It is generally considered best practice that all moderate-high risk head and neck cancer patients are seen by a speech pathologist for assessment and education when commencing definitive or post-operative radiotherapy. However this is not always feasible in many centres due to high patient numbers and limited staffing. This study aimed to investigate the effectiveness of a speech pathology assistant (SP-A) role for swallowing screening and education for specific patients in a multidisciplinary head and neck treatment clinic.
A training module was established to up-skill the SP-A and to guide the screening and education to be undertaken. A pre-test post-test design was utilised comparing outcomes in two separate groups prior to and then following implementation of the SP-A role. Outcomes included: compliance with best practice, availability of speech pathology time to spend with complex patients, swallowing-related admissions and patient satisfaction.
Fifty-one patients were included pre-implementation and 35 patients post-implementation, with 16 (46%) patients identified for SP-A screening/education during the post-implementation period. The proportion of moderate-high risk patients seen by speech pathology pre-implementation was 63%, compared to 94% seen by either speech pathology or SP-A post-implementation, c2(1, N=61)= 9.244, p=0.002. There was a (non-significant) increase in speech pathology time spent with complex post-operative patients post-implementation (total minutes per patient: mean 279, SD=115, post-implementation vs 252, SD=144 pre-implementation). There was no increase in swallowing-related admissions, and a (non-significant) increase in patient satisfaction post-implementation, indicating no compromise to patient safety or satisfaction by implementing the SP-A role.
The implementation of a speech pathology assistant role for screening specific patients within the multidisciplinary head and neck treatment clinic allowed the delivery of best practice and increased time for speech pathologists to spend with complex patients, without compromising patient safety or satisfaction.