The Role of Speech-Language Pathologists in Palliative Care: Exploring the Issues and Reaching Consensus

Abstract

Speech-language pathologists (SLPs) have become part of multidisciplinary palliative and end-of-life (EOL) care services progressively over the last 20 years. There has, however, been very limited research-based evidence and professional guidance in this valuable but emerging area of practice. A critical narrative review of published literature identified a general role for SLPs, but insufficient definition of the SLP role to guide clinical practice. A detailed examination of legislation, medico-legal and ethical literature produced a legal and ethical decision-making framework for palliative dysphagia management. A two-round eDelphi study defined key aspects of the role and agreed practice of SLPs in palliative and EOL care from the perspective of practicing SLPs. The first round identified that SLPs provide palliative intervention for people with a range of conditions in different service contexts, not just in specialist palliative care positions. Specific barriers and facilitators to working effectively were explored, and SLPs identified a gap between current practice and perceived best practice. The second round produced a set of 28 specific statements to define the role and agreed practice of SLPs. Patient access to appropriate intervention for communication and swallowing changes is emphasised, as part of comprehensive multidisciplinary care. The statements describe the diverse, patient-centred nature of these interventions, focusing on patients’ comfort and quality of life. Education of SLPs on palliative and EOL care during pre-professional training, and throughout their professional career, is supported to ensure SLPs understand their role and can provide care that is appropriate to this unique area. Ongoing research and better evaluation of the outcomes of SLP care is endorsed.