{"id":2345,"date":"2026-03-02T15:40:52","date_gmt":"2026-03-02T15:40:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=2345"},"modified":"2026-03-02T15:40:52","modified_gmt":"2026-03-02T15:40:52","slug":"speech-and-language-therapy-outcome-measures-in-palliative-care-why-a-new-approach-is-needed","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2026\/03\/02\/speech-and-language-therapy-outcome-measures-in-palliative-care-why-a-new-approach-is-needed\/","title":{"rendered":"Speech and Language Therapy Outcome Measures in Palliative Care: Why a New Approach is Needed"},"content":{"rendered":"

Authors:<\/em><\/p>\n

Karen Slyne<\/em><\/strong>
\nSpecialist Palliative Care Speech & Language Therapist, Milford Care Centre <\/span><\/i><\/p>\n

\"\"<\/a><\/p>\n

Madeline Hawkes<\/em><\/strong>
\nSpecialist Palliative Care Speech & Language Therapist, St Joseph\u2019s Hospice<\/span><\/i><\/p>\n

\"\"<\/a><\/p>\n

Identifying the gap in palliative care outcomes<\/b><\/p>\n

Outcome measurement in palliative care has traditionally prioritised medical and nursing perspectives, with limited attention to communication, swallowing, and oral comfort. As speech and language therapists (SLTs), we understand that communication, swallowing, and oral comfort shape a person\u2019s independence, dignity, and quality of life especially at end of life. But why do these speech and language therapy domains remain so poorly captured in routine outcome measurement?<\/span><\/p>\n

In 2025, recognising this gap, the Palliative Care Speech and Language Therapy Clinical Excellence Network (CEN) brought together a Working Party Group (WPG) of 11 SLTs from palliative care settings across the UK and Ireland. Our aim was to explore whether existing measures could successfully reflect SLT practice, and if not, consider what a specific SLT Outcome Measure might look like.<\/span><\/p>\n

Where existing measures fall short<\/b><\/p>\n

Our first step was to review the tools already used in palliative care. The Palliative Care Outcomes Collaboration Symptom Assessment Scale (PCOC SAS) was highlighted as a valuable tool because it is validated, brief, and allows proxy reporting which is key for use with people who may struggle to self-report, particularly as they approach end of life. One member of the group had previously tested the SAS \u201cOther\u201d domain as a means of recording communication and swallowing outcomes over a period of 12 months. Patients who used the measure following SLT intervention reported reduced swallowing burden (92%) and reduced communication burden (57%).<\/span><\/p>\n

The adapted SAS captured broad feedback from SLT interventions but it is not designed with communication or swallowing <\/span>complexity<\/span><\/i> in mind, and it relies heavily on patient self-rating. We know that patient self-rating is not always feasible for those with a communication impairment, cognitive decline, or severe fatigue. In essence, we recognised that the tool was helpful, but too general. We needed to create something specifically for SLT practice to capture the impact of SLT intervention.<\/span><\/p>\n

Towards an SLT-specific outcome measure<\/b><\/p>\n

As the work progressed, the group recognised that a therapist-led outcome measure could fill this gap. One member of the group developed a tool drawing on specific descriptors using an 11-point rating scale. The objective was to complement and not replace patient-reported measures, acknowledging that both perspectives are valuable, yet not interchangeable. Over four meetings, we refined the core descriptors and tested feasibility in routine clinical practice. Early reflections supported our conviction that relying solely on patient scoring within palliative care is not without limitations. A therapist-led measure could ensure that subtle but clinically meaningful changes such as reduced distress or burden during oral care, improved comfort when eating and drinking, or enhanced communication are recorded consistently.<\/span><\/p>\n

Early signs of reliability<\/b><\/p>\n

Five clinicians participated in informal inter-rater consistency testing using anonymised case studies. Four therapists provided identical scores across each rating point, while one deviated slightly by just 2 points. This suggests that, with further modification and clear descriptors, a therapist-led measure could achieve acceptable reliability.<\/span><\/p>\n

Why this matters now<\/b><\/p>\n

SLTs working in palliative care often see meaningful change that is difficult to measure using existing tools. In their daily work, SLTs support patients to enjoy sips of water or a spoon of ice cream without distress as well as supporting individuals to effectively communicate their final wishes to family and the wider team. These outcomes matter deeply. Yet they remain largely invisible within formal measurement systems in palliative care.<\/span><\/p>\n

As services come under increasing pressure to demonstrate impact, the absence of an SLT-specific tool risks undervaluing our contribution in palliative care. More importantly, it risks obscuring outcomes that matter most to patients.<\/span><\/p>\n

What\u2019s next?<\/b><\/p>\n

This report marks the beginning. The next phase will include:<\/span><\/p>\n