Physicians’ awareness and referral practices regarding speech and language therapists in dysphagia management: a cross-sectional study

Introduction

Dysphagia is a complex and potentially life-threatening clinical condition that requires coordinated multidisciplinary management. It is associated with serious complications such as aspiration pneumonia, malnutrition, dehydration, and increased morbidity and mortality. Speech and language therapists play a central role in both the assessment and rehabilitation of swallowing disorders through clinical and instrumental evaluation methods. Physicians are typically the first healthcare professionals to encounter patients with dysphagia and therefore play a crucial role in early recognition, clinical decision-making, and initiation of appropriate referral pathways. However, limited awareness of the professional roles and competencies of speech and language therapists may negatively affect the quality and timeliness of dysphagia management.This study aimed to evaluate physicians’ awareness of the role of speech and language therapists in dysphagia management, examine their clinical referral practices, and identify factors influencing interdisciplinary collaboration in hospital settings.

Methods

A descriptive and correlational cross-sectional survey was conducted with 104 physicians working in public hospitals in Erzurum, Türkiye. Participants were recruited on a voluntary basis. Data were collected using a structured 37-item questionnaire developed according to the Knowledge–Attitude–Behavior model. The questionnaire included sections on demographic characteristics, knowledge of speech and language therapy, attitudes toward interdisciplinary collaboration, and clinical practices related to dysphagia management. Statistical analyses were performed using IBM SPSS Statistics 25.0. Descriptive statistics were reported as frequencies, percentages, means, and standard deviations. Chi-square tests were used to compare categorical variables, and correlation analyses were conducted to examine relationships between variables.

Results

The findings indicated that most physicians reported general awareness of the speech and language therapy profession (78.8%) and expressed highly positive attitudes toward interdisciplinary collaboration (99.0%). However, only 42.3% of participants recognized that speech and language therapists are responsible for the assessment and management of dysphagia. Referral practices were notably limited, with only 4.76% of physicians reporting direct referral to speech and language therapists within clinical pathways. Although 58.0% of physicians reported that they had previously referred patients for various reasons, only 14.0% correctly identified them as the appropriate professionals for dysphagia management, while 56.0% reported not referring dysphagic patients to any professional group. In terms of clinical practice, knowledge and use of instrumental assessment methods were limited. Only 3.85% of participants reported using instrumental evaluation techniques, whereas 96.15% relied primarily on non-instrumental assessments. Additionally, 87.6% of physicians perceived interdisciplinary collaboration between speech and language therapists and other healthcare professionals as insufficient. Institutional factors also appeared to play a significant role, as 93.1% of participants reported that no in-service training or informational activities related to speech and language therapy had been conducted in their institutions.

Conclusions

Despite generally positive attitudes toward speech and language therapists, physicians’ knowledge and clinical practices regarding dysphagia management remain limited. The discrepancy between attitudes and actual referral behavior suggests the presence of both individual and systemic barriers affecting interdisciplinary collaboration. These findings highlight the need for targeted educational interventions, increased institutional visibility of speech and language therapists, and the development of structured referral pathways to support effective collaboration.

References

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