Free Flap Friday: Interdisciplinary clinic implementation and outcomes for patients undergoing head and neck cancer surgery

Abstract

Abstract Purpose:Patients with complex head and neck cancer benefit from preoperative education and multidisciplinary support. However, such care may not adequately address the need for advance care planning (ACP) in the preoperative setting. We evaluated the feasibility and impact of “Free Flap Fridays” (FFF), a comprehensive preoperative education program that offers recommendations to patients undergoing head and neck surgery with free flap reconstruction. The program is led by an interdisciplinary team comprised of social work, surgical nursing, speech and language pathology, nutrition, and specialty palliative care. Methods: This study was a quantitative, retrospective chart review analysis at an academic cancer center. We compared demographics pre- and post-surgical engagement with the interdisciplinary team, and ACP outcomes, among 48 patients who participated in FFF and 44 patients who received usual care prior to the launch of the FFF clinic. Results:Preoperative involvement of each of the five disciplines included in the interdisciplinary team increased among the intervention group. Engagement with FFF increased rates of advance care planning discussions (66.7% vs. 4.5%, p<0.0001). Documentation of a durable power of attorney also increased between the groups (72.9% vs. 31.8%, p<0.0001), although there was no difference in completed advance care documents, including advance directives or Physician Orders for Life Sustaining Treatment (POLST) documents. Conclusions:Implementation of an interdisciplinary, preoperative clinic for patients undergoing free flap reconstruction for head and neck cancer is feasible and leads to increased patient engagement and preoperative ACP discussions.