JCPSLP Vol 16 Issue 1 2014

factor that may inhibit clinicians’ involvement in clinical research is their need to be firstly accountable to their clients before considering the needs of the clinical population as a whole. Another factor cited in the literature, which is said to inhibit the completion of clinical research, is clinicians’ feelings of being ill prepared for the task (Finch, Cornwell, Ward & McPhail, 2013). Reported barriers include clinicians’ limited knowledge concerning research methodology, limited access to research opportunities and resources, and minimal collaboration with researchers (Hubbard, Vyslysel, & Parsons, 2009; Finch et al., 2013). These barriers might leave clinicians feeling “out of their depth” when considering engaging in research. Other factors that influence SLPs’ involvement in clinical research include the mobile nature of the speech-language pathology workforce and a recognised shortage of SLPs. In 2001, 80% of Australian SLPs were identified as being under 40 years of age (Australian Institute of Health and Welfare, 2003). In addition, at a state level, it has been identified that 52% of new graduate SLPs in Queensland felt that they would remain in the profession for less than 10 years (Speech Pathologists Board of Queensland, 2006). This literature suggests that numerous SLPs are leaving the workforce well before retirement age. Therefore, there are a limited number of senior members of staff who may have the potential to mentor junior staff in research. Linked to this is the issue of understaffing in the face of high caseload demand, meaning the time clinicians have to dedicate to research is limited. Experiences of Dr Bena Cartmill Although there are many barriers facing clinicians who want to engage in clinical research, we believe there are an increasing number of clinicians who are able to overcome these barriers and are actively seeking opportunities to be involved in clinical research. Dr Bena Cartmill is an experienced clinician whose practice has been enhanced through engagement in clinical research. I am an advanced speech pathologist (oncology) and research fellow at the Princess Alexandra Hospital (PAH) in Brisbane and have been conducting research in this area since 2005. Between 2006 and 2012 I completed my PhD part-time while working clinically. Currently, my unique clinical/research position is funded by the Queensland Department of Health with the aim to retain, develop and recruit health researchers to build a robust and dynamic health research workforce. My brief is to conduct research alongside and integrated with my clinical duties. My clinical position in a large, tertiary hospital has allowed me many opportunities to gather experience and skills in the specialist head and neck oncology area. I am a clinician primarily, and as such, my research interests have been directed towards improving clinical practice, patient outcomes and service delivery. Initiating research as a clinician has its challenges. Firstly, patient intervention is core business for clinicians and if workloads get busy, research activity is often reprioritised. Acquiring funding to set aside dedicated research time and space can be difficult in a busy clinical setting, as can switching between clinical and research thinking. The approach to problem-solving can be vastly different between clinical and research activities. Where the clinician aims to find an evidence-based solution that fits

within a unique and individual case, problem-solving in the research arena is the opposite. Researchers want to assess whether a unique treatment that may show promise for individual cases is translatable into a bigger, broader population. Onslow (2008) refers to this as a top down (specifics) versus bottom up (generalisations) approach. Secondly, knowing where to start and what the steps are required to successfully complete research projects means that clinicians often require access to flexible and available research resources and advice. This is at times limited by health and university professionals operating on vastly separate campuses, both geographically and philosophically. For me, I was inspired by the innovation and “research as usual practice” approach within the Radiation Oncology Department. I had a University of Queensland research fellow on campus at the PAH who was readily available to brainstorm and discuss my project ideas. My first foray into improving patient care in radiation oncology was to improve efficiency regarding the delivery of supportive care services to head and neck cancer patients. A trial period of implementing parallel, joint speech pathology and dietetic intervention alongside weekly medical and nursing sessions with all head and neck cancer patients was initiated, and resulted in a 10% reduction in unplanned admissions related to dysphagia, dehydration, malnutrition, aspiration and pneumonia (Riddle, Davidson, Porceddu, Elliott, & Balsillie, 2005). Subsequently this service delivery model became standard practice at the PAH, and was adopted by many Australian radiation oncology departments. This brought about a number of other questions about this population. What else don’t I know about this patient group? How does their swallowing change with treatment, and do different treatments result in differences in dysphagia? How long does their dysphagia last? How do we treat it? How can we avoid dysphagia in head and neck cancer patients? I found myself with too many clinical questions and not enough answers. I was encouraged to transform my clinical questions into a research project, namely a research higher degree. I had concerns about giving up clinical work, losing touch with what was important to patients, taking a pay cut, feeling divided between clinical and research work, losing clinical skills, and not having the skills to be a researcher. Support and guidance from research mentors is integral for any clinician embarking on research. In particular, clinician researchers who understood the health setting and had experience in conducting clinical research were of particular support. In my particular workplace, conjoint university and health research fellows collocated were highly accessible and understood both university and hospital systems. My project explored the swallowing, nutrition and quality of life outcomes of patients treated with an intensive radiotherapy protocol (Cartmill, Cornwell, Ward, Davidson, & Porceddu, 2011). The clinical questions my project generated and answered resulted in changes to the delivery of radiotherapy for head and neck cancer patients to reduce the toxicity associated with treatment.

16

JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology