Knowledge of Turkish Speech‐Language Pathologists on Tracheostomy Management

ABSTRACT

Background

Tracheostomy may adversely affect speech, language, swallowing, and voice, requiring multidisciplinary management in which speech‐language pathologists (SLPs) play a key role. However, there is limited evidence regarding SLPs’ self‐reported knowledge of tracheostomy management in Turkey.

Aims

This study aimed to evaluate the self‐reported knowledge of Turkish SLPs regarding tracheostomy management and related intervention practices.

Methods

A total of 113 SLPs from different regions of Turkey completed a survey designed to assess their self‐reported knowledge of evaluation and intervention for speech, language, voice, and swallowing disorders following tracheostomy.

Results

Overall self‐reported knowledge levels were moderate, with variability across domains. Self‐reported knowledge was higher in areas such as tracheostomy timing and oral hygiene, but lower in clinically critical topics including cuff pressure, cuff positioning, and their effects on vocal fold function. Self‐reported knowledge related to speech, language, and communication management was also moderate. Clinical experience and additional training were associated with higher self‐reported knowledge levels.

Conclusions

The findings highlight the need for improved education, increased clinical exposure, and the development of structured protocols to support SLP involvement in tracheostomy management.

WHAT THIS PAPER ADDS

What is already known on this subject

• Speech‐language pathologists (SLPs) play an important role in the management of dysphagia, communication, and voice disorders in individuals with tracheostomy. International guidelines emphasize structured postgraduate training, simulation‐based learning, and supervised clinical practice to achieve competency in tracheostomy management. Evidence regarding SLPs' preparedness and self‐reported knowledge in tracheostomy management remains limited in Türkiye.

What this study adds to the existing knowledge

• This is the first national study evaluating Turkish SLPs' self‐reported knowledge of tracheostomy management. Although overall knowledge levels were moderate, important gaps were identified in clinically critical areas, particularly cuff management, decannulation, and multidisciplinary care. Postgraduate education, targeted training, and direct clinical experience were associated with significantly higher self‐reported knowledge.

What are the clinical implications for this study?

• The findings support strengthening undergraduate and postgraduate education in tracheostomy management through standardized curricula, simulation‐based learning, workplace mentoring, and supervised clinical experience. The development of national clinical guidelines and standardized protocols may facilitate SLPs' effective integration into multidisciplinary tracheostomy teams and ultimately improve patient care.

1. Introduction

Tracheostomy is an artificial airway opened on the anterior part of the neck into the trachea for individuals experiencing respiratory distress (Cheung and Napolitano 2014, Kalanuria et al. 2014). Indications for tracheostomy include upper airway obstructions, respiratory failure, prolonged need for mechanical ventilation, neurological diseases, and conditions such as head and neck cancer (Lin et al. 1999, Morris et al. 2013). The knowledge and skills required for speech‐language pathologists (SLPs) managing individuals with tracheostomy are further defined through international competency frameworks and professional development resources (Intensive Care Society 2024, New Zealand Speech‐language Therapists' Association 2022, Royal College of Speech and Language Therapists 2022, Speech Pathology Australia 2005). Following tracheostomy, structural changes in the upper airway and loss of sensorimotor functions negatively affect swallowing function and increase the risk of aspiration pneumonia (Kowalski et al. 2017, Skoretz et al. 2020). The incidence of dysphagia (swallowing disorder) after tracheostomy ranges from 11% to 93% (Skoretz et al. 2020). If left untreated, this condition may lead to serious problems such as mortality, respiratory complications, and malnutrition (Cheung and Napolitano 2014, Johnson et al. 2009). While clinical swallowing assessment is important in individuals with tracheostomy, instrumental evaluation is also crucial to determine the safety of oral intake and to identify the risks that cannot be clinically observed, such as silent aspiration. Accordingly, Videofluoroscopic Swallowing Study (VFSS) (Martin‐Harris et al. 2000) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) (Hales et al. 2008) are commonly used. When oral intake is not appropriate, alternative feeding methods such as nasogastric tube (NG) and percutaneous endoscopic gastrostomy (PEG) are employed (Waldron et al. 1990).

Prolonged intubation and tracheostomy may lead to laryngeal injuries, dysphonia, pain, hoarseness, and social isolation (Ponfick et al. 2015). A key factor underlying these complications is the disruption of phonation following tracheostomy. The use of speaking cannulas and valves in individuals with tracheostomy contributes to the restoration of subglottic pressure, which in turn supports both swallowing and phonation mechanisms (Lian et al. 2022, Lin et al. 1999). Consequently, the individual's quality of life improves (McGrath et al. 2016, Pandian et al. 2020). In addition, the re‐establishment of subglottic pressure enhances sensation in the oral and pharyngeal regions, restores the cough reflex and glottic closure, thereby reducing the risk of aspiration (Gross et al. 2003).

Tracheostomy care and intervention is a complex process that requires collaboration among multiple disciplines. The presence of SLPs within such a team is of critical importance with respect to assessing and supporting essential functions such as communication, swallowing, and voice production. They are also involved in various stages of care, including the restoration and improvement of laryngeal functions, identification of augmentative and alternative communication (AAC) modalities—when necessary, secretion management, and successful implementation of the decannulation process (Bonvento et al. 2017, Dunn and Goulet 2000, Pryor et al. 2016, St John and Malen 2004). Moreover, the involvement of SLPs in the process has been associated with shorter tracheostomy duration, increased use of speaking valves, and reduced length of stay in hospitals and intensive care units (ICUs). Additionally, some of the potential complications following tracheostomy may be prevented if SLPs are within the treatment team (Bonvento et al. 2017, De Mestral 2011, Speed and Harding 2013). However, some studies have noted a lack of high‐level evidence in this area due to methodological limitations (Speed and Harding 2013).

Internationally, tracheostomy management is recognized as an advanced area of speech‐language pathology practice that requires competencies extending beyond undergraduate education (Miles et al. 2020, Ward et al. 2014). The knowledge and skills required for speech‐language pathologists (SLPs) managing individuals with tracheostomy are further defined through international competency frameworks and professional development resources (Intensive Care Society 2024, New Zealand Speech‐language Therapists' Association 2022, Royal College of Speech and Language Therapists 2022). Because opportunities to manage patients with tracheostomy are relatively infrequent and clinical exposure may be limited, simulation‐based training has become an important educational strategy for developing clinicians' knowledge, technical skills, clinical reasoning, communication skills, and confidence before independent practice. For example, human mannequin‐based simulation has been shown to be a feasible and clinically acceptable method for training SLPs with little or no previous experience in tracheostomy management (Ward et al. 2014). Likewise, structured education programmes combining theoretical instruction with simulation‐based clinical scenarios have been shown to significantly improve clinicians' knowledge, manual skills, and clinical confidence, with these gains maintained over time (Miles et al. 2020). At the pre‐professional level, standardized patient simulation has also been successfully used to develop and evaluate students' clinical communication skills in tracheostomy‐related scenarios, providing a safe environment in which to acquire essential competencies before direct patient care (Stead et al. 2023). Collectively, these studies suggest that competency in tracheostomy management is typically achieved through structured postgraduate education and simulation‐based training rather than through undergraduate education alone. Accordingly, several studies from different countries have evaluated SLPs' preparedness, confidence, clinical practices, and knowledge related to tracheostomy management (Ward et al. 2008, Ward et al. 2012, Wiberg et al. 2022).

In Turkey, however, there is limited published information regarding structured postgraduate education and competency‐based training pathways specifically addressing tracheostomy management for SLPs. Published resources are largely limited to a small number of guidelines and informational booklets prepared by non‐governmental organizations (Türk Toraks Derneği 2022). Consequently, differences in clinicians' perceived knowledge may reasonably reflect variation in access to structured education and clinical experience rather than individual capability alone. To date, no empirical studies have systematically examined Turkish SLPs' self‐reported knowledge and practices regarding tracheostomy management. Therefore, this study aimed to evaluate Turkish SLPs' perceived knowledge of tracheostomy management and to examine whether this differed according to educational background, clinical experience, and additional tracheostomy‐related training.

2. Methods

2.1. Study Design

This study employed a descriptive, cross‐sectional design. The dependent variable was the SLPs’ self‐reported overall knowledge level regarding tracheostomy, further analyzed across the domains of speech, language, communication, and dysphagia. Independent variables included educational background, years of professional experience, workplace setting, client profiles, participation in training programmes, conferences, or seminars on tracheostomy, the number of tracheostomy clients for whom intervention was provided, and clinical experience with tracheostomy clients during undergraduate education.

2.2. Ethical Approval

Ethical approval was granted by the Scientific Research and Publication Ethics Committee of Anadolu University, Faculty of Health Sciences (Protocol No. 538687, dated 5 July 2023). Ethical approval was obtained from a non‐interventional clinical research ethics committee. All participants were provided with written information about the study and gave written informed consent prior to participation. Confidentiality and anonymity were assured for all participants.

2.3. Participants

A total of 113 SLPs residing in Turkey participated in this study, including 93 female and 20 male respondents. The demographic characteristics of the participants are presented in Table 1. According to Cangi and Toğram (2020), approximately 750 SLPs were providing clinical services in Turkey at the time of their study (Cangi and Toğram 2020). Based on recent graduation rates, this number was estimated to have reached nearly 2000 by 2025. For the present study, the required sample size was calculated using the Raosoft Sample Size Calculator, assuming a population of 2000, with a 95% confidence interval and a 10% margin of error. The minimum required sample was determined as 92 participants (calculator 2004).

TABLE 1.

Demographic characteristics of the participants (N = 113).

		N	%
Gender	Female	93	82.30
	Male	20	17.70
Age	22–25	35	30.97
	26–30	51	45.13
	31+	27	23.89
Region of work	Central Anatolia	56	49.56
	Marmara	26	23.01
	Aegean	14	12.39
	Black Sea	6	5.31
	Mediterranean	7	6.19
	Southeast Anatolia	2	1.77
	Eastern Anatolia	2	1.77
Education	Undergraduate	61	53.98
	Master of science	44	38.94
	PhD	8	7.08

Abbreviations: N, frequency; %, percentage.

2.4. Data Collection Tools

The questionnaire used in this study was developed by the authors following a review of the international literature on SLPs' involvement in tracheostomy management, including previously published survey studies from Australia, Sweden, and the United Kingdom (Ward et al. 2008, Ward et al. 2012, Wiberg et al. 2022), together with professional guidance provided in the American Speech‐Language‐Hearing Association (ASHA) Practice Portal on Tracheostomy and Ventilator Dependence [American Speech‐Language‐Hearing Association 2026], to assess SLPs' self‐reported knowledge regarding the assessment and management of individuals with tracheostomy. After the questionnaire was drafted, expert opinions were sought from six SLPs experienced in the assessment and intervention of individuals with tracheostomy. The experts evaluated each item as ‘Appropriate’, ‘Appropriate but needs revision’, or ‘Not appropriate’, and provided comments and suggestions. At the end of the Expert Opinion Form, an additional section was inserted for general recommendations regarding the questionnaire. Based on the experts’ feedback, necessary revisions were made, and finally, a pilot study was conducted with five SLPs to finalize the questionnaire (Appendix A)

The questionnaire consisted of four sections with a total of 37 items. The first section included 10 questions designed to collect demographic information. The remaining three sections assessed participants' perceived level of knowledge using a 5‐point Likert scale ranging from 1 (Very poor) to 5 (Very good). Each item was presented as a complete statement describing a specific aspect of tracheostomy assessment or management, rather than as a single keyword or heading. The second section, comprising 6 items, focuses on ‘overall knowledge about tracheostomy’. This section addresses topics such as the indications for tracheostomy, the effects of the tracheostomy tube on the laryngeal mechanism, phonation and swallowing, duration of intubation, the impact of prolonged intubation on the vocal folds, hydration and calorie monitoring in tracheostomy, and decannulation. The third section, titled ‘Management of Dysphagia in Tracheostomy’, consists of 15 items evaluating participants' perceived knowledge about dysphagia following tracheostomy and mechanical ventilation, alternative feeding methods, instrumental assessment tools, oral hygiene and care in tracheostomy, cuff pressure and positioning, secretion management, the effects of cuff positioning on swallowing functions and aspiration, as well as the impact of subglottic pressure on swallowing and cough reflex strength. The final section is composed of 6 items under the heading ‘Management of Speech, Language, and Communication in Individuals with Tracheostomy’. This section covers participants' perceived knowledge regarding the use of AAC modalities, phonation, tracheostomy‐related voice disorders, use of speaking cannulas, voice prostheses/electrolarynx/esophageal speech, and breathing training.

2.5. Data Collection Process

Participants were recruited using a convenience sampling strategy. Invitations were distributed through the email list of the Association of Speech and Language Therapists and social media platforms between 22 August 2023 and 22 March 2024. Because the exact number of eligible speech‐language therapists who received or viewed the invitation was unknown, a response rate could not be calculated. On average, participants required approximately 10 min to complete the survey.

2.5.1. Statistical Analysis

Data was analyzed using IBM SPSS Statistics (Version 25). Demographic variables were described through percentage and frequency analyses. Descriptive statistics regarding the main research questions were studied using frequency, percentage, mean, and standard deviation values. An independent samples t‐test was applied to determine whether the participants’ self‐reported knowledge levels significantly differed according to their educational background, participation in any training about tracheostomy, and experience working with tracheostomy clients. Effect sizes were also computed to provide a measure of practical significance.

The mean scores of the items in the questionnaire were interpreted based on the breaks identified using the formula ‘range/number of groups’ proposed by Tekin (2000). Accordingly, the mean scores for the items were determined as follows: 1.00–1.79: Very Poor; 1.80–2.59: Poor; 2.60–3.39: Moderate; 3.40–4.19: Good; 4.20–5.00: Very Good [Tekin 2000].

3. Results

Most of the participants (73.45%, n = 83) had less than five years of professional experience. Regarding workplace, 39.82% (n = 45) were employed in special education and rehabilitation centers, 33.63% (n = 38) in hospitals, 29.20% (n = 33) in private clinics, and 19.47% (n = 22) in university‐affiliated centers. Sixty‐two participants (54.87%) reported having clinical practice with individuals with tracheostomy during their university education. Following graduation, 72 SLPs indicated that they had never, or only 1–3 times, provided intervention to individuals with tracheostomy. In addition, 69.91% (n = 79) of the participants reported not attending any tracheostomy‐related training after graduation, whereas 30.09% (n = 34) reported that they had. Detailed findings are presented in Table 2.

TABLE 2.

Descriptive characteristics of the participants (N = 113).

Work related characteristics		N	%
Professional experience as an SLP	less than 1 year	18	15.93
	1–3 years	22	19.47
	3–5 years	43	38.05
	5–9 years	22	19.47
	9–15 years	6	5.31
	More than 15 years	2	1.77
Work sector	Special education and rehabilitation Center	45	39.82
	Hospital	38	33.63
	Private clinic	33	29.20
	University	22	19.47
Types of disorders	Developmental language disorders	76	67.26
	Speech sound disorders	80	70.80
	Neurogenic acquired language disorders	46	40.71
	Motor speech disorders	52	46.02
	Feeding and swallowing disorders	41	36.28
	Voice disorders	38	33.63
	Fluency disorders	69	61.06
	Other childhood‐onset language disorders	53	46.90
Clinical practice with tracheostomy clients during university education (Undergraduate‐Master's‐PhD)	Yes	62	54.87
	No	51	45.13
Participation in any training/seminar/conference about tracheostomy clients after graduation	Yes	34	30.09
	No	79	69.91
Number of tracheostomy clients treated	None	52	46.02
	1–3	20	17.70
	4–7	8	7.08
	7–10	7	6.19
	10+	26	23.01

Abbreviations: N, frequency; %, percentage.

As shown in Table 3, participants reported good knowledge regarding the indications for tracheostomy. Participants' self‐reported knowledge of the effects of the tracheostomy tube on the laryngeal mechanism, phonation, and swallowing, the duration of intubation, the impact of prolonged intubation and multiple extubations on the vocal folds, the importance of nutrition and hydration monitoring, and the roles of SLPs in the decannulation process was generally at a moderate level. Detailed results are presented in Table 3.

TABLE 3.

Participants’ overall knowledge about tracheostomy (N = 113).

		Very poor	Poor	Moderate	Good	Very good	$\overline{X}$	SD
Indications for tracheostomy	N	4	13	48	30	18	3.40	1.01
	%	3.54	11.50	42.48	26.55	15.93
Effect of tracheostomy tube on laryngeal mechanism, phonation and swallowing	N	4	20	37	34	18	3.37	1.06
	%	3.54	17.70	32.74	30.09	15.93
Duration and importance of intubation	N	13	27	37	23	13	2.96	1.17
	%	11.50	23.89	32.74	20.35	11.50
Impact of prolonged intubation and multiple extubations on vocal folds	N	6	31	28	32	16	3.19	1.15
	%	5.31	27.43	24.78	28.32	14.16
Importance of nutrition and hydration monitoring	N	13	32	35	17	16	2.92	1.21
	%	11.50	28.32	30.97	15.04	14.16
Roles of SLPs in the decannulation process	N	18	35	32	15	13	2.73	1.22
	%	15.93	30.97	28.32	13.27	11.50

Note: Rating scale: 1.00–1.79 = Very poor; 1.80–2.59 = Poor; 2.60–3.39 = Moderate; 3.40–4.19 = Good; 4.20–5.00 = Very good.

Abbreviations: N, frequency; SD, standard deviation; $\overline{\mathrm{X}}$, mean.

As shown in Table 4, participants reported good self‐reported knowledge regarding oral hygiene in individuals with tracheostomy. Self‐reported knowledge for most of the remaining items was at a moderate level, whereas knowledge regarding cuff pressure and the effects of cuff inflation on cough reflex strength and vocal fold function was poor. Detailed results are presented in Table 4.

TABLE 4.

Knowledge level regarding dysphagia management in tracheostomy (N = 113).

		Very poor	Poor	Moderate	Good	Very good	$\overline{X}$	SD
Likelihood of dysphagia in tracheostomy with mechanical ventilation	N	9	27	30	30	17	3.17	1.19
	%	7.96	23.89	26.55	26.55	15.04
Alternative feeding methods	N	9	26	25	29	24	3.29	1.26
	%	7.96	23.01	22.12	25.66	21.24
Instrumental assessment	N	11	22	29	24	27	3.30	1.30
	%	9.73	19.47	25.66	21.24	23.89
Applicability of Evans Blue Dye Test	N	15	29	28	19	22	3.04	1.32
	%	13.27	25.66	24.78	16.81	19.47
Oral hygiene in tracheostomy	N	10	16	31	27	29	3.43	1.26
	%	8.85	14.16	27.43	23.89	25.66
Tracheostomy care	N	17	29	37	18	12	2.81	1.19
	%	15.04	25.66	32.74	15.93	10.62
Dietary modifications	N	14	35	26	20	18	2.94	1.28
	%	12.39	30.97	23.01	17.70	15.93
Secretion management	N	14	34	33	20	12	2.84	1.18
	%	12.39	30.09	29.20	17.70	10.62
Cuff pressure	N	24	42	22	14	11	2.52	1.23
	%	21.24	37.17	19.47	12.39	9.73
Effect of cuff position (inflated/deflated) on swallowing	N	24	32	20	22	15	2.75	1.35
	%	21.24	28.32	17.70	19.47	13.27
Effect of cuff position on aspiration	N	25	30	20	25	13	2.74	1.34
	%	22.12	26.55	17.70	22.12	11.50
Effect of cuff position during oral intake	N	21	32	23	20	17	2.82	1.34
	%	18.58	28.32	20.35	17.70	15.04
Silent aspiration risk factors	N	15	32	28	26	12	2.89	1.21
	%	13.27	28.32	24.78	23.01	10.62
Effects of cuff inflation on laryngeal elevation, subglottic air pressure, and laryngeal sensation	N	25	30	28	19	11	2.65	1.27
	%	22.12	26.55	24.78	16.81	9.73
Effects of cuff inflation on cough reflex strength and vocal fold function	N	23	35	29	18	8	2.58	1.19
	%	20.35	30.97	25.66	15.93	7.08

Note: Rating scale: 1.00–1.79 = Very poor; 1.80–2.59 = Poor; 2.60–3.39 = Moderate; 3.40–4.19 = Good; 4.20–5.00 = Very good.

Abbreviations: N, frequency; SD, standard deviation; $\overline{\mathrm{X}}$, mean.

As shown in Table 5, participants generally demonstrated moderate knowledge regarding speech, language, and communication management. Self‐reported knowledge was moderate across all assessed areas, including AAC systems, voice disorders following prolonged intubation, phonation methods, voice prostheses/electrolarynx/esophageal speech, the use of speaking cannulas, and respiratory muscle strength training. Detailed results are presented in Table 5.

TABLE 5.

Knowledge regarding speech, language and communication management in tracheostomy (N = 113).

		Very poor	Poor	Moderate	Good	Very good	$\overline{X}$	SD
AAC systems	N	9	24	43	27	10	3.04	1.06
	%	7.96	21.24	38.05	23.89	8.85
Phonation methods	N	9	28	37	24	15	3.07	1.15
	%	7.96	24.78	32.74	21.24	13.27
Voice disorders after prolonged intubation	N	6	27	37	28	15	3.17	1.10
	%	5.31	23.89	32.74	24.78	13.27
Use of speaking valves	N	17	28	37	17	14	2.85	1.22
	%	15.04	24.78	32.74	15.04	12.39
Voice prostheses, electrolarynx, esophageal speech	N	14	22	37	27	13	3.03	1.18
	%	12.39	19.47	32.74	23.89	11.50
Respiratory muscle strength training	N	21	37	28	19	8	2.61	1.18
	%	18.58	32.74	24.78	16.81	7.08

Note: Rating scale: 1.00–1.79 = Very poor; 1.80–2.59 = Poor; 2.60–3.39 = Moderate; 3.40–4.19 = Good; 4.20–5.00 = Very good.

Abbreviations: N, frequency; $\mathrm{SD},\mathrm{standard}\mathrm{deviation};\overline{\mathrm{X}}$, mean.

Tables 6, 7, 8 present participants’ self‐reported knowledge levels regarding tracheostomy according to clinical experience during university education, participation in post‐graduate training, and professional experience with tracheostomy cases. Significant differences were found across all three factors (p < 0.05). Specifically, participants who had clinical practice during their undergraduate or graduate studies, those who attended training, seminars, or conferences, and those who had professional experience with tracheostomy cases demonstrated higher mean scores in general knowledge, dysphagia management, and speech, language, and communication compared with those without such experience. Detailed results are presented in Tables 6, 7, 8.

TABLE 6.

SLPs’ self‐reported knowledge levels regarding tracheostomy (general information, dysphagia and speech, language and communication) based on clinical experience during university education.

	Clinical experience at university	N	$\overline{X}$	SD	df	t	p
Overall knowledge about tracheostomy	Yes	62	20.56	5.92	111	4.102	<0.001
	No	51	16.16	5.39
Dysphagia in tracheostomy	Yes	62	50.29	15.79	111	4.889	<0.001
	No	51	35.90	15.30
Speech, language and communication in tracheostomy	Yes	62	20.02	5.66	111	4.758	<0.001
	No	51	15.04	5.38

Abbreviations: df, degrees of freedom; SD, standard deviation; $\overline{\mathrm{X}}$, mean.

TABLE 7.

SLPs’ self‐reported knowledge levels regarding tracheostomy (general information, dysphagia and speech, language and communication) based on participation in post‐graduate training.

	Participation in training/seminar/conference	N	$\overline{X}$	SD	df	t	p
Overall knowledge about tracheostomy	Yes	34	21.56	6.20	111	3.605	<0.001
	No	79	17.29	5.58
Dysphagia in tracheostomy	Yes	34	51.88	16.89	111	3.458	0.001
	No	79	40.32	16.05
Speech, language and communication in tracheostomy	Yes	34	20.53	6.60	111	3.323	0.001
	No	79	16.58	5.41

Abbreviations: df, degrees of freedom; SD, standard deviation;$\overline{\mathrm{X}}$, mean.

TABLE 8.

SLPs’ self‐reported knowledge levels regarding tracheostomy (general information, dysphagia and speech, language and communication) based on professional experience with tracheostomy cases.

	Experience with tracheostomy cases in professional life	N	$\overline{X}$	SD	df	t	p
Overall knowledge about tracheostomy	Doesn't have experience	52	15.50	4.92	111	5.605	<0.001
	Has experience	61	21.20	5.75
Dysphagia in tracheostomy	Doesn't have experience	52	34.90	13.92	111	5.807	<0.001
	Has experience	61	51.38	15.92
Speech, language and communication in tracheostomy	Doesn't have experience	52	14.56	4.54	111	5.968	<0.001
	Has experience	61	20.51	5.84

Abbreviations: df, degrees of freedom; N, frequency; SD, standard deviation; X̄, mean.

4. Discussion

The findings indicate that Turkish SLPs’ self‐reported knowledge about tracheostomy management is generally moderate, which may be associated with multidimensional structural factors regarding the organization of the profession, the curricula of training programmes, and the definition of professional roles within the healthcare system. While the roles and responsibilities of SLPs in tracheostomy intervention processes—particularly in ICUs—are clearly defined in many countries, they remain under development in Turkey. The lack of structured and standardized protocols that support the integration of various disciplines emerges as one of the main factors limiting self‐reported knowledge levels. The findings should be interpreted as reflecting perceived knowledge rather than objective clinical competence; however, they provide a valuable baseline for identifying educational gaps and professional development needs among Turkish SLPs.

In countries such as Australia, the United Kingdom, Sweden, and the United States, comprehensive guidelines regarding the SLPs’ roles in tracheostomy intervention have been developed and implemented [American Speech‐Language‐Hearing Association 2026, Baumgartner et al. 2008, McGowan et al. 2014, Ward et al. 2008]. The literature shows that SLPs working within tracheostomy‐related protocols are more effectively involved in assessment and intervention processes, and that their knowledge levels and contributions are particularly higher in areas such as decannulation, use of speaking valves, alternative phonation strategies, and secretion management [McGrath et al. 2016, Miles et al. 2025, Wiberg et al. 2022]. In line with these findings, the moderate self‐reported knowledge levels observed in the present study may reflect the limited availability of structured protocols and the restricted integration of SLPs into multidisciplinary care settings in Turkey.

In the current study, the participants’ self‐reported knowledge level regarding appropriate cuff pressure was low, while their knowledge in clinical subdomains—such as the effects of cuff position on phonation and aspiration, and the identification of silent aspiration—was at a moderate level. Self‐reported knowledge levels were also moderate in intervention areas such as instrumental assessment, alternative feeding methods, and the use of speaking valves. Similarly, the participants reported a moderate level of knowledge concerning alternative communication methods, including voice prostheses, esophageal speech, electrolarynx, and AAC (Augmentative and Alternative Communication) systems. The literature emphasizes that effective implementation of these practices depends not only on individual knowledge but also on SLPs' active involvement in multidisciplinary tracheostomy care supported by structured clinical protocols (Irish Association of Speech and Language Therapists Tracheostomy management: clinical guideline 2017, Royal College of Speech and Language Therapists Communicating quality 3: RCSLT's guidance on best practice in service organisation and provision 2006, Ward et al. 2012).

The findings indicate that SLPs cannot always actively participate in tracheostomy intervention processes, which may reflect the continuing development of the profession in Türkiye, the limited availability of hospital‐based SLP positions, and the concentration of clinicians in special education and rehabilitation settings. This workforce distribution likely restricts routine exposure to medically complex tracheostomy cases and reduces opportunities to develop competence through direct clinical experience. Furthermore, even SLPs employed in hospital settings may have limited involvement in dysphagia management, which may have further contributed to the observed knowledge gaps.

From an educational perspective, the lack of tracheostomy management in undergraduate and graduate curricula highlights the need to strengthen the connection between theoretical knowledge and clinical practice. Many participants reported enhancing their knowledge in this field by attending numerous in‐service training courses after graduation. Similarly, the literature underlines that SLPs’ competency in tracheostomy is generally developed beyond basic education and through mentorship‐based learning processes and structured clinical practice (Ward et al. 2008, Ward et al. 2012).

In this context, simulation‐based training may offer a valuable strategy for addressing educational gaps in tracheostomy management. Given that opportunities for direct clinical exposure to individuals with tracheostomy may be limited, simulation‐based education provides a safe learning environment and has been shown to improve clinicians' knowledge, manual skills, and confidence (Miles et al. 2020, Ward et al. 2014). In addition, standardized patient simulation has been shown to support the development of clinical communication skills among speech‐language pathology students in tracheostomy‐related scenarios (Stead et al. 2023). Incorporating structured simulation opportunities into postgraduate education and continuing professional development programmes may therefore represent a feasible approach to strengthening tracheostomy‐related competencies among Turkish SLPs. However, challenges rooted in the system—such as increased workload in healthcare, early discharge practices, and unclear job definitions for SLPs in non‐intensive care clinical settings—may hinder the acquisition of clinical experience (Paul 2010).

Taken together, the present findings and previous evidence suggest that improving individual knowledge alone is unlikely to be sufficient without parallel structural and organizational changes within the healthcare system. SLPs should be systematically trained, supported by protocol‐based practices, and integrated into multidisciplinary teams to participate actively, competently, and safely in tracheostomy management. Consistent with this interpretation, previous guidelines emphasize that knowledge alone is insufficient and that organizational structures facilitating the translation of knowledge into clinical practice directly influence intervention processes (Irish Association of Speech and Language Therapists Tracheostomy management: clinical guideline 2017). Similarly, recent evidence has shown that SLPs working within structured protocols participate more effectively in tracheostomy management and demonstrate higher levels of knowledge, whereas the absence of clear protocols has been identified as a key factor limiting SLP involvement in tracheostomy care (Miles et al. 2025, Wiberg et al. 2022).

Accordingly, the moderate level of self‐reported knowledge observed in our study should not be interpreted as reflecting individual clinical incompetence but rather as the result of multidimensional structural factors, including the organization of the profession, curriculum content, limited opportunities for supervised clinical practice, and interdisciplinary collaboration. Therefore, educational initiatives aimed at strengthening tracheostomy‐related competencies should be accompanied by organizational strategies that facilitate the active integration of SLPs into multidisciplinary tracheostomy care. Such changes are likely to enhance competencies in dysphagia and communication management while improving patient safety and promoting effective interdisciplinary collaboration.

4.1. Clinical Implications

The findings highlight important knowledge gaps regarding tracheostomy management among Turkish SLPs. As the role of SLPs in critical care continues to evolve in Turkey, educational opportunities should be expanded to support competency development in this area. This may include strengthening tracheostomy‐related content in undergraduate and postgraduate curricula, providing dedicated postgraduate training, simulation‐based learning, and workplace mentoring. In addition, national guidelines and standardized clinical protocols may facilitate the integration of SLPs into multidisciplinary critical care teams and ultimately improve patient care.

4.2. Limitations and Future Directions

This study is limited to 113 SLPs in Turkey and is based on the participants’ self‐reported perceptions of their knowledge and practices. As data were collected via an online survey, selection bias cannot be ruled out, which may limit the generalizability of the findings to the broader population of speech‐language therapists in Turkey. In addition, because the findings are based on self‐reported data, participants' perceived knowledge may not fully correspond to their actual clinical performance or objectively measured clinical competence. Objective assessment methods, such as direct observation of individuals during clinical practice could provide more comprehensive and objective insights. Future research should incorporate larger samples and observational designs to better capture actual clinical competence.

Future research should also evaluate the effectiveness of undergraduate and postgraduate educational initiatives, simulation‐based training, workplace mentoring, and in‐service education in improving tracheostomy‐related competencies among SLPs. In addition, studies examining the implementation and impact of national guidelines and standardized clinical protocols on multidisciplinary tracheostomy management are warranted to support evidence‐based practice and guide future service development in Turkey.

5. Conclusions

This study demonstrated important self‐reported knowledge gaps among Turkish SLPs regarding tracheostomy management, particularly in dysphagia and communication interventions. These findings highlight the importance of strengthening undergraduate and postgraduate educational opportunities and expanding clinical experience in this specialist area. In addition, the absence of national protocols that clearly define the role of SLPs in tracheostomy management represents an important gap that may limit their effective participation within multidisciplinary teams. As the role of SLPs in critical care continues to evolve in Turkey, increasing awareness of tracheostomy management and supporting the active involvement of SLPs in multidisciplinary care may ultimately contribute to improved patient care and quality of life.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

Ethics Statements

Ethical approval was granted by the Scientific Research and Publication Ethics Committee of Anadolu University, Faculty of Health Sciences (Protocol No. 538687, dated 5 July 2023). Ethical approval was obtained from a non‐interventional clinical research ethics committee. All participants received written information about the study and provided written informed consent prior to participation.

Consent

Informed consent was obtained from all participants.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Supporting information

Supporting Information: jlcd70314‐supp‐0001‐SuppMat.docx

Şimşek, K. N. , and Özkan E. T.. 2026. “Knowledge of Turkish Speech‐Language Pathologists on Tracheostomy Management.” International Journal of Language & Communication Disorders 61, no. 5: e70314. 10.1111/1460-6984.70314

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.