Defining the Speech and Language Therapist role in palliative care of neuro-oncology patients: A qualitative research study.

Abstract

Abstract Speech and language therapists (SLTs) are experts in the management of swallowing and communication disorders. Although there is increasing recognition of SLTs in palliative care, evidence specifically supporting their role with primary malignant gliomas (PMG) patients is lacking, despite the prevalence of swallowing and communication difficulties in this non-curable disease. This study aimed to explore the contribution of SLT to PMG, as perceived by SLTs themselves and by members of the regional neuro-oncology multidisciplinary team (MDT). Following ethical approval, semi-structured one-to-one interviews were conducted with ten SLTs working with PMG in outpatients and community settings across South East Wales. In addition, five members of the regional neuro-oncology MDT were interviewed. Thematic analysis was used to analyse the data and to identify and pinpoint salient themes. The findings indicate that despite lack of professional guidance and previous evidence, SLTs provided evidence to suggest that they contribute beyond swallowing and communication management, to areas such as shared decision-making, key-working, patient advocacy, advanced care planning and support for psychological wellbeing. However, these extended roles are inconsistently recognised by the MDT. Five barriers were identified which hampered SLT contributions: a perceived identity crisis affecting PMG patients, lack of confidence from SLTs, inconsistent MDT integration, reduced resources and strategic direction. The study suggests that SLTs need to promote and educate the MDT in order to achieve routine integration and enhance patient-centred and holistic care. The profession may also benefit from capturing the value of their involvement with PMG to drive service developments.