Aphasia in culturally and linguistically diverse stroke patients in the acute hospital setting: findings from a 12-month chart audit at a metropolitan Australian hospital

Background: As cross-border migration increases internationally, speech pathologists will see growing numbers of people with aphasia from culturally and linguistically diverse (CALD) backgrounds. Australia is one of the most multicultural societies globally, with national census data indicating 26% of the population were born overseas and 21% of people speak a language other than English at home (Australian Bureau of Statistics, 2016 Australian Bureau of Statistics. (2016). Cultural diversity: Who we are now. Retrieved from\nhttp://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/2024.0Main%20Features22016?opendocument&tabname=Summary&prodno=2024.0&issue=2016&num=&view=\n [Google Scholar]\n). Cultural difference and language discordance can create challenges in providing optimal stroke care to patients from CALD backgrounds. These challenges may be amplified for patients with aphasia since the presence of communication disorder, in addition to possible cultural and language difference, potentially leads to further complexity for the stroke care team. In a national survey of Australian speech pathologists (Rose et al., 2014 Rose, M., Ferguson, A., Power, E., Togher, L., & Worrall, L. (2014). Aphasia rehabilitation in Australia: Current practices, challenges and future directions. International Journal of Speech-Language Pathology, 16, 169–180.\n[Taylor & Francis Online], [Web of Science ®], , [Google Scholar]\n), respondents rated their knowledge of, and confidence with therapy for CALD patients with aphasia as less than adequate. They also identified culturally appropriate treatments for CALD populations as a research priority area. The present investigation employed a multiphase instrumental case study to explore multidisciplinary practice in the provision of acute transitional care to CALD stroke survivors at a metropolitan hospital. Phase 1 was an audit of the medical records of CALD stroke patients. This paper discusses findings pertinent to CALD patients with a diagnosis of aphasia.\n\nAims: The aims of this study were: (i) to determine the proportion of the overall stroke caseload that was identified as CALD within an acute care setting; (ii) to determine the proportion of the CALD caseload with a diagnosis of acquired communication disorder and more specifically aphasia; (iii) to explore clinical pathways of CALD stroke survivors with a diagnosis of aphasia.\n\nMethods & Procedures: This study employed a 12-month retrospective audit of the medical records of CALD patients, with a diagnosis of stroke, at a 448-bed metropolitan hospital. Data was collected from the records of CALD stroke patients in relation to: patient demographics, medical history, presence of communication disorder, cultural and language information, and use of interpreters. Data was analysed using descriptive statistics.\n\nOutcomes & Results: Two hundred and fifty patients were diagnosed with stroke over a 12-month period, with 34% (n = 85) of the caseload identified as being from a CALD background. Of the CALD patients, 35% (n = 30) were diagnosed with acquired communication disorder. Around 46% of CALD patients with acquired communication disorder had aphasia. Patients with aphasia who were born overseas originated from diverse countries of birth (India, Lithuania, Jamaica, England, Germany, Malta). Patients who spoke a language other than English spoke a diverse range of languages (Serbian, Croatian, Kirundi, Filipino, Hungarian, Cantonese). The file audit revealed several issues impacting on the clinical pathways of CALD patients with aphasia including: referral to speech pathology, language assessment processes, use of interpreters, and family involvement in care. Findings regarding professional interpreters indicated: interpreters were used sparingly with some patients, despite a considerable length of stay in hospital; interpreters sometimes spoke the incorrect language; and some families expressed resistance to the use of a professional interpreter. In some cases, patients with aphasia were not referred to speech pathology or did not receive detailed language assessment.\n\nConclusions: This study provides an insight into the diversity of language and cultural backgrounds of patients with aphasia that may be present in multicultural societies like Australia. The findings of the chart audit highlight the complexities that arise in providing stroke care to individuals with aphasia from CALD backgrounds and emphasise the need for further research in this area to ensure the delivery of equitable, efficient and evidence-based services to people with aphasia from CALD backgrounds.

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