Speech pathologists

How speech pathologists address palliative care

Supporting the independence and quality of life of people with a life-limiting illness by helping them to manage difficulties associated with communication and/or swallowing.

Scope of practice

Speech pathologists provide services to people whose function is affected by communication or swallowing impairment. Communication disorders include difficulties with speaking, listening, or understanding language, reading, writing, social skills, stuttering and using voice. People who experience difficulties swallowing food and drinking safely can also be helped by a speech pathologist. [1,2]

The Scope of Practice in Speech Pathology is available on the Speech Pathology Australia website.

Speech pathologists may have roles of advanced or extended scope of practice which reflect a level of expertise within or beyond the established contemporary scope of practice. [3,4]

Role in palliative care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [5] It is useful well before death and not limited to care of the dying. [6,7]

In helping people with palliative care needs, a speech pathologist [6-12]:

• is led by the person’s symptoms and their sense of what is important to them to co-create realistic goals and expectations in the face of decline and impeding death within the context of a therapeutic relationship
• optimises the person’s ability to eat and drink in the safest, most comfortable way
• helps the person to enjoy eating, drinking and participating in mealtimes
• educates the person, their carers and family on safe swallowing techniques and expected decline in oral intake and ability to swallow
• advises on risk and benefits of feeding modes in cases of dysphagia
• educates the multidisciplinary team as to the swallowing status of the person
• may work with a pharmacist to assess and modify medication administration routes
• utilises a variety of methods to communicate meaningful and relationship sustaining conversations at different stages of life
• helps to optimise the person’s ability to communicate which may involve the use of communication strategies, communication tools, and alternative and augmentative communication systems
• assists the family, carers and treating clinicians to use strategies that optimise communication
• uses cognitive stimulation to improve or maintain communication function in people living with moderate to severe dementia
• assesses and supports strategies to manage oral care including excessive saliva production (drooling) and dry mouth
• may advocate for the person’s wishes to the palliative care or healthcare team
• liaises within the care team to promote best outcomes.

Although speech pathologists assess the safety and comfort of eating and drinking (swallowing status), the decision about what will support quality of life lies with the person, their family and carers. This decision may be a complex one for the person, their family and carers, and health professionals. [6,10,13] The Position Statement The Role of the Speech Pathologist in Supporting Informed Choice and Shared Decision Making in Dysphagia outlines the position of Speech Pathology Australia regarding the role of speech pathologists in supporting informed decision-making with people who choose not to follow dysphagia recommendations. This Position Statement is relevant to speech pathologists working with people of all ages: patients, carers, family members, and legal decision-makers.

As an integral part of the multi-disciplinary team, the speech pathologist also may advocate for the person’s wishes to the palliative care or healthcare team and provide the person and their carers/family with information and support during advance care planning. At times, the speech pathologist may help to support a person with communication difficulties to express their wishes about their will or advance care planning. The multidisciplinary team should liaise with the speech pathologist when a person with a communication difficulty wishes to discuss important issues that involve care, health, finances and legal issues. [6-9]

Palliative care is an emerging specialty area within the profession of speech pathology. [9,12,14] Speech pathologists may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [15] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [16]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

Using Evidence

Although speech pathologists are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

The International Centre for Allied Health Evidence at University of South Australia has a number of resources to support translation of evidence into practice.

Members of Speech Pathology Australia can access a section of the website: Evidence Based Practice (subscription required).

Guidelines

Clinical Guidelines from Speech Pathology Australia include:

• Augmentative and Alternative Communication - freely accessible
• Dysphagia (section 6.6.9 is entitled Palliative Care) - freely accessible
• Laryngectomy - member-only download
• Literacy - member-only download
• Tracheostomy Management - member-only download
• Working in a Culturally and Linguistically Diverse Society - member-only download

Guidelines specific to speech pathologists and palliative care in Australia have not been published, however, the Palliative Care Service Development Guidelines 2018 (332kb pdf) provides an overview of speech pathologists (as part of allied health) in palliative care. [16]

Resources for Patients, Carers and Families

Speech Pathologists have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers & Families provides links to useful information including fact sheets and printable resources speech pathologists can download and share.

Education

The National Palliative Care Strategy 2018 lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [17] This is also highlighted for the acute sector in the Guiding Principles of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [18]

The American Speech-Language-Hearing Association has information on End-of-life Issues in Speech-Language Pathology.

Courses

CareSearch lists a collection of Palliative Care eLearning resources for allied health for independent learning.