The first speech pathology job application I submitted was just prior to graduation in 1991 for a role in general medicine and palliative care at a large metropolitan hospital in Melbourne. I had to look up the meaning of palliative in a dictionary.
I did not realise it at the time, but it signalled the first of many challenges to come. My training had not prepared me for managing patients undergoing palliative care and treatment. Not that there was anything wrong with my training – quite the opposite – but the challenges of cramming the undergraduate curriculum into four years were immense then, as they are still. Palliative care was also a specialty finding its feet at that time.
I didn’t get that job but have never forgotten how underprepared I felt at that time, and on many occasions since. I have backed out of patients’ rooms feeling useless and intrusive, and often wondered how I could improve or add value to the therapeutic interaction. These sentiments were recently echoed by a colleague who reported a general perception that when a patient’s care transferred to a specialist palliative care team, it was time to “tap the mat and get out of the [boxing] ring”.
This perception of this ‘standard practice’ is not supported by the literature.
In this new century authors such as Pollens (2004) and Eckman and Roe (2005) have highlighted the role speech pathologists play in providing holistic and high-quality palliative and end of life care. The management of dysphagia, assessment and intervention for communication disorders, patient, family and carer support and education, and participating as part of the multidisciplinary team in treatment decisions and care planning are well understood roles.
Organisations such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) have set important policy directions in recent years for end of life care in the National Consensus Statement: Essential Elements for safe and high-quality end-of-life care. There is an emphasis on the roles of all health professionals to engage with patients, their families and carers in goal setting through true shared decision-making and advance care planning. Speech Pathology Australia is responding to the emerging policy context set by the ACSQHC and others through their Aged Care Working Party by considering speech pathologists’ roles and ethical issues at the end of life.
So how do we challenge our perceptions?
Thankfully, the last few years have seen the speech pathology research literature starting to build upon earlier work after a long hiatus, with authors such as Kelly et al., (2017) and Chahda et al., (2017) reinforcing professional roles and the importance of person-centred care at the end of life. We are moving away from service-focussed care planning that has seen the rise of negative terms such as ‘risk feeding’, toward person-centred care.
People with communication impairment and dysphagia need to be supported to assert their values, priorities and preferences into their own care and treatment planning. The aforementioned publications are important to support both early career and experienced speech pathologists in their role in the clinical care of patients approaching the end of life. But more is needed.
What can you do to help?
We need to support the literature on this topic, by consuming and engaging with the evidence. It is up to individual clinicians to consider how the evidence translates in their day-to-day practices. It may mean advocating for earlier referrals to palliative care services, actively participating in formal advance care planning or participating in local efforts to raise awareness of speech pathology roles in end of life and palliative care services.
Finding your feet in a ring full of challenges is never easy, but for those patients under our care, we must remember to never tap out.
CareSearch and palliAGED support all members of the multidisciplinary team to find evidence and guidance to improve practice in palliative care. The section for Speech Pathologists can be a good place to start as is the new eLearning section for allied health professionals.
Australian Commission on Safety and Quality in Health Care. (2015). National consensus statement: Essential elements for safe and high-quality end-of-life care. Sydney: ACSQHC.
Chahda, L., Mathisen, B.A. & Carey, L.B. (2017). The role of the speech-language pathologist in adult palliative care. International Journal of Speech-Language Pathology, 19, 58-68.
Eckman, S., & Roe, J. (2005). Speech and language therapists in palliative care: what do we have to offer? International journal of palliative nursing, 11(4), 179-181. doi:10.12968/ijpn.2005.11.4.28783
Kelly, K., Cumming, S., Corry, A., Gilsenan, K., Tamone, C., Vella, K., & Bogaardt, H. (2016). The role of speech-language pathologists in palliative care: Where are we now? A review of the literature. Progress in Palliative Care, Online: 1–8.
Pollens, R. (2004). Role of the speech-language pathologist in palliative hospice care. Journal of Palliative Medicine, 7(5), 694-702. doi:10.1089/jpm.2004.7.694
Wendy Pearse is the Principal Project Officer for End of Life Care, Sunshine Coast Hospital and Health Service, and a member of the Speech Pathology Australia Aged Care Working Party