Identification of predictors and construction of a prediction model for the quality of life in laryngeal carcinoma patients in China using revised core nursing outcomes

This study aimed to investigate the association between the postoperative core nursing outcomes and QoL in patients with LC after laryngectomy and to construct a prediction model for QoL. A total of 331 LC patients after laryngectomy were recruited, and the predictors for QoL included age 50.0–65.0 years, female sex, junior high school as the highest schooling level, residence in cities and towns, not consuming alcohol, partial laryngectomy, and the Physiologic Health, Psychosocial Health, Health Knowledge & Behavior, and Perceived Health scores. A prediction model constructed based on these predictors showed high predictive performance for poor QoL.

Several studies have investigated predictors of QoL in LC patients [13, 14]. Williamson et al. examined QoL in 41 patients and found that 4.9% reported poor QoL. Patients undergoing primary radiotherapy reported the best QoL, whereas the worst QoL was observed in patients undergoing chemoradiotherapy or combined surgical treatment and chemoradiotherapy [13]. Vilaseca et al. assessed QoL after transoral laser microsurgery in patients with LC and found that QoL could be affected by tumor location, adjuvant radiation, and neck dissection [14]. These studies mainly focus on the relationship between clinical characteristics of patients and their QoL. However, perioperative care such as airway management, psychological care, and swallowing training can also impact the postoperative recovery and QoL of patients. Moreover, the association of revised core nursing outcomes with QoL in patients with LC remains unclear. Hence, the current study aimed to identify the predictors of QoL in patients with LC including the core nursing outcomes.

The predictors we identified are similar to those identified in previous studies. We found a significant association between age, gender, and QoL, possibly due to variations in the severity of LC among patients of different age groups and genders. In addition, the significant impact of education level and patient’s residential environment on the QoL of LC patients can mainly be attributed to: (1) Patients with higher education levels may place more emphasis on health check-ups, resulting in milder conditions of LC when diagnosed; (2) Patients residing in urban areas have significantly better access to medical resources and a more favorable environment compared to rural areas, leading to higher levels of postoperative rehabilitation strategies and facilities, which greatly influence the patients’ QoL [12]. Consistent with previous study, this study also found alcohol consumption was associated with the QoL in LC patients undergoing total laryngectomy [15]. The surgical approach affects several domains of the revised core nursing outcomes. In previous studies, the physiological, overall functional, and head and neck functional statuses associated with partial laryngectomy were higher than those associated with total laryngectomy, especially in terms of appearance, vocalization, eating, and communication [16]. Moreover, partial laryngectomy preserves more sensory nerves in the skin and mucosa [17].

The revised postoperative core nursing outcomes reflects the use of nursing interventions in patients with LC, which is an important factor for improving their QoL [18]. Moreover, the revised postoperative core nursing outcomes mainly focuses on “Physiologic Health,” “Psychosocial Health,” “Health Knowledge & Behavior,” and “Perceived Health,” which mainly reflect the status of LC patients after laryngectomy and are significantly associated with QoL. Interesting, we noted higher Physiologic Health scores were associated with poorer QoL, which could explained by patients with higher Physiologic Health scores may have a heightened awareness of their physical limitations and symptoms, leading to a more negative perception of their overall QoL. These items in the core nursing outcome evaluation system for LC patients constructed were approved by clinical nurses, which was used to a certain extent in clinical nursing work of Otolaryngology, thus that the core nursing outcome with good clinical applicability. Therefore, targeted health education and behavior guidance based on revised core nursing outcomes to improve the QoL in LC patients, including: (1) providing individual and group counseling services to help patients cope with the emotional and psychological challenges associated with laryngectomy [19]; (2) establishing peer support programs where LC patients can connect with others who have undergone similar experiences [20]; (3) facilitating support groups that bring together LC patients and their families to share experiences, exchange information, and provide mutual support [21]; (4) incorporating mindfulness and relaxation techniques to help patients manage stress and improve their overall well-being [22]; and (5) Encouraging the involvement of family members in the care process, providing them with education and support to better understand and assist their loved ones [23].

LC surgery may entail physiological alterations such as changes in voice, difficulty in swallowing, and modifications to breathing patterns, as well as external and functional changes necessitated by the use of tracheostomy tubes or electronic speech devices. These alterations can significantly impact the patient’s mental well-being and prospects for reemployment [24, 25]. Therefore, constructing a predictive model for postoperative QoL in LC patients holds significant clinical importance. Our study constructed a prediction model based on identified predictors showed high predictive value for QoL. Thus, the revised core nursing outcomes provide a good foundation for the used in clinical practice, and multidimensional nursing interventions should be applied to further improve QoL.

This study has several limitations. First, as the sample includes patients from three hospitals, there is a possibility of selection bias. Patients from other regions or healthcare facilities may exhibit different predictors of QoL due to variations in care practices. Second, the cross-sectional design limits the ability to establish causality. Prospective or longitudinal studies would be better suited to confirm whether the identified factors genuinely impact QoL over time. Third, factors such as socioeconomic status, comorbidities, stage of LC, prior treatments (e.g., chemoradiotherapy), and access to rehabilitation services were not included in the analysis, yet these factors could significantly impact QoL of patients with LC. Fourth, the sample was predominantly male and smokers, reflecting the typical demographic for LC but potentially skewing the findings. Including a more gender-balanced sample might yield different insights, particularly given that gender was an influential factor. Fifth, LC patients were obtained in northern and northeastern China, which may limit the generalizability of our findings. Sixth, QoL was assessed using self-reported questionnaires, which are subject to response and recall biases. This can impact the accuracy of data on subjective measures like psychosocial health.