Speech and Language therapy: to treat or not to treat: Transforming tacit knowledge into explicit knowledge

Abstract

Background: Speech and language therapists (SLT) use clinical reasoning, or evidence-based practice, to make decisions. One of three elements of evidence-based practice is the use of clinical expertise. One study showed that variation in the process of decision-making between English SLTs is due to their clinical expertise. Another report showed inequity in level, type and quality of SLT provision in the UK. The question arises if similar variation exists in the Netherlands. Aim and research question: To explore clinical reasoning the research question is: Which decisions do Dutch SLTs, working in SLT practices with children age 2;0 to 4;0 years, make upon giving indication for intervention, and which components comprise their decision-making process? Method: This explorative qualitative study consisted of two parts: sorting task and focus group. Eleven SLTs performed the sorting task. The information from the sorting tasks resulted in the focus group topic list. Four SLTs attended the focus group, where their clinical reasoning was elaborated. Analysis was done using thematic analysis. Results: During the decision-making process an SLT must consider many variables, e.g.: anamnestic questions, execution and outcome of diagnostic tests, intercollegial and/or expert consultation. The adopted decision-making strategy depends on multiple components: personal and professional experience, acquired cognitions, assumptions and knowledge, and information from other parties. Conclusion: When going through the decision-making process the Dutch SLTs show outcome variation. This can be attributed to differences in individual clinical expertise. As a result children with similar problems might receive different care depending on the SLT they visit, or possibly even no care at all. Recommendation: To reduce variation in service provision SLTs should strive to maintain broad knowledge and experience. They should consider rebalancing their use of different elements of evidence-based practice as well.