In this day and age we generally consider healthcare practice to be evidence-based. Unfortunately there are not always the plethora of research articles available that address the dilemmas of day-to-day clinical practice. This piece of work considers what factors influence treatment decisions in dysphagia management amongst speech and language therapists (SLTs). The article describes the results of a survey answered by 116 Irish SLTs. The survey was disseminated via two Dysphagia Special Interest Groups (with a total of 155 potential respondents) and remained open for a period of six weeks. The survey asked questions of the demographic background of the respondents and then invited them to rate a series of 32 dysphagia therapies and techniques on a five-point Likert scale as to whether they had used the interventions (ranging from never use to always use). They were then asked to provide reasoning for this response. Results highlighted three main interventions that dominate clinical practice: texture modification, thickening fluids and positioning changes. The least used items included mostly technological items. Respondents reported their predominant rationale for choosing interventions as client suitability and accumulated knowledge. The authors highlight that this may partly reflect a resistance to change once clinicians have a preferred set of therapies but may also reflect the current state of the evidence in this area. They emphasise that more attention (and research) needs to be paid to practice-centric influences in order to influence clinical decision making in the future. This is particularly relevant in the current economic climate where services are struggling to fund training and even journal access. It is likely that clinicians are more likely than ever to rely on their own experience than the evidence.

Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice.
McCurtin A, Healy C.

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Anna Volkmer

UCL, London, UK.

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