Screening for Dysphagia: Perspectives and Practices of Speech and Language Therapists in the Republic of Ireland

Abstract

Objective: Clinical guidelines place considerable emphasis on early swallow screening, as it has significant impact on patient outcomes. This study aims to examine perspectives and practices of speech and language therapists (SLTs) in the Republic of Ireland on swallow screening, exploring challenges in screening methods to improve practice and facilitate research. Methods: An 18-item web-based survey was devised targeting SLTs working in dysphagia in Republic of Ireland. Perspectives were sought on definitions of screening, models of practice, tests used, and factors influencing decision-making. Results: Fifty-eight SLTs responded, representing a cross section of clinical settings, populations, and experience. Screening tests most frequently employed were personal screening tests (80%). Important considerations reported in test selection were patient safety (100%), ease of use (97%), staffing (97.5%), and diagnostic accuracy (97.5%). Perceived challenges were staff training associated with screening. Conclusions: It is concerning that while diagnostic accuracy was recognised as important, most respondents used tests lacking in diagnostic accuracy. While the survey response rate was low, it is hypothesised that findings reflect practice. There is a need for SLTs to equip themselves with the skills to discern which screening test is most diagnostically accurate for clinical populations with further research to improve practice.

Investigation of Dysphagia Education and Practice Among the Speech and Language Therapists in Türkiye: A Descriptive Cross-Sectional Study

“…It is possible to conclude from the findings of our investigation that practice patterns related to dysphagia in Türkiye do not reflect the education and training provided at the universities and need to move towards closer to the level of international practice standards; similar to those in the developed nations. 12,32,33 National strategies that enhance the number of SLTs who are interested in swallowing disorders and as well as the clinical training opportunities with adequate clinical resources in the field would be critical for the development and enhancement of dysphagia services in Türkiye. Please rate the following questions from 0 to 4 (0=never, 1=rarely, 2=sometimes, 3=often, 4=always).…”

“…To collect data, an online survey was designed based on similar data collection tools used in previous studies. 9,12,13 Senior committee members provided feedbacks and comments regarding the clarity, length, and relevance of the questions before the survey was uploaded to the online platform. The content of the questions in the survey was designed to unravel the general level of dysphagia education, training, and practice among the SLTs in Türkiye.…”

“…To date, various studies have been conducted to investigate the establishment and improvement of dysphagia services and also the current practice for dysphagia management among SLTs. 9,12,[14][15][16]18 The studies that have been conducted in developing countries revealed that the number of available service providers in this field was limited, a team approach towards dysphagia management was lacking, and the clinic opportunities for SLTs to practice dysphagia evaluation and treatment were inadequate. These multiple challenges were reported as great barriers to the establishment and development of dysphagia services.…”

Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation

“…However, an interesting finding was the focus on experience rather than training as the guiding factor within clinical reasoning. Several articles within the dataset referred to the level and quality of experience amongst SLTs as being the preferred factor to guide clinical reasoning (Brodsky et al, 2019 ; Doeltgen et al, 2018 ; Jones et al, 2018 ; Mathers-Schmidt & Kurlinski, 2003 ; McAllister et al, 2016 ; McCurtin & Carter, 2015 ; McCurtin & Healy, 2017 ; Pettigrew & O’Toole, 2007 ; Rumbach et al, 2018 ; Walshe, Ryan, & Regan, 2017 ). Table 1 demonstrates this with several extracts from the dataset which support the use and preference of experience in clinical reasoning.…”

White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults

“…A clinical swallowing evaluation (CSE) is typically performed after screening for swallowing problems to provide additional information to ascertain the relative risk for aspiration and to direct clinical decision making [74]. CSE findings are important in determining whether an instrumental assessment may be required (if not already performed) and to decide which compensatory strategies and postural manoeuvres need to be prioritized for trialling to inform dysphagia therapy planning and patient management.…”