The speech and language therapist’s role in supporting decision-making for people with aphasia : an international cross-sectional survey

Abstract

PURPOSE : This is the first study to describe how speech and language therapists (SLTs) support people with aphasia during decision-making conversations and mental capacity assessments across countries. METHODS : Convergent mixed methods design involving a descriptive, cross-sectional online survey. The survey was disseminated via social media and professional networks across the six World Health Organisation Regions. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS : One hundred ninety-five SLTs from 32 countries responded. Most respondents, especially those working in inpatient settings, had supported people with aphasia to make decisions as part of a general conversation or had enabled other professionals to provide decision-making support, including during capacity assessments. Fewer had been involved directly in capacity assessments. To do this work, respondents made use of different resources and methods to facilitate communication about decisions and information and practical support from family members and other professionals. Respondents identified a range of barriers and facilitators to practice, relating to multidisciplinary collaboration, the scope of practice for the SLT role, and access to sufficient time, education and guidance. CONCLUSIONS : Across countries, decision-making support for people with aphasia varies. Future research should explore clinical pathways and multidisciplinary training that might facilitate decision-making support for this group.

IMPLICATIONS FOR REHABILITATION • This study is the first to investigate how speech and language therapists (SLTs) around the world support people with aphasia to make decisions and take part in mental capacity assessments. • There are barriers to SLTs being able to provide this support, for example, other disciplines not seeking their involvement in decision-making processes. • When people with aphasia do not receive communication support to engage in decision-making, rehabilitation and care processes are less likely to be patient-centred. • Providing education to the multidisciplinary team about communication disability, decision-making and the SLT role and improved collaborative working processes may enable more people with aphasia to receive support.