JCPSLP Vol 23 Issue 2 2021

Method An online survey using Survey Monkey (http://www. surveymonkey.com) was used to collect self-reported data in a systematic way from a national sample of respondents. The survey was approved by University College London Research Ethics panel (STEMH 729). Participant consent was assumed on submission of a completed anonymous survey. The lead researcher formulated the first draft of the survey which was piloted with 27 local SLPs. The questions were then refined by making minor wording amendments. Specifically, the term “children with learning disability” clinical population was renamed “children in community”; the years of experience was changed to avoid overlap between groups; some questions were reworded for clarity; and an additional question was added to ask participants what they regarded as the highest priority for research related to safe drinking in their area of practice. These 27 pilot responses were excluded from the analysis of the main sample. The survey comprised 10 questions using a combination of question styles, including drop down options, 5-point Likert scale questions and open-ended questions for participants’ free text responses. The survey was expected to take less than 20 minutes to complete. All UK SLPs practising in the field of dysphagia with any clinical population were eligible to complete this survey, irrespective of the client group or their workplace setting (including National Health Service organisations and independent practices). The link to the anonymous online survey was disseminated on social media and by direct emails via clinical networks. Snowball recruitment was achieved by encouraging SLPs to forward the survey link to other SLP colleagues working in dysphagia. No identifiable personal data was collected and there was no direct benefit for participants to take part in the study. The survey was closed after 6 weeks. Seven safe swallowing strategies were listed in the survey with an additional option for respondents to include alternative specified techniques. Some of the specified strategies are well known and frequently recommended in clinical practice, such as the use of thickener. Other strategies are less conventional and potentially less well- known, such as syringe drinking, but included in our survey to capture clinically observed or reported strategies being used. 1. Thickener is the term used to describe recommending a fluid consistency that is thicker than water. A thickener product can be added to a liquid and binds to form a thickened drink which reduces the speed of flow through the oropharynx. Thickener is a well-known and frequently recommended strategy (Castellanos et al., 2004). 2. Drinking techniques encompasses a group of strategies and is the term used to capture any postures or techniques that change the timing of drinking or bolus flow on swallowing. Examples of drinking techniques in this study included pacing, chin tuck, head turn, head tilt, double swallow, swallow cough swallow, forced swallow. 3. Alternative delivery was the term used to capture the many different ways fluid could be placed into the mouth. For example, using a teaspoon, straw or modified cups. Based on the authors’ clinical experiences and knowledge there are many alternative delivery strategies being used by SLPs.

as a compensatory management approach in cases of poor airway protection, despite limited supporting evidence (Groher & Groher, 2012). Over the past decade the evidence for routine use of thickeners has been increasingly challenged, with the resultant controversy cited as demonstrating “a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners” (O’Keefe, 2018, p. 1). There is now a substantial and growing body of robust evidence across many clinical populations that the use of thickeners may lead to serious health consequences and patient-reported decline in quality of life (Lazenby-Paterson, 2020). Other empirical studies have identified considerable variability in therapy approaches for safe drinking. Carnaby and Harenberg’s (2013) study indicated sparse adoption of EBP; although practitioners were not asked to clarify reasons underlying their treatment decisions, the authors inferred that this may be driven by “a clinician’s familiarity and comfort with particular strategies” (Carnaby & Harenberg, 2013, p. 573). Speyer et al. (2010) emphasised the pressing need for research priorities to address this issue of lack of transparency in clinical decision-making and awareness of the recent EB. However, the number of robust intervention effectiveness studies is relatively low and many are methodologically weak (Speyer et al., 2010). While SLPs understand the drivers for EBP, embedding this into routine practice remains weak: “while studies of clinical practice point to an appreciation for EBP within the discipline generally, there is also an under-use of it to inform speech- language pathologists’ clinical decisions” (McCurtin & Healy, 2016, p. 69). Ensuring that SLPs keep up to date with the EB, use critical thinking to inform their practice and have skills to apply relevant evidence from one clinical group to another clinical area remains a significant challenge. Above all other areas of SLP clinical practice, interventions with individuals who have any risk of dysphagia demand absolute duty of care and professionalism. SLPs have traditionally learned their clinical skills through courses, training materials, books and by observing others. The extent to which research publications and evidence-based guidelines directly impact on routine practice is one of the concerns that prompted this survey. The dysphagia practice standards for SLPs in UK are now based on a highly detailed competency framework that has recently been updated (RCSLT, 2021a). SLP students complete their theoretical learning in line with the published curriculum guidance (RCSLT, 2021b). The aim is to ensure graduates have entry level knowledge and skills in eating drinking and swallowing (EDS) in order to appropriately assess and manage non-complex cases. SLP graduates are then required to undertake a more advanced EDS training in their workplace with support from experienced SLPs. Two distinctive challenges remain, however. First is the considerable gap in knowledge and skills within the existing SLP workforce, with limited access to EDS-experienced SLP professionals needed for training and supervision. Second is the broader challenge across all health care services to achieve effective and timely implementation of new research findings into clinical practice. This study therefore aims to capture and explore how frequently SLPs in the UK recommend safe drinking strategies, how they rate their skills in using the strategies, and their knowledge of the evidence base to support those strategies.

Carlotta Griseri (top) and Hazel Roddam

81

JCPSLP Volume 23, Number 2 2021

www.speechpathologyaustralia.org.au