Speech Pathologists

Supporting the independence and quality of life of people with a life-limiting illness by helping them to manage difficulties associated with communication and/or swallowing.

Scope of practice

Speech pathologists provide services to people whose function is affected by communication or swallowing impairment. Communication disorders include difficulties with speaking, listening, or understanding language, reading, writing, social skills, stuttering and using voice. People who experience difficulties swallowing food and drinking safely can also be helped by a speech pathologist. [1,2]

The Scope of Practice in Speech Pathology is available on the Speech Pathology Australia website.

Speech pathologists may have roles of advanced or extended scope of practice which reflect a level of expertise within or beyond the established contemporary scope of practice. [3,4]

  

Check out the relevant evidence for Speech Pathologists:

Role in palliative care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [5] It is useful well before death and not limited to care of the dying. [6,7]

In helping people with palliative care needs, a speech pathologist [6-12]:

  • is led by the person’s symptoms and their sense of what is important to them to co-create realistic goals and expectations in the face of decline and impeding death within the context of a therapeutic relationship
  • optimises the person’s ability to eat and drink in the safest, most comfortable way
  • helps the person to enjoy eating, drinking and participating in mealtimes
  • educates the person, their carers and family on safe swallowing techniques and expected decline in oral intake and ability to swallow
  • advises on risk and benefits of feeding modes in cases of dysphagia 
  • educates the multidisciplinary team as to the swallowing status of the person
  • may work with a pharmacist to assess and modify medication administration routes
  • utilises a variety of methods to communicate meaningful and relationship sustaining conversations at different stages of life
  • helps to optimise the person’s ability to communicate which may involve the use of communication strategies, communication tools, and alternative and augmentative communication systems 
  • assists the family, carers and treating clinicians to use strategies that optimise communication 
  • uses cognitive stimulation to improve or maintain communication function in people living with moderate to severe dementia
  • assesses and supports strategies to manage oral care including excessive saliva production (drooling) and dry mouth 
  • may advocate for the person’s wishes to the palliative care or healthcare team
  • liaises within the care team to promote best outcomes. 

Although speech pathologists assess the safety and comfort of eating and drinking (swallowing status), the decision about what will support quality of life lies with the person, their family and carers. This decision may be a complex one for the person, their family and carers, and health professionals. [6,10,13]

As an integral part of the multi-disciplinary team, the speech pathologist also may advocate for the person’s wishes to the palliative care or healthcare team and provide the person and their carers/family with information and support during advance care planning.  At times, the speech pathologist may help to support a person with communication difficulties to express their wishes about their will or advance care planning. The multidisciplinary team should liaise with the speech pathologist when a person with a communication difficulty wishes to discuss important issues that involve care, health, finances and legal issues. [6-9]

Palliative care is an emerging specialty area within the profession of speech pathology. [9,12,14] Speech pathologists may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [15] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [16]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice Support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

A section on CareSearch includes examples of speech pathology practice and reflections in palliative care by way of allied health blogs, case stories and the voice of experience.

Using Evidence

Although speech pathologists are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

The International Centre for Allied Health Evidence at University of South Australia has a number of resources to support translation of evidence into practice.

Members of Speech Pathology Australia can access a section of the website: Evidence Based Practice (subscription required).

Guidelines

Clinical Guidelines from Speech Pathology Australia include:

  • Augmentative and Alternative Communication - freely accessible
  • Dysphagia (section 6.6.9 is entitled Palliative Care) - freely accessible
  • Laryngectomy - member-only download
  • Literacy - member-only download
  • Tracheostomy Management - member-only download
  • Working in a Culturally and Linguistically Diverse Society - member-only download

Guidelines specific to speech pathologists and palliative care in Australia have not been published, however, the Palliative Care Service Development Guidelines 2018 (332kb pdf) provides an overview of speech pathologists (as part of allied health) in palliative care. [16]

Resources for Patients, Carers and Families

Speech Pathologists have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers & Families provides links to useful information including fact sheets and printable resources speech pathologists can download and share. 

Education

The National Palliative Care Strategy 2018 (6.16MB pdf) lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [17] This is also highlighted for the acute sector in the Guiding Principles of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [18]

The American Speech-Language-Hearing Association has information on End-of-life Issues in Speech-Language Pathology.

Courses

CareSearch lists a collection of  Palliative Care eLearning resources for allied health for independent learning.

