Non-pharmacological interventions for inducible laryngeal obstruction: a thematic analysis towards a standardised...

Non-pharmacological treatment is recommended for inducible laryngeal obstruction (ILO) but evidence for effectiveness is limited. A standardised approach does not exist and there are many key uncertainties for intervention delivery. The aims of the present study were to identify, from patients and speech and language therapists (SLTs), what the key considerations and components are for a standardised non-pharmacological intervention for ILO.

Qualitative data were collected during a SLT focus group and one-to-one patient semistructured interviews (SLTs (n=7); intervention-naïve patients (n=6); patients who had received a non-pharmacological intervention aimed to control ILO (n=16)). A Framework Method analysis was conducted to explore and identify themes in the data.

SLTs were very experienced (median (interquartile range; range) 19 (13; 6-34) years post-qualification and 7 (3; 4-25) years of holding a weekly ILO caseload). Patients were predominantly female (73%) with mean±sd age 53±13 years. Patient participants expressed a fear of ILO and unanimous support for an intervention. Five main themes were identified: 1) "Living with ILO" highlighted rationale and motivation; 2) "Pathway to intervention" offered understanding on the wider context related to access; 3) "Care delivery" answered important key uncertainties relating to intervention implementation; 4) "Intervention components" detailed specific components; and 5) "Views of interventions" identified mediators of change. All interviewees deemed a standardised non-pharmacological approach would be highly desirable to help improve patient outcomes.

This work provides evidence, from key stakeholders, on the fundamentals for a non-pharmacological ILO intervention. It will inform future work to establish a standardised approach worthy of a formal evaluation of effectiveness.