16
JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
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.
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
