Article

Although client participation has been part of legislation and clinical
guidelines for several years,
the evidence of these recommendations being
implemented into clinical practice is scarce, especially for people with
communication disorders.
The aim of this study was to investigate how speech
pathologists experienced client participation during the process of goal-setting
and clinical decision making for people with aphasia.
METHODS: Twenty speech
pathologists participated in four focus group interviews. A qualitative analysis
using Systematic Text Condensation was undertaken. RESULTS: Analysis revealed
three different approaches to client participation: (1) client-oriented, (2) next
of kin-oriented and (3) professional-oriented participation. Participants
perceived client-oriented participation as the gold standard. The three
approaches were described as overlapping, with each having individual
characteristics incorporating different facilitators and barriers. CONCLUSIONS:
There is a need for greater emphasis on how to involve people with severe aphasia
in goal setting and treatment planning, and frameworks made to enhance
collaboration could preferably be used. Participants reported use of next of kin
as proxies in goal-setting and clinical decision making for people with
moderate-to-severe aphasia, indicating the need for awareness towards maintaining
the clients' autonomy and addressing the goals of next of kin. Implications for
Rehabilitation Speech pathologists, and most likely other professionals, should
place greater emphasis on client participation to ensure active involvement of
people with severe aphasia. To achieve this, existing tools and techniques made
to enhance collaborative goal setting and clinical decision making have to be
better incorporated into clinical rehabilitation practice. To ensure the autonomy
of the person with aphasia, as well as to respect next of kin's own goals,
professionals need to make ethical considerations when next of kin are used as
proxies in collaborative goal setting and clinical decision making.

Langue : ANGLAIS