System development

Systems should be established to ensure involvement of people with aphasia and their family as part of the rehabilitation team.

Reference: Rosewilliam et al, 2011
NHMRC level of Evidence: III-2

Rationale: It is important that people with aphasia and their family/carers are involved in goal setting discussions with the interdisciplinary team. The literature proposes that an interdisciplinary team approach involving the client along with specialists such as speech pathologists, improves discussion and documentation of client goals (Rosewilliam, Roskell, & Pandyan, 2011). Developing interdisciplinary goals at the client’s bedside can be an effective way of including clients and their families in the goal setting process.

 The need for a formal process

Wade (2009) describes that whenever a client’s problems are sufficiently complex to require the involvement of a two or more people from different professions and/or the process is continued for more than a few days, then a formal goal-setting process may be needed to derive a set of goals that:

• Motivate the client;
• Ensure that individual team members work towards the same goals;
• Ensure that important actions are not overlooked; and
• Allow monitoring of change to abort ineffective activities quickly.

Setting goals with the interdisciplinary team

The literature proposes that an interdisciplinary team approach involving the client along with specialists such as speech pathologists improves discussion and documentation of client goals (Rosewilliam, et al., 2011). 

This is particularly important for people with communication difficulties. In the 2012 National Stroke Audit, it was reported that 76% of clients, without severe cognitive and/ or communication difficulties, had the opportunity to meet and discuss their management with the multidisciplinary team. Conversely, only 6% of clients with severe cognitive and/or communication difficulties had family members that met with the team in lieu of the client to discuss their management (National Stroke Foundation, 2012).  These results led to the recommendation that “Systems are established to ensure greater involvement of stroke survivors and the family/carer as part of the multidisciplinary team with regards to goal setting for shared recovery objectives”(National Stroke Foundation, 2012).The clear distinction between those with and without communication difficulties in the audit highlights the ongoing challenges to involvement in care decisions faced by people living with aphasia. 

 References:

1. National Stroke Foundation. (2012). National Stroke Audit - Rehabilitation Services Report. Melbourne, Victoria
2. Rosewilliam, S., Roskell, C. A., & Pandyan, A. D. (2011). A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. [Review]. Clinical Rehabilitation, 25(6), 501-514. doi: 10.1177/0269215510394467
3. Wade, D. T. (2009). Goal setting in rehabilitation: an overview of what, why and how. Clinical Rehabilitation, 23, 291-295.