Developing an Assessment for Low-risk Patients by SLTs (Speech and Language Therapists) in Head and Neck (ALPS-HN)

Research Questions What skills are required currently by healthcare practitioners who assess patients in the suspected head and neck cancer (HNC) clinic? What assessment procedure constitutes usual care to assess patients presenting to the suspected HNC clinic?

What skills and assessment procedures are important and necessary for Speech and Language Therapists (SLTs) in this role?

Aims and Objectives Aim: To develop a skills framework and assessment procedure for SLTs working in the suspected HNC ENT two-week wait (2ww) clinic pathway with patients stratified as being at low-risk of cancer on EVEREST-HN s SYNC system, informed by literature and agreed by expert consensus.

Objectives: To synthesise existing skills frameworks used by existing professions undertaking this role to develop assessment skills, including process and measurement.

To establish the assessment process used for low-risk 2ww patients with voice and/ or swallowing difficulties currently ('usual care').

To develop a skills framework and sequential assessment process for SLTs extending their scope of practice in this role through expert consensus.

Background: More than 200,000 patients annually are referred to a suspected HNC pathway for a consultation with a HNC specialist. HNC surgeons are required to see all referrals face-to-face as the first contact within 2 weeks. However, 10% of referrals do not meet this target and up to 95% of referrals do not have cancer.

One solution is an improved triage system being developed and evaluated by the EVEREST-HN programme.

Its patient-reported symptom-based risk stratification system (SYNC) aims to identify those referrals at highest risk of cancer. This will improve patient experience, expedite diagnosis, and optimise healthcare resource use. To augment this aim, alternative care pathways for patients at low risk of cancer using SYNC need to be explored.

The optimal treatment for voice and swallowing difficulties is often SLT, an under-utilised and highly skilled workforce; and an under-represented specialism of strategic importance to the NIHR.

Harnessing SLTs skills in this area aims to provide timely and effective care for benign patients on this pathway with SLT-symptoms, reducing burden on ENT services.

ALPS-HN aims to establish the skills required, and define a sequential assessment procedure, for SLTs to assess low-risk patients on this pathway presenting with SLT-related symptoms.

Focus groups and interviews with SLTs and ENTs identified this as an area requiring further research with high impact potential. Methods: 1.

Scoping review: we will identify and synthesise skills and training frameworks used currently to train professionals who assess patients on this pathway. 2.

We will analyse transcripts of ENT-led patient consultations in the suspected HNC clinic to produce a sequential assessment procedure based on usual care. 3.

We will disseminate outputs from stages 1 and 2 to expert ENTs and SLTs to agree a skills framework and assessment procedure for SLTs assessing low-risk patients on this pathway, Anticipated impact We will disseminate findings to interested parties including SLT, ENT, primary care, the public and relevant professional and regulatory bodies.

We will apply for further funding to evaluate the SLT skills framework and assessment procedure.