Prognostication in post-stroke aphasia: How do speech pathologists formulate and deliver information about recovery?

Prognostication is a complex clinical task that involves forming a prediction about recovery and communicating prognostic information to patients and families. In aphasia, recovery is difficult to predict and evidence-based guidance on prognosis delivery is lacking. Questions about aphasia prognosis commonly arise, but it is unknown how speech pathologists formulate and deliver information about expected recovery. An understanding of current practice in prognostication is needed to develop evidence-based guidelines for this process, and is necessary in order to ensure successful future implementation of recommended practice regarding prognosis delivery.

To identify the factors speech pathologists consider important when responding to questions about aphasia prognosis; to examine how they respond in different scenarios; and to evaluate their current attitudes towards aphasia prognostication.

A total of 54 speech pathologists participated in an online survey featuring hypothetical aphasia prognosis delivery scenarios, short-response questions and ratings. Open responses were analysed thematically. Multiple-choice responses were analysed using descriptive statistics and non-parametric tests.

Speech pathologists regarded factors relating to the nature and severity of post-stroke deficits, an individual's level of motivation and the availability of social support as most important for forming an aphasia prognosis. When delivering prognostic information, considerations of the recipient's emotional well-being, hope and expectations, and comprehension of information were regarded as most important. Speech pathologists' prognosis responses varied in content and manner of communication. The content of the responses included predictions of recovery and information about various attributes and activities contributing to recovery. Prognostic information was most frequently communicated through qualitative probability expressions, general statements and uncertainty-based expressions. A need for more professional support in aphasia prognostication was indicated.

There is variation in the way speech pathologists respond to questions about aphasia prognosis, and it is unknown how these conversations affect people with aphasia and their significant others. Further research to understand speech pathologists' clinical reasoning and professional support needs, and the perspectives of people living with aphasia, may help to develop an evidence-based approach to prognostication in aphasia. What this paper adds What is already known on this subject Questions about aphasia prognosis are difficult to answer. Current methods for predicting aphasia recovery are yet to demonstrate the reliability and individual specificity required for clinical application. At present, there is no evidence-based guidance or support for prognosis delivery in aphasia. What this study adds to existing knowledge There is variation in the way speech pathologists predict aphasia recovery, the prognostic information they deliver and the manner in which they communicate prognoses. Current approaches to aphasia prognostication are reliant on experience and professional judgement, and speech pathologists desire more support for undertaking this task. What are the potential or actual clinical implications of this work? Speech pathologists lack a consistent approach to aphasia prognostication and desire more support in this task. The present findings offer insight into clinician attitudes and practice, and provide a direction for future research to establish best-practice guidelines for this complex and demanding area of aphasia management.