Clinicians' perceptions of candidacy for conversation partner training in aphasia: How do we select candidates for therapy and do we get it right?

Abstract

Background: Recent studies have demonstrated success in training partners to facilitate conversation in people with aphasia (e.g., Booth & Swabey, 1999; Kagan, Black, Duchan, Simmons‐Mackie, & Square, 2001). Among other issues highlighted by these studies are those related to partner selection and suitability, or candidacy, for such an approach, and whether outcome may be related to the characteristics of the conversation partner. This paper reports a study of speech and language therapists' perceptions of candidacy requirements for conversation partner training (CPT), exploring both the characteristics that clinicians attend to in judging candidacy for therapy of this nature and whether these have validity with respect to outcome. We wish to acknowledge the speech and language therapists from the Newcastle upon Tyne, York, and Manchester study groups, JG and PM for their willingness to partake in the study, Frauke Buerk for her involvement in delivering the intervention, and Janet Webster and Julie Morris for comments on earlier drafts. Aims: The study aimed first to determine the criteria used by clinicians when making decisions on candidacy of partners of people with aphasia and recruiting to conversation training programmes, and second to use these criteria to develop a method of profiling candidacy for potential partners attending training. The resulting profiling procedure was subsequently piloted within a single case design to evaluate the outcome of intervention against initial candidacy criteria. Methods & Procedures: A focus group methodology and questionnaires were used to establish the criteria on which experienced therapists based their judgement of conversation ability and their subsequent decisions to offer intervention involving CPT. Following an analysis of how frequently particular behaviours and attitudes needed to be present to influence therapists' decision making, a procedure to profile conversational partner characteristics (the Profile of Partner Candidacy for Conversation Training) was developed which integrated data from a structured interview and an analysis of conversation between the couple. The procedure was used to characterise the suitability of one carer, PM, who was subsequently offered a support and conversation training programme (Lock, Wilkinson, & Bryan, 2001) with his spouse who had aphasia. Post‐intervention analysis of conversation evaluated the effectiveness of CPT in the light of partner characteristics. Outcomes & Results: Clinicians identified a core set of conversational behaviours and attitudes or perceptions about communication as being influential in making decisions, with attitudes to communication being regarded as more influential than conversational behaviours in determining a good candidate for CPT; i.e., a partnership where a positive outcome would be anticipated. Profiling indicated that PM was a good candidate, overall, for CPT, demonstrating positive attitudes towards communication and numerous positive conversational features. However, some conversational behaviours were present that did not fall into the high‐candidacy band. These behaviours were successfully targeted in CPT, and the outcome of the training programme in the context of PM's candidacy profile was evaluated. Conclusion: Drawing on clinicians' perceptions to highlight partner characteristics has enabled a systematic method of profiling partner attitudes and conversation behaviours to be developed, with an emphasis on the attitudes of the partner. The case of PM demonstrates the positive but complex relationship between profiling behaviour and attitudes pre‐intervention and the outcome of intervention. This study is a preliminary attempt to address this clinically. It is recognised, however, that the use of the profile with a range of different partners is needed to further explore this relationship, along with the links between clinicians' perceptions and outcome. This may in turn assist in determining whether, and how, particular partner characteristics may influence response to intervention.