Prognostication in post-stroke aphasia: speech pathologists’ clinical insights on formulating and delivering information about recovery

Abstract

Purpose

For people with post-stroke aphasia, “Will I get better?” is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists’ formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists’ clinical experiences, reasoning, and support needs in aphasia prognostication.

Materials and methods

Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis.

Results

Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there’s no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit.

Conclusions

Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.

Implications for Rehabilitation

• Aphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.

• Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.

• Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.

• Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.

Keywords:

• Aphasia
• stroke
• rehabilitation
• recovery
• prognostication
• clinical communication

Acknowledgements

We thank the speech pathologists who participated in this study, and Kelly Beak for providing feedback on the preliminary interview guide.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Australian Government under a Research Training Program Scholarship, and the National Health and Medical Research Council under a NHMRC Emerging Leadership Investigator Grant.