Legal decision-making by people with aphasia: Critical incidents for speech pathologists

Ferguson, Alison, Duffield, Gemma and Worrall, Linda (2010) Legal decision-making by people with aphasia: Critical incidents for speech pathologists. International Journal of Language and Communication Disorders, 45 2: 244-258. doi:10.3109/13682820902936714

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Author Ferguson, Alison
Duffield, Gemma
Worrall, Linda
Title Legal decision-making by people with aphasia: Critical incidents for speech pathologists
Journal name International Journal of Language and Communication Disorders   Check publisher's open access policy
ISSN 1368-2822
Publication date 2010-03-01
Year available 2009
Sub-type Article (original research)
DOI 10.3109/13682820902936714
Open Access Status
Volume 45
Issue 2
Start page 244
End page 258
Total pages 15
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background: The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist.

Aims: The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations.Methods: &

Procedures: The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software.

Outcomes & Results: The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication.

Conclusions: & Implications: The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area.
© 2010 Royal College of Speech & Language Therapists.
Keyword Aphasia
Speech-language therapy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 31 December 2009

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
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Created: Sun, 14 Mar 2010, 10:04:33 EST