Article Summary of Clinician's Treatment Decisions

I have selected a peer reviewed article out of the International Journal of Speech-Language Pathology aimed at understanding speech-language pathologists decision for treatments of dysphagia and their rationale for selecting specific therapies and what factor lead that decision making (McCurtin & Healy, 2017).

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Dysphagia is the difficulty of swallowing that is present in many different population such as, neurological disorders, head and neck oncology, intellectual disability, physical disability (McCurtin & Healy, 2017). The rationale for this research is that clinical practices and treatments should be lead by evidence-based practice, in which clinicians make medical treatment decision based on research, practice evidence, and patient evidence (McCurtin & Healy, 2017).

The background knowledge on clinicians treatment decision of dysphagia is that tend a range of therapies is used, such as elements of individual therapies, adaptations of common therapies, and different therapies during at different stages of a client's treatment but that evidence-based therapy is not utilized as much in speech-language pathology decisions as other disciplines (McCurtin & Healy, 2017). Previous research on the topic illustrates that a clinician's experience, colleagues’ experiences, culture, an intervention’s characteristic, and resource availability are factors that contribute to their decision (McCurtin & Healy, 2017). This different approach to treatment decisions may be a result of a lack of high quality research evidence accessible to speech-language pathologist, which indicates that scientific foundations of treatments is not prominent component when choosing a therapy of dysphagia (McCurtin & Healy, 2017).

The methods used in the study was an electronic survey sent to 155 practicing speech-language pathologist, specifically on dysphagia in Ireland, in which 116 elect to participate in the survey (McCurtin & Healy, 2017). In the survey participants responded to how frequently they used a specific treatment or technique and select a one of the thirty-three drop down answer explaining their useage or lack of usage of the treatment. The dysphagia treatments asked about in the survey were obtained from a specialist speech-pathologist who were experts in different domains of treatment of dysphagia were asked to list and define different techniques (McCurtin & Healy, 2017).

It was found that the three most common treatments of dysphagia were texture modification, thickening fluids, and positioning changes (McCurtin & Healy, 2017). Clinicians who had more experience tended to have a larger range of therapies they used (McCurtin & Healy, 2017). Client suitability and clinician experience were found to be two large factors of treatment selection. In broader terms practice evidence (which encompasses clinician experience along with other clinician factors) and patient reasons made up eighty-nine percent of all reasoning. The most common reasons for not using selecting a particular treatment were lack of training on the technique or lack of suitability for the situation (McCurtin & Healy, 2017). The authors’ interpretation of the results were that bolus modification techniques were appealing for the treatment of dysphagia. Additionally, the results were interpreted that client susceptibility is a major consideration to take into account for clinical decisions. Client characteristics and the therapist’s knowledge largely make up the practice-based rules speech-language pathology use more when selecting treatments rather than evidence-based rules (McCurtin & Healy, 2017).

While I do think having a better understanding of why clinician make the treatment decisions they do is valuable I felt the resources devoted to this study could have been more valuable in other areas of dysphagia research such as exploring new treatment or examining the effectiveness of current techniques. I think one of the most valuable aspects found in this study was the major role that clinicians’ training and experience have on treatment decisions and the range of techniques used. This findings makes contributions not only in understanding clinicians decisions but in the education of speech-language pathologist. This study demonstrates the importance of experience on decision making, which raises questions of way to better instruct students by exposing them to more experiences early on to familiarize them with treatment. While the study did not specifically look at ways to better prepare Communication Sciences and Disorders and Speech-Language Pathology students in treating of dysphagia, this could be a future direction of the study. An improvement that could be in made for future research whether it be specific to research in the article or future directs would be to obtain a more representative sample of all speech-language pathologist. This study only used participants from Ireland, hurting its external validity, as its findings can only be generalized to speech-language pathologist in that country.

The researchers did a thorough job of ensuring to include multiple treatments of dysphagia as well as many different statements of reasoning as to why or whynot a speech-language pathologist uses that specific treatment. I think research methods which yielded that results of interest were done appropriately to answer the question of , why clinicians choose the therapy techniques they do. However, I think the methods used to obtain information on dysphagia treatments and their definitions was not appropriate as snowball sampling was used (McCurtin & Healy, 2017). Snowball sampling is a form of purposive samplings, that is biased as participants are asked to recommend acquaintances to also be in the sample. While it is helpful to find rare individuals, it is not representative because people are recruited through social networks (Morling, 2018). I understand researcher wanted to have experts identify and describe the treatments, but as a result of all of the experts being affiliated identification of treatments may be specific to that network or treatments described in a way not everyone would understand.