Klaske van Sluis

144 8.5. Discussion 8.5.1 Recommendations for clinical practice The insights provided by this study may help improve clinical practice by en- abling a more patient-centred approach in pre-treatment counselling and reha- bilitation. As we move towards health models driven by patient-centred care, understanding the differential impacts of surgical procedures on subgroups of our patients, in this case women, is critically important to help improve our care models, patient education and support systems. We support the conclu- sions of earlier research recommending personalized rehabilitation provided by a multidisciplinary team and recognize the presence of unmet supportive care needs in women undergoing total laryngectomy [2, 3, 7, 9, 12, 29–31]. First, we recommend that standard pre-treatment counselling procedures be re-evaluated. Counselling involves exploring patients’ priorities, values and concerns about the treatment and the outcome, as well as possible benefits, risks and implications of the treatment options [27, 28, 32]. However, we rec- ommend that the information given also includes expected everyday issues after the procedure, specifically as experienced from a patients’ point of view. This implies providing information on gender-specific issues. It therefore seems pru- dent to match patients and patient visitors based on both gender and age to facilitate realistic expectations and enhance peer support possibilities. Secondly, we recommend tailored rehabilitation programs following total laryngectomy, with attention to gender-specific issues. Our study suggests that women face specific problems while reintegrating on an individual as well as on a societal level after total laryngectomy. Lee et al. (2010) propose that women may particularly benefit from rehabilitation programs which aim to improve emotional and social functioning post-laryngectomy, since they found this to be significantly impacted in female laryngectomees. Our study shows the persistent vulnerability on the long term including the dependence on others, stigma-related problems, and problems with returning to the former job. Thus, rehabilitation programs should include psychosocial and practical support to pursue participation in social activities and work-related activities. Thirdly, it is important to involve the partner in the treatment and reha- bilitation process. Women following total laryngectomy experience a greater impact of the procedure on their relationship than men [8]. Our study specifies this with the reported shift in give-and-take balance of the spousal relationship, challenges in performing care work, and problems with intimacy. We therefore highlight the importance of involving partners in the process of rehabilitation and recommend that clinicians create openness in discussing the impact of the surgery on the relationship and family roles. This will allow females following to re-integrate into their former roles in as well family, social life as in work. This study has some limitations. Qualitative research in general is never representative for the entire population, because it draws on the experiences of a relatively small sample. Also, since only women were recruited, experiences specific to men were not addressed in this study. However, the main themes “Disease and treatment as a turning point”, “Returning to everyday activities”