From the Guidelines
A comprehensive consent form for laryngectomy should include several key risks, prioritizing the patient's understanding of the life-altering changes they will experience, as highlighted in the most recent guideline evidence 1. The form should clearly outline immediate surgical risks including bleeding, infection, and anesthesia complications, as well as specific risks related to laryngectomy, such as permanent loss of normal voice and the need for alternative communication methods like esophageal speech, voice prosthesis, or electrolarynx.
- Potential swallowing difficulties that may require tube feeding temporarily or permanently should be mentioned.
- Breathing changes are critical to address, as patients will breathe through a permanent stoma in the neck rather than through the nose and mouth.
- Other important risks include:
- Changes in sense of smell and taste
- Neck and shoulder stiffness or pain
- Pharyngocutaneous fistula (abnormal connection between throat and skin)
- Narrowing of the stoma requiring revision
- Psychological impacts including altered body image and potential depression The form should also mention the possibility of recurrent cancer requiring additional treatment, as emphasized in the American Society of Clinical Oncology clinical practice guideline 1. These risks are essential to include because laryngectomy fundamentally changes how a person breathes, speaks, and eats, affecting both physical function and quality of life, and patients need this information to make a truly informed decision about this life-altering procedure, as supported by the Association of Anaesthetists of Great Britain and Ireland guidelines 1.
From the Research
Risks Associated with Laryngectomy
The following risks should be included on a consent form for a laryngectomy:
- Post-operative complications, such as wound infection, pharyngocutaneous fistula, and respiratory tract infections 2, 3, 4
- Operative time and patient age as factors associated with overall complications 2
- Steroid use and class III wound classification as factors associated with major complications 2
- Pre-operative hematocrit as a factor correlated with a reduction of all and major complications 2
- Alcohol consumption, cN stage of tumour, and pre-operative albumin levels as risk variables for post-operative wound infection 3
- Hospital-acquired pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Serratia marcescens, as potential causes of infection 3
- Difficulty in managing respiratory tract infections, such as tracheobronchitis, due to the risk of airway obstruction and the need for humidification 4
Patient Understanding and Recall of Risks
It is essential to ensure that patients understand and recall the potential risks and complications associated with laryngectomy:
- Patients' recollection and understanding of informed consent can be low, particularly among older individuals 5
- The use of education materials, such as written or interactive multimedia, can improve patients' understanding of the implications of surgery 5
- The consent form should include details of benefits and serious or frequent risks, and patients should be given the opportunity to discuss these with their healthcare provider 6
Importance of Accurate Documentation
Accurate documentation of potential complications on the consent form is crucial:
- A significant proportion of serious or frequent complications may not be documented on the consent form, which can have ethical and medico-legal ramifications 6
- Healthcare providers should ensure that patients are fully informed of the potential risks and complications associated with laryngectomy, and that these are accurately documented on the consent form 6