Patients using antifungals following laryngectomy : a qualitative study of community pharmacists in the North of England

Abstract

Objective: To explore community pharmacists’ understanding and opinions in relation to prevention of fungal colonisation of voice prostheses amongst laryngectomy patients. Method: Semi-structured interviews were conducted on a purposive sample of 12 community pharmacists from the North of England. Interviews were undertaken until data saturation was reached and responses were transcribed verbatim and analysed using a thematic approach. Key findings: Six themes emerged from the data analysis. These were: terminology confusion about laryngectomy, stoma and voice prostheses; smoking as a risk factor for the development of laryngeal cancer; using nystatin to prevent biofilm formation; counselling information related to nystatin; prescription intervention and additional education in relation to laryngectomy. The theme of counselling information related to nystatin use and additional education was a key finding: our data show that when dispensing nystatin to patients with a voice prosthesis, community pharmacists would either give no advice related to medication use or would give incorrect advice that may lead to premature prosthesis failure amongst this patient group. Conclusion: This study highlights that community pharmacists lack understanding in relation to laryngectomy and are unaware of the off-label doses and administration methods of the drugs (specifically nystatin) used to prevent fungal colonisation on voice prostheses. Additional information sources – possibly obtained through the local Speech and Language Therapy Department – in the form of an educational leaflet would be perceived as a valuable resource to support community pharmacists who are required to manage these patients in the community.