Table 2 Service delivery process, contact employee actions, and service FPs on the HNC treatment journey

Stage 1 (Cancer diagnosis and staging work-up)

-Registering patient information

(P) Suspecting cancer, ordering diagnostic evaluation tests

(R) Symptom/visit record review/report

(N) Confirm Reservation /care guide

(F1) Lack of adequate explanation of the need for cancer diagnosis tests and the treatment procedures

(F’1) The burden of repeatedly explaining the diagnostic procedures to patients to persuade them get tested

-Referral to other departments

(P/R) Reviewing medical records

(N) Reviewing evaluation test order

-

-

-Reporting initial medical assessment results

(R) Running diagnostic evaluation tests

(N) Confirming reservation information on departments to visit

(P/R) Reviewing medical records

(F1) Lack of adequate explanation of the need for tests for cancer diagnosis and the treatment procedures

-

Stage 2 (Preoperative counseling)

-Reporting diagnosis and treatment methods

(P) Cancer diagnosis

(P) Explain treatment process and methods

(N) Confirming Reservation /care process guide

(P/R) Review medical records

(F2) limited Access to the Internet for comprehensive, reliable HNC information

(F3) Lack of comprehensive explanations of the entire treatment process

(F4) Severe shock after being diagnosed with cancer, anxiety about surgery, hard to find patient survivor stories

(F’2) Sudden cancellation of surgery or delays in decision-making due to distrust of the doctor’s suggestions

(F’3) Burden of repeatedly explaining treatment methods to older patients until they fully understand

-Reporting surgery schedule

(P) Scheduling for surgery

(N) Confirming/scheduling Reservation

(P/R) Reviewing medical records

-

-

Stage 3 (Obtaining informed consent)

-Reporting informed consent

(P) Explaining surgical process and risks

(R) Printing out consent forms and explaining the meaning of informed consent

(P/R) Reviewing medical records

(F5) Lack of information about post-surgery care plan, rehabilitation, and post-discharge management

-

-Managing consent form (review/print)

(R) Explaining informed consent

(P/R) Reviewing medical records

(F6) Having anxieties and worries about unpredictable surgery results after hearing the explanation of the long and complicated contents of the consent form

(F7) Text too small on the consent form, and too much content, making it difficult to understand the main point and focus on important content

(F8) Content that is difficult to understand through text alone, complex and long explanations that are difficult to understand after hearing them once

(F’4) The burden of explaining long and complex consent forms to older patients and helping them understand the contents

-Managing consent form (review/scan)

(R) Scanning the signed forms

(N) Confirming/scheduling Reservation

(P/R) Reviewing medical records

(N) Checking patient admission and surgery schedule

-

-

Stage 4

(Surgery and recovery)

-Reporting surgery hospitalization data

(P/R/N) Performing surgery

-

-

- Reviewing and reporting on postoperative evaluation

(R) Prescribing medication for pain control

(N) Responding to patient needs, administering pain control, disinfecting surgical wounds

(P/R/N) Reviewing medical records

(F10) High level of anxiety about the results of surgery and recovery due to pain and difficulty speaking, Difficulty finding other patients’ successful rehabilitation stories

(F11) Difficulties in vocalization and limited communication due to tracheotomy, resulting in passive expression of needs

(F12) Difficulty communicating with pen and paper, emotional fatigue after surgery

(F13) Passive and simple communication using gestures due to vocalization difficulties

(F’5) Difficulty quickly identifying and responding to the pain and condition of patients who do not actively express it

-Consulting support departments

(P) Explaining postoperative conditions, ordering postoperative evaluation tests

(R) Update on postoperative condition

(N) Discharge information guide

(P/R) Reviewing medical records

(F9) Slow update on postoperative progress, and no information about the changes in symptoms during recovery

(F’7) Lack of opportunities to provide emotional support and motivation to prevent patients from giving up treatment

Stage 5 (Rehabilitation and follow-up)

-Reporting medical assessment results

(R) Guide to rehabilitation therapy

(F15) Increased incidence of depression due to the burden of self-managing long-term rehabilitation and a need for social/psychological support from people around the patients

(F’6) Contact with patients only in outpatient clinics, difficulty in providing additional rehabilitation information

- Reviewing and reporting on postoperative evaluation

(P) Ordering follow-up evaluation tests, explaining the postoperative condition

(N) Scheduling/guide on the evaluation tests

(P/R) Reviewing medical records

(F14) Limited access to information on cancer metastasis, treatment progress, rehabilitation treatment, and self-management after discharge

-

-Managing medical appointments

(N) Scheduling/managing notifications

-

-