May Susann, Mühlensiepen Felix, Plotho Laura, Darkow Robert
Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Brandenburg, Germany.
AGEIS, Université Grenoble Alpes, Saint-Martin-d'Heres, Auvergne-Rhône-Alpes, France.
BMJ Open. 2024 Dec 3;14(12):e085849. doi: 10.1136/bmjopen-2024-085849.
Clinical guidelines recommend high-frequency speech therapy for people with aphasia. Little is known about the experiences of people with aphasia with high-frequency speech therapy, why they do not receive it, what they expect from it and their general wishes and requirements for therapy. The aim of this qualitative study was to investigate the reasons for refusing high-frequency speech therapy and therapy preferences of patients with aphasia.
An interview study with people with aphasia.
Interviewees were recruited via snowball sampling in different settings of healthcare system (eg, speech and language practices, self-help groups, clinics of neurorehabilitation).
Twenty-one people with aphasia and one relative participated in semi-structured interviews.
We identified five categories of not using high-frequency speech therapy: patient-related factors, health system-related factors, disease-related factors, social-economic factors and organisational factors. Most reasons for non-utilisation are within the domain of the healthcare system and are partly attributable to personnel shortages in care provision and knowledge deficits among healthcare practitioners. Patient therapy preferences notably pertain to the enhancement of speech therapy services, encompassing sessions both inclusive and exclusive of family members as well as the facilitation of information dissemination.
As expected, there were indications of a lack of staff, poor care in rural areas and the influence of being affected by aphasia for a longer period on utilisation behaviour. These factors in the healthcare system and organisational factors are not unknown to those with practical experience, and some of them must and could be changed quickly. This would require a change from the established face-to-face setting in presence to sufficient digital therapy adjuvants. The results of patient-related factors could be a further reason to reflect on speech therapy and its settings and to view and treat people with aphasia in a more holistic, less language-focused way.
临床指南推荐对失语症患者进行高频言语治疗。对于失语症患者接受高频言语治疗的体验、他们未接受该治疗的原因、对该治疗的期望以及他们对治疗的总体愿望和要求，我们了解甚少。这项定性研究的目的是调查失语症患者拒绝高频言语治疗的原因以及治疗偏好。
对失语症患者进行访谈研究。
通过滚雪球抽样在医疗系统的不同场所（如言语治疗诊所、自助小组、神经康复诊所）招募受访者。
21名失语症患者和1名亲属参与了半结构化访谈。
我们确定了不使用高频言语治疗的五类因素：患者相关因素、卫生系统相关因素、疾病相关因素、社会经济因素和组织因素。未使用的大多数原因属于医疗系统范畴，部分归因于护理人员短缺以及医护人员的知识不足。患者的治疗偏好尤其涉及言语治疗服务的改进，包括有家庭成员参与和没有家庭成员参与的治疗课程以及信息传播的便利。
正如预期的那样，有迹象表明存在工作人员短缺、农村地区护理质量差以及失语症患病时间较长对治疗利用行为的影响。医疗系统中的这些因素和组织因素对于有实际经验的人来说并不陌生，其中一些因素必须且可以迅速改变。这将需要从现有的面对面治疗模式转变为充分利用数字治疗辅助手段。患者相关因素的结果可能是进一步反思言语治疗及其设置，并以更全面、更少以语言为中心的方式看待和治疗失语症患者的另一个原因。
