JCPSLP Vol 23, Issue 1 2021

Speech pathology: An agile and responsive profession

Client and student perceptions of a group-based, student-led service model “Dysphagia Afternoon Tea” A feasibility study Shelley Gapper, Rachel Wenke, Melissa Lawrie, and Elizabeth Cardell

This study explored the feasibility and impact of a novel student-led group-based intervention—Dysphagia Afternoon Tea (DAT)—delivered to community-dwelling people with chronic dysphagia. Community- dwelling individuals with chronic dysphagia (M 70yrs; SD 9.71) participated in the DAT. Participants with dysphagia (n = 20) and students (n = 24) completed questionnaires satisfaction of the group. Participants with dysphagia reported high satisfaction and significantly increased confidence ( p = 0.002) and understanding of their swallowing ( p = 0.003) following the group. Students reported statistically significant improvements in 11 out of 12 items related to confidence ( p = <0.009), all eight questionnaire items assessing dysphagia knowledge ( p = <0.02), and reduced anxiety about working with adults with dysphagia ( p = 0.001). Student-led group-based intervention may be a feasible service-delivery model for managing people with milder dysphagia in the community and may facilitate dysphagia skill development in students. Further research into clinical outcomes and cost effectiveness of the model should be considered. D ysphagia is the medical term used to describe difficulty swallowing or inefficient or unsafe transit of food and fluid from the oral cavity to the stomach. Serious complications can be associated with dysphagia including dehydration, malnutrition, and aspiration pneumonia (Kayser-Jones & Pengilly, 1999; Marik & Kaplan, 2003). Moreover, dysphagia can have a significant impact on an individual’s well-being and quality of life (Eslick & Talley, 2008). For clients with chronic dysphagia living in the community, ongoing and regular speech-language pathology (SLP) management is essential to reduce the risk of associated secondary complications such as aspiration pneumonia, reduce the high incidence of hospital before and after the DAT assessing knowledge, confidence, anxiety and

readmissions, and address anxiety associated with living with dysphagia (Drozdz et al., 2014; Sura et al., 2012). There are known increased demands on health care services within the community setting due to the ageing population, and more people living with complex and chronic conditions (Howells et al., 2019). The prevalence of chronic dysphagia continues to increase, particularly in the chronic obstructive pulmonary disease and neurological degenerative disease populations (Marik & Kaplan, 2003; Sura et al., 2012; Terada et al., 2010). In addition, hospitals are directing health care to outside of the hospital setting for these population groups to facilitate promotion of person- centred care and self-empowerment (Howells et al., 2019). As a result, many public health settings, SLP services for chronic dysphagia (i.e., community health setting and hospital dysphagia outpatients) are continuing to receive an increased number of referrals. These population groups require regular reviews to promote self-management of their deficits, implementation of compensatory strategies and in some cases, dysphagia rehabilitation to optimise swallowing function (Howells et al., 2019). To address the issue of increased referrals without commensurate increases in SLP services, SLPs working with other populations have started trialling group-based interventions in the community. Such groups include people with aphasia (Rodriguez et al., 2013; Wenke et al., 2014) and dysarthria (Bridle et al., 2013; Edwards et al,, 2018) and have demonstrated positive results for clients and services. With the exception of the Port Kembla initiative (Hogg, 2010), which used a participation group model for community dysphagia management, group-based service models have had limited application to dysphagia management. The Port Kembla initiative involved swallow screening within a social group morning tea context delivered by two qualified SLPs (Hogg, 2010). However, this model of care has not been evaluated formally or published. More recently, Howells et al. (2019) completed a survey with SLPs across Australia regarding access to SLP community access for people with dysphagia. The study found that 9% of SLPs utilised group treatment sessions for dysphagia management in some capacity; however, the nature of these groups was not described (Howells et al., 2019). Apart from these findings, there appears to be no other known reports of group-based models of dysphagia management. Student-led clinics In addition to group-based models, another service delivery model which may assist in reducing waiting times and meet

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS ASSESSMENT COMMUNITY DYSPHAGIA GROUP STUDENT-LED

Shelley Gapper (top) and Rachel Wenke

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology