Speech-Language Pathologists' Use of Patient-Reported Outcome Measures for Adult Patients With Cognitive-Communication Disorders: A Survey Study

Abstract

Purpose:

Speech-language pathologists (SLPs) primarily assess patients with cognitive-communication disorders using performance-based measures. Patient-reported outcome measures (PROMs) may also prove useful in clinical practice with these populations, as they can capture applied communication constructs with subjective or unobservable elements (e.g., cognitive fatigue). We conducted a survey to gain insight into SLPs' clinical use of PROMs with these populations.

Method:

Ninety-five SLPs responded to 26 survey items that explored SLPs' (a) current use of PROMs in clinical care for adults with cognitive-communication disorders, (b) needs and barriers related to PROM use in clinical practice, and (c) gaps and needs with respect to the measurement of patient health-related quality of life. A convergent mixed-methods design was used to analyze qualitative and quantitative survey responses. Free-response questions were coded using a conventional content analysis.

Results:

Forty percent of respondents reported using PROMs with their patients with cognitive-communication disorders, most often for goal setting, followed by assessing treatment effects. SLPs also reported barriers to PROM use with patients with cognitive-communication disorders, such as patient insight deficits and limited time. The identified barriers of poor implementation and dissemination have implications for future research directions.

Conclusions:

The survey findings suggest that many SLPs do not currently use PROMs with patients who have cognitive-communication disorders, but those who do find them useful for goal setting. Survey findings also indicate several barriers that limit broader adoption of PROMs for this clinical population, which should be addressed through future implementation research and clinical initiatives such as creating PROM education for SLPs.

Patient-reported outcome measures (PROMs) quantify health constructs from the patient's perspective, including subjective constructs that are difficult to assess with performance-based measures, such as health-related quality of life (QoL), and can contribute to a comprehensive assessment of communication disorders (Cohen & Hula, 2020). Over the past 15 years, numerous PROMs have been developed that are relevant to the field of speech-language pathology; the reader is directed to Baylor et al. (2013), de Riesthal and Ross (2015), Hula et al. (2015), Simmons-Mackie et al. (2014), and von Steinbüchel et al. (2010) for examples. New PROMs related to the field continue to be developed, such as a measure of communicative participation for children and adolescents (Alons et al., 2024). Additionally, existing PROMs are being modified for use with new populations. For example, the Communicative Participation Item Bank (CPIB) was originally developed for individuals with spasmodic dysphonia; then validated for clients with Parkinson's disease, multiple sclerosis, and head and neck cancer; and then recently modified for use with gender-diverse clients (Baylor et al., 2009, 2013, 2024).

Although many PROMs were developed primarily for research purposes, recent advancements in psychometrics and new practice policies have improved their clinical value and utility. Some PROMs are constructed using an item response theory (IRT) model—a psychometric framework that models the probability of a response to an item based on various attributes, such as the item's difficulty and the individual's underlying level of the trait being measured (Bandalos, 2018). IRT supports the use of computerized adaptive testing (CAT), which uses computer algorithms to select which PROM items are presented to an individual based on their previous responses. PROMs delivered via CAT are beneficial for clinical practice as they reduce respondent burden while preserving measurement reliability. For more information about IRT, the reader is referred to Baylor et al. (2011), Cohen and Hula (2020), and Fries et al. (2005). The American Speech-Language-Hearing Association (ASHA) added several PROMs to the National Outcomes Measurement System (ASHA, 2022a), and payor sources (e.g., Medicare) have supported the use of PROMs to capture functional outcomes in clinical settings across patient populations (Centers for Medicare & Medicaid Services [CMS], 2022).

Within adult-focused speech-language pathologist (SLP) clinical practice, most PROM clinical implementation efforts have focused on the areas of voice, swallowing, and language (Gardener et al., 2024). However, PROMs may also be useful for SLPs working with adults with cognitive-communication conditions. MacDonald's (2017) model of cognitive-communication competence, which delineates seven domains (e.g., physical, emotional) of functioning, illustrates the complexity and multidimensionality of cognitive-communication and its assessment. This complexity makes cognitive-communication impairments challenging to evaluate briefly or solely with performance-based measures. PROMs might also be useful by better capturing the nuanced and dynamic nature of cognitive abilities in real-life situations compared to performance-based measures. For example, because many executive functions are influenced by contextual and environmental factors (Fischer-Hicks et al., 2022), a PROM might reveal everyday executive dysfunction better than performance-based tests of executive function that are administered in quiet rooms with clear instructions. In this way, PROMs may provide a perspective of a patient's cognitive-communication abilities that can complement data from performance-based measures.

Mild cognitive and communication impairments can be challenging to detect, particularly when using brief measures. For instance, a recent study reported that some individuals with Alzheimer's disease or Parkinson's disease screened negative (i.e., scored in the “normal” range) on the Montreal Cognitive Assessment but reported mild-to-moderate communication difficulties in everyday life on the CPIB (Stagge et al., 2024). Additionally, some PROMs are phrased in a way that helps reveal if a person's current functioning is perceived as a decline, which can be useful for diagnostic purposes and justifying the need for speech therapy services. As an example, the Everyday Cognition measure prompts patients or their informants to rate if their current performance of everyday tasks differs from 10 years ago (Farias et al., 2011).

For these reasons, PROMs may be valuable to clinical practice with adults with cognitive-communication disorders, but their current use by SLPs is largely unknown. Recent survey studies have explored SLPs' cognitive-communication assessment practices broadly (Frith et al., 2014; Lanzi et al., 2022; Morrow et al., 2020; Ramsey & Blake, 2020; Roitsch et al., 2021) but have not focused on PROMs. These studies revealed wide variability among SLPs in their assessment practice patterns (Morrow et al., 2020; Roitsch et al., 2021), with many reporting a primary reliance on performance-based measures (de Riesthal & Ross, 2015; Lanzi et al., 2022). SLPs have also reported a desire for more/better options for functional and person-centered assessment (Lanzi et al., 2022; Torrence et al., 2016). While performance-based measures capture important data, they do not always gather functional information that is personally relevant to the patient (de Riesthal & Ross, 2015). When used alongside performance-based measures, PROMs may provide complementary data that are both functional and person centered (Cohen & Hula, 2020; Yorkston & Baylor, 2019).

Therefore, the present survey was motivated by a desire to learn more about whether and how SLPs use PROMs when serving adult patients with cognitive-communication disorders. Given the significant footprint that cognitive-communication disorders have on an SLP's caseload (ASHA, 2023) and the reported need for functional and person-centered assessment by clinicians working with these populations (Lanzi et al., 2022; Torrence et al., 2016), exploring SLPs' current use of PROMs may inform future research efforts, such as tailoring generic PROMs for SLP populations or services, potentially resulting in more personalized clinical care. Survey questions were written to address the following research questions:

1. Are SLPs using PROMs with patients with cognitive-communication disorders, and if so, how?

2. What are the barriers to PROM use for patients with cognitive-communication disorders?

3. What do SLPs need with respect to the clinical measurement of health-related QoL for their patients with cognitive-communication disorders?

Method

Survey Design

The results reported here are part of a comprehensive survey about the practice patterns of SLPs who work with adults with cognitive-communication disorders. The survey was piloted with 10 SLPs working in adult health care settings, and feedback from those participants was used to adjust the initial version of survey (e.g., tone, length; Lanzi et al., 2022). One component of this survey was published elsewhere (Lanzi et al., 2022) and addressed SLPs' training, practice patterns, and needs regarding assessment and treatment for adults with mild cognitive impairment (MCI) or early-stage dementia specifically. In the present study, we analyzed responses from other survey components that explored SLPs' (a) use of PROMs in clinical care for adults with cognitive-communication disorders (from any condition, not just MCI or early-stage dementia), (b) needs related to PROM use in clinical practice, and (c) needs related to the measurement of health-related QoL (Appendix A contains all survey items). The 26 survey items analyzed in the present study consisted of the following formats: Likert scale, multiple choice, visual analog scale (e.g., scale of 0%–100%), and text boxes for open responses.

The survey design allowed participants to complete questions in more than one sitting, if needed, to minimize respondent burden. The inclusion of both closed- and open-ended questions permitted the exploration of similarities between two different data strands: qualitative and quantitative (Crewswell & Plano Clark, 2018).

Survey Distribution

The survey was programmed and disseminated using the Research Electronic Data Capture software (Harris et al., 2009, 2019). All study procedures were approved by the University of Delaware's Institutional Review Board. The survey was open for a predetermined period from December 2020 until February 2021. Eligible participants (a) were 18 years of age or older, (b) were an ASHA-certified SLP, and (c) provided clinical services to adults with cognitive-communication disorders. Sources for recruitment included e-mail listservs, Facebook groups (e.g., Medical SLPs), and research lab websites and social media pages. In addition, SLPs who had previously completed research studies in the labs of authors A.M.L. and M.L.C were recontacted. At the end of the survey, participants could opt in to a raffle to win one of several gift cards.

Data Analysis

Data were analyzed with a convergent mixed-methods design (Creswell & Plano Clark, 2018) to examine survey responses quantitatively (e.g., percentage of yes/no responses) and qualitatively (i.e., content analysis of open-ended textboxes). After each item was analyzed, quantitative and qualitative data were merged, using joint displays, to draw meta-inferences related to each research question (Creswell & Plano Clark, 2018). To address our first research question (i.e., Are SLPs using PROMs with patients with cognitive-communication disorders, and if so, how?), we analyzed responses from 13 survey items. The first item asked SLPs if they used PROMs for patients with cognitive-communication disorders. If so, subsequent items asked how they use them to support their screening, assessment, goal setting, and outcome measurement and with which PROMs. To answer our second research question (i.e., What are the barriers to PROM use for patients with cognitive-communication disorders?), we analyzed responses from three survey items that asked about barriers to using PROMs with this population from respondents who said they did use PROMs as well as those who said they did not use PROMs.

To answer our third research question (i.e., What do SLPs need with respect to the clinical measurement of health-related QoL for their patients with cognitive-communication disorders?), we analyzed responses from five survey items. The first question in this section asked about which aspects of cognitive-communication health-related QoL SLPs would like to measure more effectively and why. Subsequent questions asked about the importance of new or better PROMs to capture patient perspectives of QoL in various domains of the International Classification of Functioning, Disability and Health (ICF) biopsychosocial framework (i.e., personal factors, environmental factors, activities and participation, and symptoms/functioning; World Health Organization, 2001). The reader is referred to Appendix A for a complete list of survey items analyzed and the corresponding research question, as well as the corresponding number of respondents for each question.

Quantitative Analysis

We quantitatively analyzed responses to yes/no, visual analog scales, and Likert scale items with descriptive statistics using Microsoft Excel (Version 2016). For yes/no questions, the percentage of “yes” answers for each question was calculated, and visual analog scale responses were transformed to intervals such as percentages or numbers 0–100. We reported mean responses for questions with a 4-point Likert scale.

Qualitative Analysis

We used a conventional content analysis approach to qualitatively analyze the data in five steps. This approach is useful for uncovering new areas that have not yet been explored and allows researchers to derive categories directly from the data (Hsieh & Shannon, 2005). Regarding positionality, authors F.S., A.L.J., and A.M.L. are SLPs, and author M.L.C. is a clinical neuropsychologist. Each author has experience using PROMs with adult clients with cognitive-communication disorders from various causes and in various settings (e.g., acute care, inpatient rehab, skilled nursing facilities, home health, and outpatient clinics).

In Step 1 of the analysis, author F.S. familiarized herself with the data by (a) reading through open-ended responses carefully, noting important words or phrases (Hsieh & Shannon, 2005), (b) writing initial analytic memos (Saldaña, 2021), and (c) breaking responses down into meaningful units (MUs; i.e., segments consisting of one general idea). In Step 2, author F.S. used descriptive coding (Saldaña, 2021) to categorize the MUs, and these categories became second-level codes. Through analytic written memoing, author F.S. decided that MU segments would be categorized under one code only (i.e., no MU was “double-coded”) since the average length of each MU was relatively short; on average, MUs were only one sentence/phrase. The other authors agreed that single-coding helped facilitate clarity of the data and that no nuance was lost. In Step 3, author F.S. determined which codes could be clustered together to make first-level codes (i.e., higher level categories). For example, the second-level codes billing and time clustered together to make the first-level code poor implementation. In the fourth step of the analysis, authors F.S., A.L.J., and A.M.L. ensured that the codes could not be refined further (Hsieh & Shannon, 2005). During this step, two rounds of peer review were conducted by authors F.S. and A.L.J., and the consensus process was conducted as needed with author A.M.L., to support the validity of codes (Lincoln & Guba, 1986). In Step 5, a codebook was created by author F.S., with expert review provided by author A.M.L. Lastly, author F.S. organized the codes to align with the guiding research questions (see Appendix A for which survey items correspond to particular research questions).

Integration

After separate qualitative and quantitative analyses, joint displays were created to link qualitative codes to quantitative findings (Guetterman & Fetters, 2022; Haynes-Brown & Fetters, 2021; McCruddena et al., 2021). Author F.S. used an iterative process to create and refine visuals that best represented the data (Haynes-Brown & Fetters, 2021), leading to joint display figures and tables. The research team discussed the findings until reaching a consensus on data interpretation (Duran et al., 2006).

Results

Participant Demographics

Ninety-five SLPs responded to the sections of the parent survey (see Appendix A for number of respondents for each item) relevant to PROMs and QoL measurement. Participants were predominantly White (95%), female (95%), and non-Hispanic/Latino (97%). Most respondents held master's degrees as their highest level of education (95%), while five respondents held doctorate degrees (5%), and years of experience ranged from 0–2 years to 21+ years. Most respondents reported working in outpatient settings (31%), followed by skilled nursing facilities (19%), inpatient rehab (18%), acute care (8.5%), and “other” (8.5%). See Table 1 for complete participant demographics.

Table 1.

Participant demographic information.

Demographics	n
Age
24–33	38
34–43	25
44–53	15
54–63	12
64–73	5
Sex
Female	90
Male	5
Ethnicity
Hispanic/Latino	3
Not Hispanic/Latino	91
Race
Asian	2
Black	2
Biracial	1
White	90
Education
Master's	90
PhD	5
Employment status
Full-time	68
Part-time	22
Leave of absence	1
Actively searching	1
Other	1
Years as speech-language pathologist
0–2	14
3–5	20
6–10	17
11–20	19
21+	24
Years in current setting
0–2	25
3–5	25
6–10	15
11–20	17
21+	12

Qualitative Results

Overall, the process resulted in 42 first-level codes and 40 second-level codes across all three research questions. This total also reflects codes repeated across time points in the continuum of care (i.e., the code collect functional data in screening, diagnosis, and measuring treatment effects counted as three separate codes). See Appendix B for the full code book. In the subsequent sections of this report, codes will be denoted by italicization (first-level codes in a listed format will be denoted with numbers [e.g., 1 = patient deficits], and second-level codes in a listed format will be denoted with lowercase letters [e.g., a = insight deficits]).

Integrated Qualitative and Quantitative Results

Are SLPs Using PROMs With Patients With Cognitive-Communication Disorders, and If So, How?

Approximately 40% of the SLPs surveyed responded “yes”—they use PROMs with their patients with cognitive-communication disorders. When asked which PROMs they use, responses varied widely (e.g., no measure was listed more than five times across participants). See Appendix C for a full list of PROMs reported by SLPs. SLPs who responded “yes” to using PROMs were then asked to indicate at which time point(s) in the continuum of care (i.e., screening, diagnosis, goal setting, or assessing treatment effects) they used them. SLPs reported using PROMs most often for goal setting (59%) and assessing treatment effects (53%), followed by screening (40%) and supporting diagnosis (24%). We asked respondents to further elaborate on how they used PROMs for each time point. Qualitative analysis of the SLPs' open-ended responses resulted in four first-level codes to describe how they are using the PROMs: 1 = monitor progress, 2 = collect functional data, 3 = learn caregiver's perspective, and 4 = goal personalization. Further qualitative analysis revealed seven second-level codes (e.g., facilitate collaborative goal setting; see Table 2).

Table 2.

How speech-language pathologists report using patient-reported outcome measures (PROMs).

		Point in the Continuum of Care
		Screen	Diagnosis	Goal setting	Treatment effects
	Percent use (%)	40%	24%	59%	53%
Codes	Monitor progress	✔		✔	✔
	Collect functional data	✔	✔		✔
	Quality of Life (QoL)				✔
	Learn caregiver's perspective	✔	✔
	Patient insight deficits		✔
	Patient emotions		✔
	Support Diagnosis	✔
	Goal personalization			✔
	Facilitate collaborative goal setting			✔
	Prioritize patient concerns			✔
	Facilitate functional goals			✔

Note. Bolded text indicates a first-level code, and ✔ denotes code for how PROMs are used.

Our joint display revealed a large overlap as to how SLPs are using PROMs across time points in care (i.e., screening, diagnosis, goal setting, and treatment effects). For example, the code monitor progress (e.g., “if scores are improving, it generally means treatment is working”) was reported as a reason SLPs use PROMs to support their screening and goal setting and to demonstrate treatment effects. However, some themes were unique to a specific care time point. For example, the second-level code QoL (e.g., “if impairment remains [but] … quality of life has improved, then therapy has been successful”) was unique to treatment effects.

What Are the Barriers to PROM Use for Patients With Cognitive-Communication Disorders?

SLPs were asked to report whether they face barriers to PROM use in practice for patients with cognitive-communication disorders and, if so, to describe them. Seventy-five percent of SLPs who use PROMs responded “yes”—there are barriers to using PROMs with this population. Qualitative analysis found a great overlap of barriers reported by SLPs who use PROMs and by those who do not. Three main first-level codes, 1 = poor implementation, 2 = poor dissemination, and 3 = patient deficits, and five second-level codes, a = time, b = SLP access difficulties, c = sensory deficits, d = cognitive deficits, and e = insight deficits, were shared by both groups (see Table 3).

Table 3.

Overlaps between barriers of speech-language pathologists (SLPs) who use patient-reported outcome measures (PROMs) and SLPs who do not.

Codes	Do not use PROMs (n = 57)	Do use PROMs (n = 38)	Interpretation
Poor implementation Time	“Due to productivity standards, I don't have time to look for things like this on the clock, and I refuse to work off the clock.”	“Some of the tests are way too long …”	Responses are mostly congruent, with additional focus on productivity mentioned by one SLP who does not use PROMs
Poor dissemination SLP access difficulties	“This is the first time I have head of [PROMs]” “We do not have any available to us at our current site.”	“They could be more widely known and then would probably be used more often” “Finding ones that are comprehensive but still within my scope.”	Responses are mostly congruent, with acknowledgement from SLPs who do use PROMs that is a lack of dissemination, and this is also observed from SLPs responses who don't use PROMs saying they are not familiar with them Responses are mostly congruent in that a difficulty is noted accessing PROMs, but an added layer of difficulty noted by SLPs who use PROMs finding specific ones they are looking for.
Patient deficits Sensory deficits Cognitive deficits Insight deficits	“Many SNF clients cannot read and write well.” “Many patients are too severe to use” “Patients are often not self-aware of their deficits”	“Hearing and vision deficits” “Significantly impaired cognitive function (e.g. dementia) patients do not always understand how to fill out the form.” “Clients with limited awareness of deficits may not be able to accurately describe cog-com changes.”	Responses are mostly congruent - sensory difficulties such as hearing and vision could impact reading and writing well Responses are congruent, acknowledgement that severity of cognition impacts ability to use PROMs Responses are congruent, acknowledgment that insight may impact ability to respond to questions representing accurate performance

Note. Bold text indicates a first-level code.

In addition, our joint display compared the barriers reported by the SLPs who use PROMs to those who do not (see Figure 1) and revealed differences between the groups. For example, those who use PROMs reported unique barriers related to billing (e.g., “not recognized/accepted by insurance carriers”) and informants (e.g., “lack of access to family members or others that are familiar with prior level of functioning”). Those who reported not using PROMs reported the unique barriers practice patterns (e.g., “it's just not something our company does”) and setting (e.g., “doesn't seem relevant in acute care”).

Figure 1.

Codes that describe barriers to patient-reported outcome measure (PROM) use. First-level codes are bolded. SLPs = speech-language pathologists.

Further integration of the data revealed that the majority of barriers reported were reported both by SLPs who do and do not use PROMs (see Table 3). For example, both SLPs who use and do not use PROMs reported barriers related to poor implementation, poor dissemination, and patient deficits. Under the first-level code of the poor implementation, a second-level code time was present. However, those who do and do not use PROMs reported different types of responses within the subtheme time. An SLP who does not use PROMs stated, “I don't have time to look for PROMs,” while another SLP who uses PROMs stated, “some [PROMs] are way too long.” Under the first-level code poor dissemination, the second-level code SLP access difficulties was present. Those who do not use PROMs provided evidence of access difficulties by responding in such ways as “we don't have any available.” In contrast, SLPs who use PROMs reported more specific access difficulties such as “finding ones that are comprehensive but still within [an SLP's] scope.” Under the first-level code patient deficits, three second-level codes were present—sensory deficits, cognitive deficits, and insight deficits. SLPs who use and do not use PROMs provided similar responses that resulted in these codes. In particular, insight deficits was a frequently applied code to responses such as “patients are often not self-aware of their deficits” or “patients with limited awareness of deficits may not be able to accurately describe cognitive-communication challenges.”

What Do SLPs Need With Respect to the Clinical Measurement of Health-Related QoL for Their Patients With Cognitive-Communication Disorders?

Lastly, this survey explored what SLPs might want from future PROMs to better assess the health-related QoL of their patients with cognitive-communication disorders. Overall, SLPs agreed that new/better PROMs are needed for all four domains presented in the survey: (a) activities and participation, (b) environmental factors, (c) personal factors, and (d) symptoms/function. SLPs were asked to rate the importance/urgency of new/better PROMs in each domain using a visual analog scale in which participants could slide a marker to indicate their response, with the anchors of not important/urgent (represented as 0) to very important/urgent (represented as 100). Activities and participation averaged a rating of 71, making this domain participants' highest priority. The other three domains—environmental factors, personal factors, and symptom/function—were rated with similar importance: 66, 69, and 65, respectively.

When asked with an open-ended response format what SLPs need related to the measurement of QoL, responses resulted in eight first-level codes and 10 second-level codes. First-level codes were as follows: 1 = psychological and behavioral health, 2 = activities and participation, 3 = QoL (general construct), 4 = social determinants of health, 5 = support networks, 6 = risk factors for cognitive change, 7 = goal personalization, and 8 = patient insight. Second-level codes were as follows: a = safety, b = self-appraisal of goals, c = communicative participation, d = activities of daily living, e = impact of day-to-day, f = personally relevant activities, g = emotional experience after a diagnosis, h = mental health comorbidities, i = reaction to diagnosis, and j = motivation. The first-level code of activities and participation was the most frequently applied and was associated with the most second-level codes (i.e., safety, self-appraisal of goals, communicative participation, personally relevant activities, activities of daily living, and day-to-day impact). As an example of the second-level code day-to-day impact, one SLP reported, “I would like to have a better measurement of [the patient's] cognitive ability in actual day-to-day function and their view of their cognitive function in day-to-day activities.” In addition, SLPs emphasized communicative participation in ways such as wanting to assess “how well [patients] communicate with and understand communication from their [doctors].”

The majority of first- and second-level codes mapped well to one of the four ICF domains (i.e., activities and participation, environmental factors, personal factors, and perspective of symptoms/function; see Table 4). For example, the second-level codes safety, communicative participation, and day-to-day impact map to the activities and participation domain. The first-level codes social determinants of health and support network are examples of codes that map to the environmental factors domain. Overall, SLPs reported not only needing better/new PROMs for all four domains, but also provided specific examples of constructs they would like to measure within those domains (e.g., communicative participation within activities and participation).

Table 4.

Integration of qualitative and quantitative analysis—what do speech-language pathologists want to measure better about health-related quality of life?

Domain	Rating of importance	Quote
Activities and Participation	71	“I would like to have a better measurement of their cognitive ability in actual day to day function and their view of their cognitive function in day-to-day activities.”
Environmental Factors	66	“What assistance would they be amenable to upon discharge from groups such as the corporation for aging, meals on wheels, home care, etc.?”
Personal Factors	69	“Specific needs related to religion or personal belongings.”
Symptoms/function	65	“Depression and mental health.”

Discussion

PROMs can contribute to the comprehensive assessment of patients with cognitive-communication disorders (Cohen & Hula, 2020), yet little is known regarding SLPs' clinical use of them. The results from our survey provide an initial understanding of how SLPs are using them, as well as perceived barriers and outstanding measurement needs.

Are SLPs Using PROMs for Patients With Cognitive-Communication Disorders, and If So, How?

Less than half of the SLP respondents reported using PROMs with patients with cognitive-communication disorders. The theme caregiver's perspective was present, even though the question did not specifically ask about caregivers/informants, indicating some SLPs are using PROMs to gather information from people other than the patient. SLPs who reported using PROMs said that they most often use them for goal setting, followed by assessment of treatment effects, and least often for diagnostic purposes. These findings are notable because most PROMs were not specifically designed to support goal setting. For example, one SLP reported using the Everyday Memory Questionnaire to help set goals. This PROM was developed to capture a patient's view of their subjective memory deficits (Royle & Lincoln, 2008) and was not explicitly designed to help create treatment goals, although it is not necessarily inappropriate.

There is existing literature on evidence-based tools and processes that SLPs can use to set goals; however, to our knowledge, there is no specific guidance on how PROMs could be implemented within these frameworks. The FOURC 4-pronged model, named for its four sequential steps beginning with the letter “c” (Haley et al., 2019), and goal attainment scaling (Scholsser, 2004) are two evidence-based goal setting tools that could be informed by PROM data. Because our survey findings indicate that SLPs find value in using PROMs for goal setting, future research and development may be warranted to optimize PROMs for this purpose. In addition, future research should explore how existing screening or assessment tools, particularly performance-based ones, may benefit from complementary patient report modules. For example, a performance-based measure of executive functions (e.g., task planning or switching) could also ask participants to rate their success in doing similar tasks in everyday life. The Functional External Memory Aid Tool (FEMAT) is an example of a performance-based assessment with a published case example to illustrate how to use the FEMAT alongside PROMs to facilitate the development of person-centered goals (Lanzi et al., 2024).

SLPs who responded to the survey of Torrence et al. (2016) reported a lack of standardized, participation-based assessments and treatments as a barrier to providing functional care. Our data, however, demonstrated that at least some SLPs use PROMs for purposes related to functional assessment and treatment (see Table 2). Therefore, more research and continuing education may be needed to support the ongoing dissemination and implementation of PROMs in clinical practice.

What Are the Barriers to PROM Use for Patients With Cognitive-Communication Disorders?

The barriers reported by SLPs in our study, such as the billing, time, or practice patterns, align with barriers previously reported by SLPs (Torrence et al., 2016), as well as other allied health professionals (Briggs et al., 2020). SLPs' awareness of or access to PROMs was a named barrier, which may be related to inadequate dissemination or implementation, which has also been reported as a barrier encountered by other allied health professionals (Briggs et al., 2020). For example, SLPs may not know about CAT, how brief PROM short forms can be (e.g., four items; Cohen & Hula, 2020), or that payor sources have started endorsing PROM use (CMS, 2022).

Many PROMs are free and easily accessible, but SLPs still report access difficulties. PROM developers may benefit from expanding their strategies for dissemination. For example, previous research suggests SLPs learn information most frequently from colleagues and continuing education (Zipoli & Kennedy, 2005). Therefore, increasing dissemination and implementation may require building stronger clinical–research partnerships, such as creating workshops or modules for continuing education credit. Partnering at the hospital or facility level could facilitate working directly with SLPs to integrate PROMs into electronic medical record systems.

A first-level code, patient deficits, and the second-level code, insight, describe a barrier that is commonly perceived by SLPs working with cognitive-communication disordered populations who may lack the cognitive/linguistic ability to complete the measure, or who have limited insight. For example, several respondents reported that if a patient's insight improves over the course of therapy, a PROM score could reflect worse functioning than at baseline, leaving the SLP potentially feeling responsible for describing this qualitatively. It is worth emphasizing that a PROM only captures the subjective perspective of the respondent and is best interpreted alongside other data, including performance-based and informant-report measures, to provide context. Many measures, including the Everyday Cognition measure (Farias et al., 2011), have both patient and informant versions, which can help contextualize the patient's perspective. It is also true that PROMs are not appropriate or useful for every client or situation (Cohen & Hula, 2020).

What Do SLPs Need With Respect to the Clinical Measurement of Health-Related QoL for Their Patients With Cognitive-Communication Disorders?

Overall, our findings align with previous findings that SLPs want more/better tools to quantify functional skills and health-related QoL domains (Torrence et al., 2016). However, many high-quality PROMs already exist that assess constructs described as needed but not mentioned by our respondents (Appendix C), perhaps because they did not know about them. For example, the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities item bank (Cella et al., 2010) and the CPIB (Baylor et al., 2013) can help measure activities and participation. The CMS created The Accountable Health Communities Health-Related Social Needs Screening Tool to help capture certain environmental factors, such as social determinants of health (CMS, 2019). Self-efficacy, a personal factor, can be measured with the Memory Self-Efficacy Questionnaire (Berry et al., 1989). Future research could explore whether SLPs are unaware that these PROMs exist or if they are aware but are unsatisfied with them for use in clinical practice.

Limitations

Our sample was predominantly White and female and was also younger than the population of practicing SLPs in the United States (ASHA, 2022b). This may be due to our recruitment strategies (e.g., social media), and future research could explore whether PROM use varies by practitioner age or other demographic variables. Minimal attrition occurred from the beginning to the end of the survey, but certain items, particularly open-ended ones, did have a relatively low number of responses (see Appendix A). Although survey items were written thoughtfully and piloted with 10 SLPs before distribution, some items could have been more effective if phrased differently. For example, a few items contained two or even three questions in one (e.g., “Can you say more about how you use PROMs to screen for a condition? What do they do well? What could be improved?”). This also may have influenced the open-ended responses. SLPs tended to respond to each question in the above example by first responding to what PROMs do well and then with how they could be improved. Fortunately, parsing apart MUs did help overcome this limitation. Furthermore, the third research question provided the following domains when asking SLPs to rate how important new/better PROMs would be in those areas: (a) activities and participation, (b) environmental factors, (c) personal factors, and (d) symptoms/function. We acknowledge these domains could interact, which may have influenced SLPs' responses. For example, an SLP client's poor internet service (an environmental factor) could affect their use of a digital calendar, limiting their ability to participate in personally meaningful activities due to difficulties managing a schedule.

It is also possible that some of our yes/no or visual analog scale questions influenced respondents' answers to subsequent open-ended, qualitative questions. For example, participants were asked if they use PROMs for a particular aspect of the continuum of care (e.g., screening) and then asked how PROMs were used in that part of the continuum of care. It is possible SLPs are using PROMs for aspects of care that are not within the continuum proposed in the survey items. It is also likely that not every component of this continuum is present in every setting, and the components may overlap (e.g., a doctor's order may specify that the SLP should “screen and assess”). This could have influenced the responses and may also explain some of the overlap seen across the components. Furthermore, the use of the ICF as a theoretical framework for the writing of survey items likely influenced how SLPs responded to the survey and how our investigative team created and named codes. It is possible that our respondents use other clinical frameworks (e.g., a medical model, disability model), but we selected the ICF because ASHA endorses it for the training and professional practice of SLPs (ASHA, n.d.).

The survey explicitly defined PROMs but did not give examples. While this was intended to decrease the likelihood of participants overreporting the use of the examples, it did assume the participants would be able to recognize examples of PROMs from within their own practice. SLPs may be using more PROMs than they report because they did not identify the measure as a “PROM” according to our definition. Also, although the survey was asking about patients with cognitive-communication disorders, we did not specify that patients could only have cognitive-communication disorders. Therefore, SLPs did list PROMs for other service areas (e.g., Voice Handicap Index).

Conclusions

The results from this exploratory analysis help contribute to the sparse research investigating PROM use by SLPs for adult patients with cognitive-communication disorders. Because PROMs may be helpful as part of a comprehensive assessment (Cohen & Hula, 2020), it is important to understand how SLPs are currently using them. SLPs reported using PROMs most often for goal setting, followed by assessing treatment effects. This work clarifies what SLPs perceive as barriers to PROM use with these patients, such as patient insight deficits and time. The barriers of poor implementation and dissemination may also be an important finding and relatively easily addressed, for example, by forming or strengthening research–clinical partnerships to address how PROMs could be developed or modified to more intentionally inform goal setting.

Author Contributions

Faith Stagge: Conceptualization, Investigation, Methodology, Project administration, Data curation, Validation, Visualization, Writing – original draft, Writing – review & editing. Matthew L. Cohen: Conceptualization, Investigation, Project administration, Supervision, Funding acquisition, Writing – review & editing. Allyson Lindsay Johnson: Investigation, Validation, Writing – review & editing. Alyssa M. Lanzi: Conceptualization, Funding acquisition, Data curation, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

Data Availability Statement

The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Appendix A

How Survey Items Supported Research Questions

Research questions Question 1: Are SLPs using PROMs with clients with cognitive-communication disorders, and if so, how? Question 2: What are the barriers to PROM use for clients with cognitive-communication disorders? Question 3: What do SLPs need with respect to the clinical measurement of health-related QoL for their clients with cognitive-communication disorders?
Survey item	Item format	Data supported which research question (e.g., 1, 2, or 3)?	Number of respondents (n)
Section 5
Do you ever use patient-reported outcome measures (PROMs) with your adult clients with cognitive-communication conditions (from stroke, traumatic brain injury (TBI), Alzheimer's disease,frontotemporal lobar degeneration (FTLD or FTD), Parkinson's disease, Huntington's disease, mild cognitive impairment (from any cause), amyotrophic lateral sclerosis (ALS), cancer, and similar conditions)?	Yes/no	1	95
Why do you not use PROMs? Are there any barriers that limit your ability to use PROMs?	Open-ended response	2	50
Do you measure the patient's perspective of their symptoms, function, or quality of life?	Yes/No	—	58
If yes, how so?	Open-ended response	—	44
For what percent of cog-comm clients do you use PROMs for screening?	Visual analog scale	1	37
Which PROMs specifically do you use to screen for a condition?	Open-ended response	1	23
Can you say more about how you use PROMs to screen for a condition? What do they do well? What could be improved?	Open-ended response	1	21
For what percent of cog-comm clients do you use PROMs to diagnose a cog-comm condition?	Visual analog scale	1	37
Which PROMs specifically do you use to diagnose a condition?	Open-ended response	1	15
Can you say more about how you use PROMs to diagnose a condition? What do they do well? What could be improved?	Open-ended response	1	14
For what percent of cog-comm clients do you use PROMs for goal setting?	Visual analog scale	1	37
Which PROMs specifically do you use for goal setting?	Open-ended response	1	26
Can you say more about how you use PROMs to set goals? What do they do well? What could be improved?	Open-ended response	1	25
For what percent of cog-comm clients do you use PROMs for assessing treatment effects?	Visual analog scale	1	36
Which PROMs specifically do you use for assessing treatment effects?	Open-ended response	1	22
Can you say more about how you use PROMs to assess treatment effects? What do they do well? What could be improved?	Open-ended response	1	20
Are there any barriers that limit your ability to use PROMs with your cog-comm clients?	Open-ended response	2	36
If yes, please explain	Open-ended response	2	26
Do you use any assessments or tools in addition to PROMs to measure Quality of Life?	Yes/no	—	50
If yes, which assessments or tools?	Open-ended response	—	9
Overall, how satisfied are you with your options for 1- Very Dissatisfied patient-reported outcome measures (PROMs) for adult 2 cognitive-communication clients?	Multiple-choice	—	90
Section 6
What aspects of your cog-comm clients' health-related quality of life (e.g., their health, functioning, beliefs, emotions, etc.) would you like to measure more effectively and why? Maybe these are things that you are currently asking informally during an interview. Try to list 3 responses	Open-ended response	3	81
How important and urgent are new/better PROMs to assess the cog-comm client's perspective of their symptoms and function (e.g., cog-comm abilities and impairment)?	Visual analog scale	3	89
How important and urgent are new/better PROMs to assess the cog-comm client's perspective of personal factors (e.g., emotions, motivation, awareness, beliefs)?	Visual analog scale	3	88
How important and urgent are new/better PROMs to assess the cog-comm client's perspective of environmental factors (e.g., partner attributes, societal attitudes, and communication environment)?	Visual analog scale	3	86
How important and urgent are new/better PROMs to assess the cog-comm client's perspective of activities and participation (e.g., completion of roles and responsibilities, engagement in the community)?	Visual analog scale	3	84

Appendix B

Code Book for Survey Data Reporting Patient-Reported Outcome Measures (PROM) Use in Clinical Practice

	Question	Codes	Definition	Example
USE PROMs	Screen	Monitor progress	Meaningful unit (MU) has the concept of tracking progress	“Easy way to see if the patient is make progress.”
		Learn patient's perspective	MU is about the patients perception in regard to their cognitive-communication	“They do a great job of identifying how the patient perceives their disorder.”
		Collect functional data	MU refers to functional data such as impact on day-to-day life, quality of life, or patient priority	“Patients will often elaborate as they respond- this gives me a better grasp on the functional impacts of their symptom.”
		Learn caregiver's perspective	MU includes the caregiver perspective about the patient's cognitive-communication	“One of my first evaluation tasks is to ask patient and family members about what they've noticed about specific domains pre and post injury.”
		Barriers to PROM use	MU report any barriers to PROM use	“May not always be an accurate depiction.”
		Other	Any responses/MU that don't fit in the codes for that question	“I don't use them to screen for a condition - but to screen for behaviors that could be changed.”
	Diagnose	Support diagnosis	MU refers to using PROMs to support a diagnosis, not using it to actually diagnose	“The info provided by the patient helps to support the diagnosis I've arrived at based on standardized test scores and clinical observations.”
		Collect functional data Impact on day-to-day life Limitations of performance-based tests	MU refers to functional data such as impact on day-to-day life, quality of life, or patient priority Specific functional data collection about the impact on day-to-day life Using PROMs as functional data collection because performance-based tests have limitations	(no example, all MUs fall under second level codes) “I will use this to assess the severity of impact.” “This allows for additional consideration of functional impairments/changes that may not be identified on standardized measures d/t higher premorbid function or relatively preserved decontextualized skills.”
		Learn patient's perspective Insight deficits Patient's emotions	MU refers to the perspective of the pt themselves Specifically mentions the patient's awareness or insight Specifically mentions how a patient's emotions is a part of their perspective	(no example, all MUs fall under the second-level codes) “however might not give you the real picture if they have limited awareness of deficits.” “In some cases, the patient's emotional view of their condition significantly contributes to the severity. In those cases, PROMs help to establish the need for therapeutic intervention to address the condition.”
	Set goals	Goal personalization Facilitate collaborative goal setting Prioritize patient concerns Facilitate functional goals	MUs are all related to increasing personalization of goal setting Specifically mentions the process of goal setting by using the PROM to support that process Specifically mentions the idea of patient priority Specifically mentions targeting a specific skill set or activity that patient wants to work on	(no example, all MUs fall under second-level codes) “They capture domains for treatment targets in a way that some individuals can't articulate, helping me to narrow my goal focus.” “Usually priorities come up for discussion as they respond- it shows me what they are most bothered by or motivated to do.” “The items are very useful for providing tangible functional activities to pursue, and ratings provide applicable information in setting goals.”
		Barriers for using PROMS to set goals Setting Poor dissemination to clinical practice Patient's insight deficits	MU about barriers to PROM use for cognitive-communication Specifically mentions a setting Mentions information that demonstrates poor dissemination Specifically mentions the patient's awareness or insight	(no example, all MUs fall under second-level codes) “It would be best in an out-patient setting. Most helpful if given to patients (if able) and another one to family members as a written tool *before* the first meeting, to help focus and streamline the evaluation process.” “They could be more widely known and then would probably be used more often.” “My biggest issue is less with the PROMs and more due to the fact that most of the patient's I work with are at a lower level, and therefore very unaware of their deficits.”
		Monitor progress	MU has the concept of tracking progress	“I also like that I can do it pre-and post treatment.”
		Ideas for improving PROMs	MU has an idea for improving PROM use for individuals with cognitive-communication deficits	“I could see it potentially being helpful to have associated potential goals with each assessment measure.”
	Treatment effects	Monitor progress	MU has the concept of tracking progress	“I give it pre and post treatment. The patient and I compare the two and discuss any changes we see.”
		Ideas for improving PROMs	MU has an idea for improving PROM use for individuals with cognitive-communication deficits	“but it would be nice to have one, more efficient tool to obtain this information in a more time efficient manner.”
		Collect functional data Quality of life	MU refers to functional data such as impact on day-to-day life, quality of life, or patient priority Specifically mentions quality-of-life as a construct	“It shows me the potential functional impact of intervention when I am unable to observe in the patient's natural environments.” “Hopefully at the end of the patient's therapy course their self-reported functional abilities have improved or their quality of life has improved.”
		Insight	Any responses/MU that discusses insight	“They are best for treating insight/awareness.”
	Barriers to use	Poor implementation Billing Time	Mentions information that demonstrates poor implementation or training in health care systems Billing as a barrier to administering PROMs The length or time it takes to administer PROMs	“We are still living in an age where SLPs will only use performance based measures.” “not recognized/accepted by insurance carriers.” “time - Dysphagia evals, oral motor exam, interview, documentation takes precedence of administering formal PROMs.”
		Patient's deficits Insight deficits Cognitive deficits Sensory deficits	Any aspects of the patient's functioning that make it more difficult to use PROMs Specifically mentions the patient's awareness or insight Specifically mentions how cognitive deficits could impact any part of the PROM process Specifically mentions patient sensory deficits that could be barriers to PROM use	(no example, all MUs fall under second-level codes) “Clients with limited awareness of deficits may not be able to accurately describe cog-com changes.” “Significantly impaired cognitive function (eg. dementia) patients do not always understand how to fill out the form.” “Hearing and vision deficits.”
		Barriers to including informants	MUs about the difficulty including informants, such as caregivers or family members, as part of the PROM process	“lack of access to family members or others that are familiar with PLOF.”
		Poor dissemination SLP access difficulties	MUs mentions information that demonstrates poor dissemination Specifically mentions the construct of access to PROMs	“They could be more widely known and then would probably be used more often.” “Accessing them.”
	What do you want to measure better?	Activities & Participation (A&P) Safety ADL/IADLs Self-appraisal of goals Communicative participation	MUs that revolve around the impact of participation in activities at the level of the individual Specifically mentions the safety aspect of A&P Specifically mentions activities that are categorized as known ADL/IADLs Specifically mentions the self-appraisal of how a deficit impacts their life Specifically mentions an activity where communication is the main aspect of participation	(no example, all MUs fall under second-level codes) “safety implications of memory and attention deficits regarding driving.” “Medication management.” “how they feel they are completing daily tasks.” “ability to interact with friends/ family.”
		Patient insight deficits	MU about the patient's awareness or insight	“awareness of deficits and/or the severity/impact of their changed cog status (if they think it's changed).”
		Social determinants of health (SDOH)	MU about non medical factors related to SDOH clinician want to measure	“Health literacy.”
		Psychological and behavioral health Mental health comorbidities Reaction to diagnosis Motivation	MUs related to psychological and behavioral health constructs Specifically mentions a mental health diagnosis Specifically mentions as aspect of the continuum of the emotional experience an individual experiences with a new diagnosis Specifically discusses motivation	“Sleep.” “Depression.” “acceptance/denial.” “A measure about WHY they are not motivated. Because so often people report being not motivated by anything/not planning on doing anything at home other than watch TV. I don't really know how this measure would be useful per se, but it would be interesting to try to understand why people are so not motivated to improve.”
		Quality of life	Specifically mentions quality of life	“Life participation and functional impact on QOL.”
		Support network	MUs about the types of support an individual has	“Degree of family support.”
DON'T USE PROMs	Ways to measure pt perspective SLP report using that aren't PROMs	Informally/interview	MU that refers to informal interview or questions	“Informally through patient interview.”
		Pt self-reflection	MU about asking the patient to self-reflect on their own functioning	“By asking what they view as their weaknesses and strengths.”
		Using other types of scales/measurements	MU where clinician's report using a different kind of measurement for patient perspective	“I use the Borg effort scale to ask my patient on scale of 1–10 how hard tasks are/were.”
		Impacts on their daily life/work ADLs	MU regarding impact on ADLs	“Effects on their daily life/work ADLs.”
	What do you want to measure better?	A&P ADL/IADLs Personally relevant activities Safety Impact on day-to-day Communicative participation	MUs that revolve around the impact of participation in activities at the level of the individual Specifically mentions activities that are categorized as known ADL/IADLs Specifically mentions personally relevant activity constructs Specifically mentions the safety aspect of A&P Specifically mentions the impact on daily life Specifically mentions an activity where communication is the main aspect of participation	“current level of functioning.” “Function at home on tasks such as money, meds, etc.” “What are you not doing now that you enjoyed doing a year or two ago?” “Impact of deficits in safety awareness” “Impact of memory deficits on daily life.” “How well they are able to communicate wants and needs.”
		Patient's insight deficits	MU about the patient's awareness or insight	“self-perception/insight into deficits.”
		Psychological health Mental health comorbidities Emotional experiences of a diagnosis Motivation	MUs related to psychological health constructs Specifically mentions a mental health diagnosis Specifically mentions as aspect of the continuum of the emotional experience an individual experiences with a new diagnosis Specifically discusses motivation	“Emotions.” “[I] always ask about the impact of PTSD or other mental health issues, and it they are receiving treatment for any of these.” “understanding of medical condition's effect on emotions/mental health.” “motivation, self-efficacy.”
		Other risk factors for cognitive changes	MU that relate to wanting information about other cognitive impairment risk factors	“How loneliness and isolation affects quality of life and cognitive communication.”
		Goal personalization	MUs are all related to increasing personalization of goal setting	“Patient's likes and dislikes.”
		Support network	MUs about the types of support an individual has	“What assistance do they have around the home and are they able to get more help?”
		Other	Any responses/MU that don't fit in the codes for that response	“I don't think these type of things are measurable or even stable.”
	Barrier to use	Poor implementation Training Time Setting barriers Practice patterns	Mentions information that demonstrates poor implementation or training in health care systems Specifically mentions lack of training The length or time it takes to administer PROMs Specifically mentions setting barriers Specifically mentioning systematic practice barriers	(no example, all MUs fall under second-level codes) “Have not been trained, although I have heard of them.” Due to productivity standards, I don't have time to look for things like this on the clock, and I refuse to work off the clock.” doesn't seem so relevant in acute It's not something that our organization uses.”
		Poor dissemination SLP access difficulties	MU mentions dissemination of knowledge Specifically mentions the construct of access to PROMs	“Don't know much about PROMs.” “We do not have any available to us at our current site.”
		Patient deficits Insight deficits Cognitive deficits Sensory deficits	Any aspects of the patient's functioning that make it more difficult to use PROMs Specifically mentions the patient's awareness or insight Specifically mentions how cognitive deficits could impact any part of the PROM process Specifically mentions patient sensory deficits that could be barriers to PROM use	(no example, all MUs fall under second-level codes) “I tend to use PROMS more for patients with aphasia or dysphagia. I feel there is often a lack of awareness regarding deficits when it comes to cog comm.” “I haven't found one that seems appropriate for people with mod-severe dementia.” “Many SNF clients cannot read and write well.”
		Dislike	MU about dislike	“Don't have one that I like.”

Appendix C

Patient-Reported Outcome Measures (PROMs) Used Across the Continuum of Care Reported by Speech-Language Pathologists (SLPs)

Screening	Diagnosis	Goal setting	Assessing treatment effects
Attention Process Training-II programme–Attention Questionnaire	Behavior Rating Inventory of Executive Function	Academic Skills Needs Assessment	Aphasia Needs Assessment
Behavior Rating Inventory of Executive Function	Burden of Stroke Scale	Aphasia Needs Assessment	Change in scaled scorea
Center for Epidemiology Studies Depression Scale	Communicative Participation Item Bank	Cognitive-Communication Checklist for Acquired Brain Injury	Cognitive-Communication Checklist for Acquired Brain Injury
Central Sensitization Inventory	Eating Assessment Toolb	Communication Confidence Rating Scale	Communication Confidence Rating
Cognitive-Communication Checklist for Acquired Brain Injury	Everyday Memory Questionnaire	Communication Confidence Rating Scale for Aphasia	Communication Effectiveness Index
Communication Outcome After Stroke	La Trobe Communication Questionnaire	Communicative Participation Item Bank	Durham Memory Questionnaire
Communicative Participation Item Bank	Multifactorial Memory Questionnaire	Consensus Auditory-Perceptual Evaluation of Voice	Eating Assessment Tool
Dementia Quality of Life	Neuro-QOL	Durham Memory Questionnaire	Eating Assessment Toolb
Eating Assessment Toolb	Post-Concussion Syndrome Scale	Eating Assessment Tool	Everyday Memory Questionnaire
Environment & Communication Assessment Toolkit for Dementia Care	Rivermead Post Concussion Questionnaire	Everyday Memory Questionnaire	La Trobe Communication Questionnaire FACT-Cog
Everyday Memory Questionnaire	Self-Awareness Deficits Interview	Goal Attainment Scalinga	Mayo-Portland Adaptability Inventory
Informal Interviewa	The Functional Assessment of Cancer Therapy—Cognition	Interview/informala	Multifactorial Memory Questionnaire
Latrobe Communication Questionnaire	Traumatic Brain Injury Quality of Life	La Trobe Communication Questionnaire	Neuro QoL Communication Short Form
Memory Functioning Questionnaire	Voice Handicap Indexb	Multifactorial Memory Questionnaire	Post-Concussion Syndrome Scale
Neuro QoL Communication Short Form		Neuro Qol Communication Short Form	PROMIS Item Bank v2 Cognition Short Form
PROMIS Item Bank v2 Cognition Short Form		Patient Competency Rating Scale	Rivermead Post Concussion Scale
Reflux Symptom Indexb		PROMIS Item Bank v2 Cognition Short Form	The Functional Assessment of Cancer Therapy—Cognition
Rivermead Post Concussion Questionnaire		Reflux Symptom Index	Voice Handicap Index
S-Scaleb		Rivermead Post Concussion Scale
Voice Handicap Indexb		Self-Awareness Deficit Interview
		Vocal Priority Questionnaireb

^aIndicates a tool listed by a participant, but is not a PROM.

^bIndicates a PROM relevant for an SLP service area different than cognitive-communication.

Funding Statement

This study was supported by a pilot research grant (to author M.L.C.) that was part of an Institutional Development Award from the National Institute of General Medical Sciences under Grant U54-GM104941 (PI: Hicks). This work was also supported by the National Institute of Aging of the National Institutes of Health under Award Number K23AG070185–01 (PI: Alyssa Lanzi).