Examining Clinical Reasoning during Stimulability Testing for Voice-Specialized Speech-Language Pathologists: A Qualitative Study

PurposeStimulability testing is a wide-spread and highly valued behavioral assessment tool for voice-specialized speech-language pathologists (SLPs). However, there is currently no research examining how voice SLPs use stimulability testing to inform their clinical reasoning process and decisions. The purpose of this qualitative study was to examine the clinical reasoning underlying stimulability testing for voice-specialized SLPs across the experience spectrum. MethodsSemi-structured interviews were conducted with eight voice-specialized SLPs (four early-career, four late-career) regarding stimulability testing, including how they used stimulability testing to form clinical conclusions such as candidacy and prognosis for behavioral therapy. Interviews were transcribed and analyzed using the interpretative phenomenological analysis (IPA) framework (Smith & Osborn, 2003). ResultsFive themes emerged from the IPA analyses: Perceiving and monitoring patient responses; Developing and trusting clinical skills; Decision-making strategies; Drawing clinical conclusions; and Fostering a purposeful therapeutic relationship. Within the Drawing clinical conclusions theme, clinicians differed on the utility of stimulability testing as a tool for determining patient candidacy and prognosis for behavioral therapy. ConclusionSLPs rely on both analytical and intuitive methods of clinical reasoning during stimulability testing. However, the lack of research tying stimulability testing to clinical outcomes has led to an overreliance on intuitive reasoning when SLPs attempt to draw clinical conclusions. Further empiric support for the clinical functions of stimulability testing is needed to support the clinical reasoning process surrounding this assessment tool.