Patients' Attitudes Regarding Treatment for Vocal Fold Atrophy

Objective. To understand patient-identified factors affecting decision-making about treatment for vocal fold atrophy and to identify potentially correctable systematic impediments to appropriate treatment. Study design. Prospective observational study. Setting. Tertiary academic voice center. Subjects and methods. Prospective study of 34 consecutive patients with primary diagnosis of vocal fold atrophy. Participants answered an anonymous, single-page questionnaire at end of clinic visit following development of treatment plan. Results. Nineteen patients (56%) wanted to pursue treatment (eg voice therapy or surgery) and 15 patients (44%) did not. Most common reasons for pursuing treatment included desire for better voice (100%), aggravation by voice symptoms (84%) and decreased functionality of voice (63%). Most common reasons to forego treatment included feeling reassured by the lack of malignant findings (67% and 40% of those not wanting surgery and voice therapy, respectively) and the lack of a significant degree of symptomatology (80% and 53%, respectively). No patients cited insurance or transportation concerns, and few (13 and 27%, respectively) indicated other health issues taking priority. Conclusions. This pilot study represents an important first step in understanding patients' motivations in pursuing or declining treatment, which will help clinicians better counsel and guide patients to make appropriate treatment choices. It is imperative that clinicians develop better understanding about treatment outcomes as symptomatology and functionality are primary driving factors in the treatment-seeking population. Improved methods to assess candidacy for appropriate treatment are needed.