Perceptions of hospital-based clinical staff on the role of speech and language therapists in palliative care

Background: This research originated in response to anecdotal concerns regarding the withdrawal of palliative care (PC) referrals to speech and language therapists (SLTs) in an acute setting. Although a synthesis of the literature identifies the role of SLTs in palliative care in four areas: consultation, communication strategies, dysphagia and holistic care; there remains a lack of clarity around how the role is defined in an acute setting. This study aims to explore how SLTs working in an acute setting perceive their role in PC; to explore how hospital-based clinical staff (HCS) responsible for SLT referrals perceive the role of SLTs in PC; and to present an integrated overview of these findings. Methods: A qualitative research design was implemented using a focus group and semi-structured interviews. SLT and HCS participants were recruited via a gatekeeper internal to the SLT department in an acute hospital setting. 7 SLTs participated in a focus group. 8 HCS participated in semi-structured interviews. HCS consisted of 2 doctors, 2 nurses, 3 medical social workers and 1 dietician. Data was transcribed, anonymised and analysed using thematic analysis and organised according to thematic networks. Results: Three global themes were identified: The role of the SLT in PC; Palliative considerations; and Referral matters. Findings demonstrate that in the patient-centred and evolving speciality of PC, SLTs work as part of a multidisciplinary team, providing mainly dysphagia work with limited fulfilment of their role in communication intervention. It was found that particular factors influence HCS to make or withdraw PC referrals to SLTs. Conclusions: The themes arising from the data reflect that although SLTs are perceived to have a role in PC, especially relating to dysphagia management, a lack of certainty still exists about this role. It is recommended that increased clarity can be facilitated through SLT specific PC education, inter-professional education, intra-professional discussions and guidelines and further research.