Speak Out August 2021

Training to support end of life issues in clinical practice

A new training program has been designed to help speech pathologists understand and feel more confident about legal issues they face in end of life clinical practice.

Speech pathologists have a significant role in caring for and supporting patients at the end of life. In this area of practice, speech pathologists are often involved in decision-making relating to dysphagia assessment and treatment, and/or supporting patients to communicate their decisions, values and preferences. 1 Involvement in this type of decision-making requires knowledge and understanding of the law at end of life. However, research shows that some speech pathologists have knowledge gaps and lack confidence in this area. 2 The End of Life Law for Clinicians 3 Training Program has been designed to help speech pathologists understand and feel more confident about the legal issues they face in end of life clinical practice. Decisions about treatment and care for patients approaching the end of their lives are a frequent, and often challenging part of clinical practice for speech pathologists. The law plays an important role in these situations by providing a broad framework for end of life decision-making and advance care planning. It also establishes processes for resolving intractable disputes (e.g., with families/support networks or substitute decision-makers) and protects health professionals who act within the law. Speech pathologists play critical clinical and legal roles when providing end of life care. For example, when a patient does not have decision-making capacity or is a child, a speech pathologist will need to know who the patient’s substitute decision-maker is for consent to assessment and treatment. 1,4 Some speech pathologists also contribute to the assessment of a person’s capacity

to make medical treatment decisions e.g. when a person has communication difficulties. 5, 6 This may involve supporting a person to demonstrate they have capacity by ensuring that their communication needs are met during patient education and capacity assessment (maximising the person’s understanding), and assisting the person to communicate relevant information during a capacity assessment. 7 Speech pathologists facilitate informed choice and shared decision-making when working with patients who choose not to follow dysphagia recommendations (i.e., working with "risk feeding"). 5 They may also be involved in decisions to provide, withhold or withdraw modified foods and fluids or artificial nutrition or hydration (ANH), and contribute to assessments about whether treatments for dysphagia are likely to be futile or non-beneficial. 1,2 An example is whether ANH should be continued for people with end-stage dementia. Understanding the law on consent to and refusal of treatment can support speech pathologists in these situations. Another end of life legal role performed by speech pathologists is involvement in advance care planning (usually informally) about future treatments such as dysphagia management, ANH, or communication supports/interventions. 7 Where a patient has an advance care directive, the situation may require a speech pathologist to decide whether they are required to follow the patient’s directions about treatment. 1,7 Performing these roles successfully relies on having sufficient knowledge of the law that governs end of life decision-making. Recent research undertaken by our

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August 2021 | Speak Out