JCPSLP Vol 23 Issue 2 2021

Gillman, A., Winkler, R., & Taylor, N. F. (2017). Implementing the Free Water Protocol does not result in aspiration pneumonia in carefully selected patients with dysphagia: A systematic review. Dysphagia , 32 (3), 345–361. https://doi.org/10.1007/s00455-016-9761-3 Groher, M. E., & Groher, T. P. (2012). When safe oral feeding is threatened: End-of-life options and decisions. Topics in Language Disorders , 32 (2), 149–167. https:// doi.org/10.1097/TLD.0b013e3182543547 Lazarus, C. (2004). Syringe feeding in long-term care. ASHA Leader , 9 (13), 3–25. https://doi.org/10.1044/ leader.FTR3.09132004.3 Lazenby-Paterson, T. (2020). Thickened liquids: Do they still have a place in the dysphagia toolkit? Current Opinion in Otolaryngology & Head and Neck Surgery , 28 (3), 145–154. https://doi.org/10.1097/ MOO.0000000000000622 Lippert, W. C., Chadha, R., & Sweigart, J. R. (2019, May). Things we do for no reason: The use of thickened liquids in treating hospitalized adult patients with dysphagia. Journal of Hospital Medicine , 14 (5), 315–317. https://doi.org/10.12788/jhm.3141 McCurtin, A., & Healy, C. (2017). Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice. International journal of speech language pathology , 19 (1), 69–76. https://doi.org/10.310 9/17549507.2016.1159333 McHorney, C. A., Kesterson, J., Williams, L., & Tierney, W. (2003). Relating quality-of-life scores to future sentinel clinical events and health care utilization. Clinical Therapeutics , 25 , D19–D20. doi:10.1016/s0149- 2918(03)80257-6 Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science , IS, 6 (1), 42–42. https://doi.org/10.1186/1748-5908-6-42 Ney, D. M., Weiss, J. M., Kind, A. J. H., & Robbins, J. (2009). Senescent swallowing: Impact, strategies, and interventions. Nutrition in Clinical Practice , 24 (3), 395–413. https://doi.org/10.1177/0884533609332005 O’Keeffe, S. T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatrics , 18 (1), 167–167. https://doi. org/10.1186/s12877-018-0839-7 Park, B. H., Seo, J. H., Ko, M. H., & Park, S. H. (2013). Effect of 45° reclining sitting posture on swallowing in patients with dysphagia. Yonsei medical journal , 54 (5), 1137–1142. https://doi.org/10.3349/ymj.2013.54.5.1137 Royal College of Speech and Language Therapists (RCSLT). (2021a). RCSLT competencies in eating, drinking, and swallowing for the pre-registration education and training of speech and language therapists. https://www.rcslt.org/wp-content/ uploads/2021/02/RCSLT-Competencies-in-EDS- for-pre-registration-education-and-training-of-SLTs_ February-2021.pdf Royal College of Speech and Language Therapists (RCSLT). (2021b). Curriculum guidance for the pre registration education of speech and language therapists. https://www.rcslt.org/wp-content/uploads/2020/08/ RCSLT-Curriculum-Guidance-March2021.pdf

strategies. This may have influenced strategy choices made by SLPs, particularly those newly graduated. Response bias must be considered, as question phrasing can influence participants to choose a desired response rather than reflection of actual practice and knowledge. An other category was included but rarely used. Important treatment strategies—for example, oral care, upright position, awake and alert, and environmental modifications—were not specifically named within the study and it was noted that these were not added by respondents. Conclusions This study benchmarks what safe drinking strategies SLPs are recommending to patients with dysphagia. The clinical decision-making that underpins the selection of drinking aids/equipment to support safe drinking can be complex. Influencing how drinks are delivered to the oral cavity could help control the bolus size delivered, the pace of delivery, encourage a head position that increases safety (chin down head posture) and/or help a person to drink independently, reducing a known predictor of pneumonia. Achieving greater clarity and specificity around clinicians’ classification of alternative delivery strategies could contribute deeper insights into their clinical decision making regarding the use of various drinking aids and pieces of equipment that alter how drinks are delivered. implementation science (Bauer et al., 2015; Michie, van Stralen & West, 2011). The implication for further research includes potential for comparative studies in other national contexts, as well as highlighting the need for appropriate designs to elicit deeper insights into the influences on SLPs’ clinical reasoning when recommending drinking strategies. Training for SLPs needs to ensure not only high levels of clinical skills but should also explicitly promote knowledge of the relevant EB and how to implement practice change. The findings of this survey support the case that further “studies detailing the mapping of EBP decision-making in dysphagia rehabilitation” (Carnaby & Harenberg, 2013, p. 573) are still needed for this aspect of dysphagia practice. References Baijens, L. W. J., Clave, P., Cras, P., Ekberg, O., Forster, A., Kolb, G. F., Leners, J.-C., Masiero, S., Mateos-Nozal, J., Ortega, O., Smithard, D. G., Speyer, R., & Walshe, M. (2016). European Society for Swallowing Disorders European Union Geriatric Medicine Society white paper: Oropharyngeal dysphagia as a geriatric syndrome. Clinical Interventions in Aging , 11 , 1403–1428. https://doi. org/10.2147/CIA.S107750 Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology , 3 (1). doi:10.1186/s40359-015-0089-9 Carnaby, G. D., & Harenberg, L. (2013). What is “usual care” in dysphagia rehabilitation: A survey of USA dysphagia practice patterns. Dysphagia , 28 (4), 567–574. https://doi.org/10.1007/s00455-013-9467-8 Castellanos, V. H., Butler, E., Gluch, L., & Burke, B. (2004, Aug). Use of thickened liquids in skilled nursing facilities. Journal of the American Dietetic Association , 104 (8), 1222–1226. https://doi.org/10.1016/j. jada.2004.05.203 Establishing reliable data on current practice is an essential step in behaviour change models of

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology