Counseling before laryngectomy.

Counseling of laryngectomy patients was studied by a questionnaire survey among 294 fellows of the American Society for Head and Neck Surgery and otolaryngology house officers (77% attendings and 23% residents). Seventy-nine percent of respondents spent less than one hour counseling patients. Subjects emphasized during preoperative counseling included: extent of surgery, loss of speech, alternatives to surgery, immediate postoperative disfigurement, possible effects of surgery on life expectancy, and possibility of recurrence. At least 24% of physicians were unwilling to discuss the psychosocial effects laryngectomy. Ninety-five percent of respondents often or always included family members in preoperative counseling sessions. The speech pathologist was utilized by at least 80% of the respondents to help with preoperative counseling. Differences in counseling practices between attendings and residents are discussed.