A. Description of the Study
• What was the purpose of the research?
The purpose of this research was to assess the barriers to speech and language services for head
and neck cancer (HNC) patients post-acute in rural settings. The researchers gathered data from
HNC patients and SLPs to better understand the factors that prohibit these patients from
receiving quality care in rural Australia.
• Does the problem have significance to medical SLP?
The problem is significant to our field because it impacts medical SLPs as they attempt to
transfer patients to local services in rural areas once being discharged from the hospital. The
problem also touches on the specialization differences between medical and local SLPs. Despite
both being clinicians, medical and local SLPs receive different training, which impacts the
patients they can service.
• Why is the problem significant/important?
This problem is important because as SLPs attempt to transfer their clients to local services, there
are a plethora of barriers that make it increasingly difficult for clients to receive services thus
impeding their progress. As SLPs, we have a responsibility to provide our patients with quality
services as well as reduce barriers to receiving services. Additionally, many of the barriers
presented in the study are a direct result of actions taken by SLPs. One barrier that directly
relates to our field is a reluctance of local SLPs to accept HNC patients. Many clinicians believe
that HNC patients should be treated in hospitals as those SLPs are more equipped to treat them.
Another barrier is the lack of SLPs in rural areas, which also makes it difficult for HNC patients
to receive services.
B.
Sample
• Who were the subjects?
The subjects were 13 HNC patients from rural Australia who received speech and language
services for post-acute care and 12 SLPs involved in HNC care.
• What were the inclusion criteria for participation in the study?
Inclusionary and exclusionary criteria were established for the HNC patients. Inclusionary
criteria included being an HNC patient who received SLP services for post-acute care between
November 2016 and April 2019 and live within the included health services catchment areas.
Exclusionary criteria included individuals with primary parotid/thyroid gland tumors and
individuals on palliative pathway.
• Are the size and key characteristics of the sample described?
The sample contained 13 HNC patients as well as 12 SLPs. Each HNC participant engaged in
individual semi-structured interviews with the primary investigator. The SLPs engaged in group
interviews, excluding SLPs who were the sole clinician within their setting. The HNC patients
discussed their experiences receiving services, while the SLPs discussed their experience
providing or transferring services. The data was then interpreted by the researchers.
• How representative is the sample?
It is not clear how representative the sample was. The researchers gathered HNC patients living
in rural areas as well as SLPs. However, there is no mention of age, race/ethnic background, or
SES.
D.
Clinical Significance
• How does the study contribute to the body of knowledge?
The study contributed to the body of knowledge by adding insight to barriers that impact
individuals in rural settings from receiving care. As SLPs, our mission is to provide care to as
many individuals as possible, therefore, acknowledging barriers that impede clients from
receiving services allows us to discover ways to dismantle them.
• Discuss implications related to practice/education/research
This study brings attention to difficulty accessing speech and language services for those in rural
areas, as most SLPs are located within the metropolitan areas. The study highlights a need for
SLPs to work in rural areas as services are typically limited. Additionally, the study provides
SLPs with an opportunity to learn how to better service individuals in rural areas by reducing the
existing barriers. It was discussed that local SLPs do not feel well equipped to treat HNC
patients. This study presents an opportunity to further explore that problem and discover ways in
which local SLPs can feel more confident accepting patients who were previously seen by
medical SLPs. One challenge to providing services mentioned is that local SLPs do not receive
the same training as medical SLPs. Perhaps this study can encourage local SLPs to pursue further
training or additional education. Furthermore, patients mentioned receiving quality care in the
hospital, but feeling alone and lost once being discharged. These patients have also received less
follow up appointments in comparison to patients living in the metropolitan areas. Overall, the
study provides a call for SLPs to come together, given the data gathered, to assess effective
methods to ensure all patients in need of speech and language services receive them.
• What additional questions does the study raise?
The study raises a few questions. First, why does there appear to be a disconnect regarding their
areas of specialization between medical and local SLPs? Local SLPs rejecting HNC patients due
to the belief that they require hospital treatment is harmful to rural patients who are unable to
commute to hospitals in the metropolitan areas. This leads to the second question: What can be
done to ensure local SLPs feel confident and competent enough to treat HNC patients? Third,
what can be done to increase the number of SLPs in rural areas? There are clearly insufficient
clinicians in the rural areas, and there may be barriers in place preventing SLPs from working in
those areas.
References
Foley, J, Nund, RL, Ward, EC, et al. Clinician and consumer perceptions of head and neck cancer
services in rural areas: Implications for speech pathology service delivery. Aust J Rural
Health. 2022; 30: 175– 187. doi:10.1111/ajr.12829