{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:11:01Z","timestamp":1789042261850,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical Voice Restoration is the gold standard method of re\u2010establishing spoken communication after laryngectomy, where the voice\u2010box is surgically removed. A silicone voice prosthesis (valve) allows voicing. To minimise health risks, valves must be changed swiftly if they fail. While self\u2010management of health conditions is considered a key NHS objective, few people with laryngectomy in the UK change their own valve, requiring ongoing clinic attendance and healthcare professional input.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore the perspectives of people with laryngectomy on self\u2010changing, determining pertinent factors in decision\u2010making around valve change methods with a view to informing clinical practice and supporting provision of personalised care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Procedures<\/jats:title>\n                    <jats:p>Ten semi\u2010structured interviews were carried out online and via telephone. Five \u2018self\u2010changers\u2019 and five participants using clinician\u2010led valve changes were recruited via social media and charitable organisations. Reflexive Thematic Analysis was used to generate themes within the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes and Results<\/jats:title>\n                    <jats:p>Thematic analysis generated three main themes. (1) My valve, my way; (2) Unequal relationships; (3) A search for normality. Data synthesis revealed patient perspectives on life with surgical voice restoration, which have otherwise not been explored in research to date. Valve leaks were associated with distress and linked to diminished social participation and quality of life. Barriers and facilitators to self\u2010changing were highly individual, indicating the need for a personalised approach to education and decision\u2010making around self\u2010changing. Perceptions of disempowerment were expressed by people with laryngectomy, with limited opportunities for shared decision\u2010making and an imbalance of power between patient and healthcare professional. Analysis also showed that self\u2010changing may offer benefits by reducing the impact of valve changes on quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Implication<\/jats:title>\n                    <jats:p>Laryngectomy and surgical voice restoration have a significant impact on the activity and participation of people with laryngectomy. Empowering people with laryngectomy to participate in shared decision\u2010making around their care is essential. A personalised approach is required, including the provision of tools, support and opportunity to jointly make decisions around valve change methods. Clinical implications include the core elements of decision\u2010making conversations and training processes alongside points to consider for individual clinicians, service managers and policy makers. Further research on treatment burden and shared decision\u2010making tools is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>WHAT THIS PAPER ADDS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>What is already known on the subject<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Surgical voice restoration, using a silicone voice prosthesis (valve) to allow voice production, is considered the gold\u2010standard in re\u2010establishing communication after laryngectomy. The lifespan of each valve is finite, requiring swift replacement upon failure, to minimise health complications. Despite NHS objectives encouraging self\u2010management of health conditions, a minority of people with laryngectomy learn to change their own valves; most remain reliant on healthcare professionals for valve changes. Little is known about the impact of this on daily life, as perspectives of people with laryngectomy have not been sought to date.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What this paper adds to existing knowledge<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This study adds to the limited evidence\u2010base around self\u2010management in laryngectomy and represents the seldom\u2010heard perspectives of people with laryngectomy on the consequences of surgical voice restoration on daily life. We report inequitable waiting times for valve changes and lack of confidence in out\u2010of\u2010hours care. We highlight pertinent factors in decision\u2010making around valve change methods and reveal perceptions of disempowerment and restricted choice experienced by some people with laryngectomy who undergo surgical voice restoration. We raise queries over whether current practice meets multi\u2010disciplinary recommendations around offering self\u2010changing where appropriate.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                      <jats:italic>What are the potential or actual clinical implications of this work?<\/jats:italic>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This study demonstrates the need for a personalised approach to decision\u2010making around valve management in surgical voice restoration. We recommend increased support and opportunity for shared decision\u2010making in clinical practice and further research into the treatment burden of surgical voice restoration and the impact on quality of life after laryngectomy. Core elements of shared decision\u2010making conversations and training processes pertinent to self\u2010changing are discussed, with direct applicability to clinical contexts. Specific and actionable clinical implications are provided, relevant to individual clinicians, service managers and policy makers.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1460-6984.70276","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:24:59Z","timestamp":1783686299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient Perspectives on Self\u2010Management of Voice Prostheses in Surgical Voice Restoration After Laryngectomy"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3453-5548","authenticated-orcid":false,"given":"Nicky","family":"Gilbody","sequence":"first","affiliation":[{"name":"Centre for Language and Communication Science Research School of Health and Medical Sciences City St George's, University of London  London UK"},{"name":"Speech and Language Sciences, School of Social Sciences Leeds Beckett University  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4255-8315","authenticated-orcid":false,"given":"Patricia","family":"Holch","sequence":"additional","affiliation":[{"name":"Centre for Psychological Research Leeds Beckett University  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Hurren","sequence":"additional","affiliation":[{"name":"Speech and Language Sciences, School of Social Sciences Leeds Beckett University  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u201013\u2010467"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.10.851"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0738-3991(02)00032-0"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000610"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2022.2115553"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215113001382"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-69909-7_3470-2"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820960728"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11135\u2010021\u201001182\u2010y"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010016\u20100546\u20103"},{"key":"e_1_2_14_13_1","volume-title":"Research Design: Qualitative, Quantitative, and Mixed Methods Approaches","author":"Creswell J. 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