Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

Abstract

BackgroundCommunication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs.MethodsSpeech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.Results320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.ConclusionsThere are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

“…Although the NZ context of this study is unique, the key findings that guideline characteristics, hospital policies, resources, patient and family characteristics and therapist characteristics are all influential factors in guideline implementation are consistent with international studies with a variety of health professional participants [3,[12][13][14][15][16].…”

“…These resources could include inadequate staffing, physical resources (e.g. equipment and hospital beds), and time [3,13,15,16]. Lack of time was frequently mentioned as a barrier and has consistently been reported as a major influencing factor throughout relevant literature.…”

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

“…Consistent with previous studies, participants in this study also expressed that any pathway designed should include the capacity to audit performance (Hadely et al, 2014;Miao et al, 2015), however given the desire to devolve accountability to clinicians it is perhaps prudent to ensure that ownership of the audit-feedback cycle lies with clinicians.…”

“…Participants in this study keenly supported the notion of a standardised, evidence-supported care pathway for acute aphasia management. Consistent with knowledge transfer and exchange models (Graham et al, 2006), each stage of the knowledge creation process -design, implementation, and evaluation -should be tailored to the needs of the potential users (Hadely, Power, & O'Halloran, 2014;Miao et al, 2015).…”

“…Findings from recent research into guideline implementation by speech pathologists suggest that in order to enhance the uptake of such pathways, a number of strategies may need to be utilised at the design, implementation, and evaluation stages of development (Hadely et al, 2014;Miao et al, 2015). Consistent with knowledge transfer and exchange models (Graham et al, 2006), each stage of the knowledge creation process should be tailored to the needs of the potential users.…”