procedure, when participants were first confronted with symptoms and functional issues, received their diagnosis, and were offered a treatment plan. When presented with the treatment plan, some respondents initially felt an aversion to total laryngectomy: