title: Speech pathologists' experience of involving people with stroke-induced aphasia in clinical decision making during rehabilitation.
abstract: OBJECTIVE
  Although client participation has been part of legislation and clinical guidelines for several years, the evidence of these recommendations being implemented into clinical practice is scarce, especially for people with communication disorders. The aim of this study was to investigate how speech pathologists experienced client participation during the process of goal-setting and clinical decision making for people with aphasia.
  
  
  METHODS
  Twenty speech pathologists participated in four focus group interviews. A qualitative analysis using Systematic Text Condensation was undertaken.
  
  
  RESULTS
  Analysis revealed three different approaches to client participation: (1) client-oriented, (2) next of kin-oriented and (3) professional-oriented participation. Participants perceived client-oriented participation as the gold standard. The three approaches were described as overlapping, with each having individual characteristics incorporating different facilitators and barriers.
  
  
  CONCLUSIONS
  There is a need for greater emphasis on how to involve people with severe aphasia in goal setting and treatment planning, and frameworks made to enhance collaboration could preferably be used. Participants reported use of next of kin as proxies in goal-setting and clinical decision making for people with moderate-to-severe aphasia, indicating the need for awareness towards maintaining the clients' autonomy and addressing the goals of next of kin.
  
  
  CONCLUSIONS
  Speech pathologists, and most likely other professionals, should place greater emphasis on client participation to ensure active involvement of people with severe aphasia. To achieve this, existing tools and techniques made to enhance collaborative goal setting and clinical decision making have to be better incorporated into clinical rehabilitation practice. To ensure the autonomy of the person with aphasia, as well as to respect next of kin's own goals, professionals need to make ethical considerations when next of kin are used as proxies in collaborative goal setting and clinical decision making.
authors.affiliation: a Department of Neuroscience, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway .
authors.forename: Karianne
authors.initials: K
authors.lastname: Berg
authors.affiliation: b Department of Public Health and General Practice , Norwegian University of Science and Technology , Trondheim , Norway .
authors.forename: Marit By
authors.initials: MB
authors.lastname: Rise
authors.affiliation: c Faculty of Health , School of Health & Social Development, Deakin University , Burwood , Australia .
authors.forename: Susan
authors.initials: S
authors.lastname: Balandin
authors.affiliation: d School of Psychology and Social Science, Edith Cowan University , Perth , Australia , and.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Armstrong
authors.affiliation: a Department of Neuroscience, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway .|e Department of Physiotherapy, Faculty of Health and Social Work , Sør-Trøndelag University College , Trondheim , Norway.
authors.forename: Torunn
authors.initials: T
authors.lastname: Askim
mesh_terms: D000328:Adult; D001037:Aphasia / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D009664:Norway; D010349:Patient Compliance / Q000523:psychology*; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D000066768:Rehabilitation Research; D013066:Speech-Language Pathology; D059039:Standard of Care; D020521:Stroke / Q000150:complications*
keywords: Aphasia; client participation; clinical decision making; goal-setting; stroke