DYSPHAGIA · ADULTS

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Can you DISCERN what’s EBP in dysphagia?

Scientists are starting to tackle the question of how to measure the quality of online dysphagia resources.

November 5, 2021

How do we know which dysphagia resources are high-quality and which aren’t? This paper from Hazelwood and Pollack starts to tackle this question by using the DISCERN scale to judge online dysphagia resources—from podcasts to CEU sites to Facebook groups. Take a peek at the DISCERN here.
 

The first finding was that most of the resources named by SLPs earned “mediocre quality” overall scores. Oh, great.

 

The second finding was that it wasn’t easy to predict which people would be more likely to recommend high-quality resources. Things like familiarity and confidence in quality appraisal, having a BCS-S, or years of experience simply didn’t matter. Oh, double great!?!

 

So now what? 

 

First, this paper is a huge step in the right direction. Our field has needed product quality appraisal for a while now, and it’s really not being done anywhere, in any thorough or structured way. So kudos to the authors for kicking this off!

 

But, we need to discuss caveats, and where we might want to go next. Some big things to consider:

  • This data isn’t particularly strong, for what people may be tempted to infer from it. For example, a score of “mediocre quality” doesn’t mean the resource is actually mediocre quality. It could mean that! Or, it could mean that there wasn’t adequate information to judge quality. The DISCERN doesn’t account for this. Also, each resource was rated from a single webpage, using Section 1 of the DISCERN only. For some, that meant the home (or marketing) page of the website, without any clinical content on it at all. As the authors state, “...information embedded within website or podcast audio information was not considered.” That’s a whole lot of missing information. And might point toward the cons of doing this by-brand in the first place.
  • Is the DISCERN even a good option for our field to use? Could there be better options? Or adjustments that need to be made? Our interventions are much more complex than, say, popping a pill; so how are those contextual factors considered? And who’s going to read the manual and perform the rankings (55 pages published in 1998, prior to the onslaught of info we are bombarded with now)?
  • Are we adequately considering real-world implementation? For example, are we certain that we should rank resources higher if they are based on well-controlled trials, but haven’t been tested in real-world settings? What about practice-based research; where would that fall on the scale? Implementation science comes next.
  • What happens when we try to put a scale in place? If a scale becomes broadly used in our field and is actually successful in increasing informed consumership, businesses will respond. Sometimes by ramping up the quality; other times by discrediting the scale, or doing things to artificially inflate their scores. Put more bluntly—we need to be fully prepared for what may happen when companies are concerned that they may look bad in the eyes of SLP consumers. We already see responses to the call for evidence in our field, where businesses will simply plop scientific citations on their website. Citations that are low-quality or are unrelated to what they’re selling. (I mean—who’s going to check?) And with this paper, we’re already seeing some folks excitedly sharing it on social media, because it down-ranks groups, people, or businesses they aren’t fans of (not at all the authors' intent, but people will use papers however it serves them). Triple great.

Finally, this is a really good example of why discussion among all stakeholders is critical for implementation. This includes students, clinicians, scientists, supervisors and teaching faculty, business owners, social media influencers, leadership, and our clients. Together we can see the barriers and facilitators of implementation that would have been impossible for us to address in our own silos, with our own blindspots. We DISCERN a call to engagement.


PS: Headed to read the paper? Note that you won’t find TISLP there. Our dysphagia content was launched for the first time in August 2019, which was the month this data was collected.

 

 

Hazelwood, R. J., & Pollack, L. M. (2021). Critical review of online resources frequently used by certified speech-language pathologists for dysphagia management. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2021_persp-21-0010  [available to ASHA SIG members]

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Meredith Harold, PhD, CCC-SLP

Meredith Harold, PhD, CCC-SLP

Meredith Poore Harold, PhD, CCC-SLP is founder and owner of The Informed SLP—a website dedicated to connecting clinicians and scientists with each other’s work. Learn more about her at www.meredithharold.com
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