{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:51:09Z","timestamp":1777611069944,"version":"3.51.4"},"reference-count":62,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["ICA\u2010CDRF\u20102017\u201003\u2010036"],"award-info":[{"award-number":["ICA\u2010CDRF\u20102017\u201003\u2010036"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Procedures<\/jats:title><jats:p>Semi\u2010structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID\u201019, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes and Results<\/jats:title><jats:p>Twenty\u2010four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub\u2010themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential \u2018need to fix\u2019 patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Implications<\/jats:title><jats:p>More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>There is limited and low\u2010quality evidence for above cuff vocalisation (ACV) and clinical application and practice varies substantially. However, the reasons for this variation in practice and healthcare professionals\u2019 (HCPs\u2019) opinions of ACV were unclear.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this study adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>HCPs\u2019 experiences and opinions of ACV vary as a result of the uncertainty and subjectivity surrounding ACV compounded by their personal experiences with it. A need for caution also appears to emerge as HCPs become more familiar and experienced with using ACV.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the clinical implications of this work?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Implementing standardised procedures, safety processes and competencies may help to compensate for the uncertainty and subjectivity surrounding ACV and may reduce the frequency of adverse events. Widening the focus of purpose of ACV, including swallowing in addition to communication, may increase the number of potential candidates and increase the potential benefits of ACV. Using multidisciplinary team (MDT) simulation training for ACV competency development might help to improve MDT working and ACV implementation.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.12970","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T10:51:09Z","timestamp":1698663069000},"page":"932-946","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Worth a try or a last resort: Healthcare professionals\u2019 experiences and opinions of above cuff vocalisation"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3436-3876","authenticated-orcid":false,"given":"Claire S.","family":"Mills","sequence":"first","affiliation":[{"name":"Speech &amp; Language Therapy Department Leeds Teaching Hospitals NHS Trust  Leeds UK"},{"name":"Leeds Institute of Health Sciences University of Leeds  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia","family":"Michou","sequence":"additional","affiliation":[{"name":"Centre for Gastrointestinal Sciences The University of Manchester  Manchester UK"},{"name":"Speech Language Therapy Department University of Patras  Patras Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark C.","family":"Bellamy","sequence":"additional","affiliation":[{"name":"Leeds Institute of Medical Research at St James's University of Leeds  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi J.","family":"Siddle","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy A.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences University of Leeds  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Bojke","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences University of Leeds  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2007.11.006"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319852007"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/jpcs.jpcs_62_19"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/13620-004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/capr.12360"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1704846"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733012462049"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11135\u2010021\u201001182\u2010y"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020966776"},{"key":"e_1_2_9_13_1","article-title":"Thematic analysis: a practical guide","author":"Clarke V.","year":"2022","journal-title":"Los Angeles"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1751143718787753"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1191\/0969733002ne557oa"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs.2010.046227"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2018.11.030"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2016.04.003"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra054784"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.2.226"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/104973202129120052"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2018.02.004"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613\u2010017\u20100293\u20102"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2004.10.003"},{"key":"e_1_2_9_25_1","unstructured":"Health and Safety Executive(2022)What is Competence?\u2014Competence in health and safety Health and Safety Executive. Available from:https:\/\/www.hse.gov.uk\/competence\/what\u2010is\u2010competence.htm[Accessed: 17 August 2022]"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2017786"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3109\/13561820.2010.520248"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102020\u2010012239"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489416683192"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/14623940802005475"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733009351951"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/1751143715607549"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/1751143718767055"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.23736\/s0375\u20109393.20.14878\u20108"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.08.016"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29591"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010023\u201007064\u20101"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/a014106"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2022.154145"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102011\u2010000148"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/1468794112446106"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28211"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479\u20106988.2005.00026.x"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/0894318406296306"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13706"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0107\u20102019"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2013.11.002"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1177\/1525822\u00d702239569"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/1477750919886088"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537\u2010197709000\u201000003"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01354549"},{"key":"e_1_2_9_52_1","unstructured":"Skills for Health(2022)\u2018National Occupational Standards Overview\u2019 Skills for Health 17August. Available from:https:\/\/www.skillsforhealth.org.uk\/info\u2010hub\/national\u2010occupational\u2010standards\u2010overview\/[Accessed: 17 August 2022]"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004098"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0375\u20109393.20.13989\u20100"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12564"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020916747"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010009\u20101551\u2010z"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1177\/17511437221113162"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjae.2021.02.005"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.5116\/ijme.4ff7.0f68"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10511"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_AJSLP\u201019\u20100001"}],"container-title":["International Journal of Language &amp; Communication Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1460-6984.12970","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T09:45:15Z","timestamp":1715161515000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1460-6984.12970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,30]]},"references-count":62,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/1460-6984.12970"],"URL":"https:\/\/doi.org\/10.1111\/1460-6984.12970","archive":["Portico"],"relation":{},"ISSN":["1368-2822","1460-6984"],"issn-type":[{"value":"1368-2822","type":"print"},{"value":"1460-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,30]]},"assertion":[{"value":"2023-08-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}