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

Background Palliative care is defined as the active holistic care of patients with advanced progressive illnesses (National Institute for Clinical Excellence; NICE 2004). In recent years, speech and language therapists (SLTs) have become involved in palliative care; from both communication and dysphagia perspectives (Sharp et al 2006). However, the role of SLTs in this area is currently unclear, poorly defined and under researched (Pollens 2012). Considering the increasing concentration on palliative care services and the recency of SLT intervention in this area, it is timely to gain an integrated overview of the role of hospital-based SLTs in palliative care. Aim To examine the perceptions of the role of the SLT in palliative care from the perspectives of hospital staff who tend to be the primary referral sources and also the SLTs who provide such services. Methods An acute hospital identified an issue with withdrawal of referrals to SLT. Participants were recruited from this hospital via a Senior SLT, who acted as gatekeeper. Data collection took place on site in the hospital. Ethical approval was obtained. One focus group was run with seven SLTs. Eight semi-structured individual interviews took place with hospital clinical staff including doctors, nurses, medical social workers and a dietician who are primary referrers to SLT. Data was transcribed, anonymised and analysed using thematic network analysis (Attride-Stirling 2001). Results Three key themes were identified; SLT role in palliative care, Referral matters and Palliative considerations. Findings reflect the complex nature of SLTs working in palliative care. The SLT scope of practice is largely dysphagia based with a need for more communication work highlighted. SLTs face challenges in their role which include working in a hospital setting, a lack of training and a lack of confidence. Referrals are affected by the patient’s prognosis and varying levels of knowledge of the SLT role by team members. Palliative medicine as a speciality has evolved with quality of life and choice the key constructs for patient-centred care. Conclusions The expansion of palliative medicine has led to an increase in demand for SLT services. Role development at a professional level with specific training for SLTs working in palliative care would increase confidence in the area. Additionally, interdisciplinary discussion between teams would further increase awareness of the role of the SLT in palliative care. In particular, the importance of communication at end of life needs addressing in order to improve service provision for palliative patients.