Evidence-Based Clinical Practice Guidelines for Communication Strategies to Support End-of-Life Decision-Making by Persons with Aphasia

Abstract

Background: Everyone has the right to participate in important life decisions. This includes decisions about end-of-life, which are relevant not only to those for whom death seems imminent. Persons with aphasia (PWA) may experience communication barriers that present challenges to their participation in such decisions. With appropriate communication support, PWA may be able to participate in end-of-life decision-making. Aim: The purpose of this research was to develop evidence-based clinical practice guidelines for communication strategies to assist speech-language pathologists (SLPs) in supporting PWA to make end-of-life decisions. Method: An exploratory sequential mixed method design was implemented. Guided by the framework of evidence-based practice, the study comprised three phases. Phase 1 (exploratory phase) entailed gathering data regarding communication strategies to support end-of-life decision-making by PWA. Phase 2 (development phase) involved synthesising the information gathered in Phase 1 in developing the guidelines. In Phase 3 (evaluation phase) the guidelines were appraised. Results: The outcome of this study is evidence-based clinical practice guidelines for SLPs to use when supporting PWA to make end-of-life decisions. The guidelines comprise a list of end-of-life decisions that PWA may be confronted with to make, as well as a list of communication strategies that support the different components of the decision-making process. An indication is given of the sources of evidence from which these decisions and communication strategies were derived. A description is given of challenges and facilitators to the decision-making process, and of ways to approach difficult conversations. The guidelines were appraised to be of a high quality. Conclusion: When provided with communication support, PWA can be included in complex decision-making. With their skills in facilitating the exchange of information, SLPs are in an ideal position to support complex decision-making by PWA. By informing clinical activities, these clinical practice guidelines aim to foster optimal participation by PWA in end-of-life decision-making.