Between Necessity and Feasibility: A Qualitative Study on How Clinicians Navigate Bedside Voice Assessment

This study aims to provide critical insights into how speech-language pathologists (SLPs) approach bedside voice assessment in medical settings, highlighting assessment strategies, practical barriers, and the feasibility of integrating objective tools into routine care.

Twenty-five SLPs with experience in voice, swallowing, or upper airway disorders participated in semi-structured interviews conducted via Zoom. A hybrid inductive-deductive thematic analysis was applied to examine clinicians' perceptions of bedside voice assessment. Coding focused on assessment practices, barriers, research-practice translation, and the patient-centered role of voice in recovery.

Ten themes were identified across four domains: (1) clinical prioritization, (2) practical strategies, (3) research-practice gaps, and (4) patient-centered care. Clinicians consistently reported that swallowing takes precedence over voice assessment in medical care contexts due in part to workflow demands and risk prioritization. Limited access to instrumental tools and environmental constraints often led clinicians to rely on informal perceptual methods, non-standardized digital tools, and patient-reported outcomes. While these methods were practical, concerns were raised about their validity, particularly in complex inpatient populations. Many SLPs expressed frustration with the limited feasibility of implementing research-backed tools. Still, they emphasized the significance of voice for patients' emotional well-being and identity, describing vocal recovery as a marker of broader rehabilitation progress.

Despite systemic and logistical constraints, clinicians recognize voice assessment as critical to holistic patient care. Current practices are shaped by necessity rather than preference. Bridging the gap between research and practice-through portable tools, validated protocols, and clinician-researcher collaboration-is essential to ensure voice assessments are both feasible and meaningful in medical contexts.