Search

Speech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

BACKGROUND Eating, drinking, and feeding are individual acts signaling our values, our identity, our cultural alignment, and care giving. Humans need oxygen, a system to transport oxygen, and fuel (food and drink), but only with the last of these do we choose what, where and with whom. Swallowing difficulties (dysphagia) affect nine million adults in the United States. Health care providers report more discomfort with dysphagia decisions than other clinical interventions. Feeding is a unique form of clinical care because providers live in both worlds: eating, drinking and feeding as fundamentally and culturally part of 1) human experience and 2) clinical process. AIM To explore health care providers’ personal and professional attitudes to eating, drinking, and feeding focusing on the incongruities between the two perspectives. METHODS Two focus groups occurred with speech-language pathologists (total n=15) from rehabilitation settings and two groups with non-SLP front line providers (total n=15) from an urban health care network. Participants considered: 1) eating/drinking/feeding as a) a human experience, and b) a biomechanical task in dysphagia care, and 2) why health care providers may deviate from practice guidelines. Dialogue was audio recorded, transcribed and studied using Thematic Analysis. RESULTS A list of 33 codes gave rise to 8 themes: we eat and drink for health and life; meanings of food and feeding; nutrition/hydration versus food/drink; reasons for practice patterns; professional collaboration; patient control; economic concerns; improving things. Participants voiced concern that a) patients lose control over a highly meaningful life process, and b) health care providers do not recognize their role in this problem. Participants expressed inner turmoil with feeding interventions/decisions. BIOETHICAL SIGNIFICANCE Dysphagia intervention uniquely challenges and distresses people making decisions. Health care providers aim to do good but the definition o

Variability has long been known to be a primary feature of the disorder of stuttering (Bloodstein & Bernstein Ratner, 2008; Costello & Ingham, 1984; Yaruss, 1997a, 1997b). Many factors that affect variability have been investigated (Brown, 1937; Johnson & Brown, 1935; Quarrington, Conway, & Siegel, 1962) yet the typical range of variability experienced by speakers remains unknown. This study will examine the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency, duration, and types of stuttered events that occur on the tasks will be compared within and between speakers. The focus will be on describing variability in stuttering frequency and duration within speakers and attempting to detect consistent patterns between speakers.