 

  1. Speech Pathology Australia (SPA). What is a speech pathologist? [Internet]. 2016 [cited 2019 Nov 7].
  2. Allied Health Professions Australia (AHPA). Speech Pathology [Internet]. 2017 [cited 2019 Nov 7].
  3. Queensland Health. Extended Scope of Practice [Internet]. 2016 [updated 2016 Apr 12; cited 2019 Nov 7].
  4. Government of South Australia, SA Health. Allied Health Practice Profiles: Speech Pathology (532kb pdf). Adelaide: SA Health; 2017.
  5. Pautex S. Rehabilitation for Palliative Care and End-of-Life Management. In: Masiero S, Carraro U, editors. Rehabilitation Medicine for Elderly Patients. Cham, Switzerland: Springer International Publishing; 2018.
  6. Kelly K, Cumming S, Corry A, Gilsenan K, Tamone C, Vella K, et al. The role of speech-language pathologists in palliative care: Where are we now? A review of the literature. Prog Palliat Care. 2016;24(6):315-23.
  7. The contribution to palliative care of allied health professions. In: Watson MS, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford Handbook of Palliative Care. 3rd ed. Oxford: Oxford University Press; 2019.
  8. Chahda L, Mathisen BA, Carey LB. The role of speech-language pathologists in adult palliative care. Int J Speech Lang Pathol. 2017 Feb;19(1):58-68. doi: 10.1080/17549507.2016.1241301. Epub 2016 Oct 20.
  9. Luckett T, Reid KLP. Speech and language therapy in palliative care. In: Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC, editors. Oxford Textbook of Palliative Medicine. 5th ed. Oxford: Oxford University Press; 2015.
  10. Krikheli L, Mathisen BA, Carey LB. Speech-language pathology in paediatric palliative care: A scoping review of role and practice. Int J Speech Lang Pathol. 2018 Oct;20(5):541-553. doi: 10.1080/17549507.2017.1337225. Epub 2017 Jun 30.
  11. Swan K, Hopper M, Wenke R, Jackson C, Till T, Conway E. Speech-Language Pathologist Interventions for Communication in Moderate-Severe Dementia: A Systematic Review. Am J Speech Lang Pathol. 2018 May 3;27(2):836-852. doi: 10.1044/2017_AJSLP-17-0043.
  12. O’Reilly AC, Walshe M. Perspectives on the role of the speech and language therapist in palliative care: An international survey. Palliat Med. 2015 Sep;29(8):756-61. doi: 10.1177/0269216315575678. Epub 2015 Mar 11.
  13. The Speech Pathology Association of Australia Limited. Clinical Guideline: Dysphagia. Melbourne: 2012.
  14. Pascoe A, Breen LJ, Cocks N. Being prepared for working in palliative care (99kb pdf). Journal of Clinical Practice in Speech-Language Pathology. 2015;17(2):82-4.
  15. The Royal Australian College of General Practitioners (RACGP). RACGP aged care clinical guide (Silver Book). RACGP; 2019.
  16. Palliative Care Australia (PCA). Palliative Care Service Development Guidelines. Canberra: PCA; 2018 Jan.
  17. Australian Government Department of Health. National Palliative Care Strategy 2018. Canberra: Australian Government Department of Health; 2019 Feb 22.
  18. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Consensus Statement: essential elements for safe and high‑quality end-of-life care. Sydney: ACSQHC, 2015.

CareSearch Articles

As part of the CareSearch Engagement Project, the following articles published in the Speech Pathology Australia magazine (2019) describe the role of speech pathology in palliative care, tools that can help speech pathologists to care for people approaching the end of their life, and the importance of self-care. These articles may be useful for speech pathologists new to palliative care seeking to develop their understanding of their role. These may also be useful resources to share with other health professionals interested in understanding the role of speech pathology in palliative care:

Case stories

Blog

Video

Special Interest or Support Groups

  • Australian Allied Health in Palliative Care (AAHPC) is a group developed to facilitate and promote research and to be a voice to promote and raise the profile of allied health in palliative care. Contact Chair Deidre Morgan, Pauline Cerdor or aahpc.committee@gmail.com
     
  • Speech Pathology Australia website hosts information about special interest groups such as SPECS, Speech Pathology Head and Neck Cancer Google Group and state-based dysphagia interest groups.
     
  • Palliative Rehabilitation Facebook page allows sharing of information amongst people with an interest in palliative rehabilitation.

 

Last updated 14 November 2019