The SLP’s role in adult palliative dysphagia care : current practice trends in Malta

Abstract

The involvement of speech-language pathologists (SLPs) in palliative dysphagia care is crucial for maintaining the quality of life (QoL) of adult patients who are receiving palliative care, and are experiencing compromised swallowing. While the significance of the SLP's role in palliative care is widely recognized, several international studies have pointed out barriers to its implementation, particularly in addressing dysphagia management. However, local research in Malta is limited in this regard. A critical review by Azzopardi (2018) established practical guidelines for SLPs delivering palliative dysphagia care in Malta, yet there remains a lack of local scientific investigation into the current implementation of the SLP's role within this context. This study aimed to fill this gap by identifying perceptions regarding role and responsibilities, examining current practices, identifying barriers, and proposing measures for improvement. Through a mixed-method approach, data was collected via an online questionnaire completed by 20 SLPs currently working in palliative dysphagia care locally, along with 3 interviews. Results indicated that SLPs are aware of their role in enhancing quality of life, providing comfort, and ensuring safe swallowing through their management strategies. Despite the absence of local specific codes of practice, SLPs integrate their role as suggested by literature. Nonetheless, the need for clinical guidelines remains valid. Legal barriers were identified as hindering the fulfillment of the SLP's role, as they do not support the necessary shift from traditional care and impede the implementation of evidence-based practices such as comfort-feeding. Overall, there is a consensus among local SLPs regarding the necessity for further enhancement of undergraduate training and the significance of specialized training in the field of adult palliative dysphagia care.