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Please give a brief background (Employment, interests of study, special honors/certifications etc.)
I am currently an assistant (soon-to-be-associate!🤩) professor and the director of the Communication Disorders and Sciences Program at the University of Oregon. My research is focused on taking a more holistic, or comprehensive, view of swallowing and dysphagia. Swallowing does not happen in isolation. The swallow is part of the broader eating process, which is really a full-body experience. Eating is part of the larger mealtime process and, as such, encompasses two of our most fundamental human needs – the need for nutritional sustenance and the need for interpersonal relationships. Thus, when someone is experiencing dysphagia, it is far more than their swallow itself that is negatively impacted. The work in my lab, O-SEE Lab, serves to take this broader view in order to
identify more effective management approaches that can improve both health and quality of life for individuals with dysphagia and their family members.☯️
If you could conduct any research study on any topic/issue (meaning money/funding, time, subjects, IRB, etc. are NOT a problem!), what would it be? In other words, what’s your dream study?!
Wow – what a dreamy question🤩! I think given my current research trajectory and passion, I would definitely create a study focused on caregiver burden and family relationships. If we are thinking big, I would propose a multi-part study.
First, I would want to follow A LOT of families longitudinally across their dysphagia journey to explore how aspects of the dysphagia influence caregiver health and well-being as well as family dynamics. Including individuals with dysphagia resulting from a variety of etiologies (e.g., stroke, dementia) would really allow us to better understand how families deal with dysphagia in the acute and chronic stages as well as identifying their unique needs across these points in time.
I am a particular lover of qualitative methodology; including in-depth, family interviews across time would allow for rich analysis of these families’ lived experiences with dysphagia. Using the information gleaned in this first stage, I would then want to create a family-centered, multidisciplinary treatment that could target the needs of both the patient with dysphagia as well as their family, with the hopes of reducing the burden of care and reducing dysphagia’s negative impacts on family functioning.👏👏👏👏
If you could change one thing about having to do research, what would it be?
The resources needed to do research can really make it challenging. Certainly, there is the money needed to do the studies you really want to do (see above!) and you often have to put the dream studies on hold while you try to obtain that funding💰💰. Time is also another huge barrier. Depending on the setting you are doing research in, you may or may not have a lot of protected research time. You also may or may not be able to support a research team who can help with all of the research pieces (e.g., scheduling participants, collecting data, analyzing data). It is not surprising that we often see many of the same names continue to produce the top research in our field as they have successfully navigated the system and now have the resources to maintain their well-oiled machines. For some of the rest of us, we rely on a bit of scrappiness while we aspire to attain that status!
What’s one thing you think clinicians should be excited about in our field regarding research?
Research is one important mechanism for shifting the status quo and implementing system-level changes. Insurance companies, healthcare systems, large organizations – data is the language they speak. They are constantly calculating costs, risks, and benefits👩💻. We know there are major issues for speech-language pathologists operating within these systems and that there are practices we want to be implemented, but can’t. As we learn more about best practices in our field and can document the benefits of these new practices – for example, decreased mortality and decreased economic burden – we can use that data to push these systems to change.♻️
What’s one thing you think researchers should be excited about in our field regarding clinical practice?
Ultimately, we are doing research in order to enhance clinical practice – and if ever our research does not have this clear translation, we should be taking a step back and asking what is the purpose. It has been so wonderful to see our practices advance since I was in graduate school and know that this ultimately is improving the health and quality of life for our patients and their families.
I feel the Results section of studies can be the most misunderstood or difficult to navigate through, what tidbits or tips/tricks can you share to help clinicians process these sections?
I completely agree! (And this is coming from someone who minored in applied statistics in undergrad
AND completed a PhD🤓) When navigating the results in a research article, there are a few things I like to do. Truth be told, I will often read article sections out of order🙃. I like to start with the Introduction, read through the Methods, and then jump to the Discussion to get a sense of what the authors’ final conclusions were.
Then, I will tackle the Results to determine for myself whether those conclusions were actually valid. (Caveat 1: Authors can overstate their actual findings. We are all susceptible to this as we hope for earth-shattering, grand conclusions and just get a bit overly excited sometimes. But a solid article that has been published by a solid research team and revised based on solid feedback from a solid group of
reviewers and undergone solid editing *shouldn’t* have overstated conclusions. Although see Caveat 2 below. As part of this process, I will first go back and review the purpose of the study and what the research questions were.
In any good study (Caveat 2: not all published studies are good studies and not all journals are created equal😲), the Results should be directly mapped onto those questions of interest as these are the questions the paper purported to answer!
Once I have reviewed the purpose, I will review the Discussion/Conclusion to determine what types of results I am looking for that would support the claims made. Once I have reminded myself of this information, I will dig into the Results themselves. I do not hesitate to use sources like YouTube, Google, and other internet pages (e.g., Discovering Statistics…formerly “Statistics Hell” by Dr. Andy Field) to be sure I know what I am trying to interpret. I try to pull out from the results information about a) whether a statistical test resulted in a statistically significant finding, and b) whether a test resulted in a clinically meaningful finding🤔
Could you pick one technical jargon (e.g. “ANOVA” “two-tailed test” etc.) to explain in a relatable and easily understandable way (real-life, simple examples get bonus points😉)?
Let’s talk about logistic regression. Most basically, logistic regression assesses the relationship between a categorical dependent variable and any number of independent variables.
Categorical: Think categories, fixed options
Dependent variable: The variable that changes based on other factors
Independent variables: Those factors that can make the dependent variable change
To provide an example, let’s say we were interested in what factors influence caregiver burden among caregivers of older adults (Full disclosure – I am an author on two studies that did just that!😉). Of particular relevance for our field, maybe we are wondering whether dysphagia status is one of those factors. So first we will identify our dependent variable: caregiver burden.
If we are defining burden as “yes/no”, this would be categorical and we would use logistic regression for our analysis. Then, we identify all of our independent variables. Often the list of potential variables is selected based on previous literature and what the authors hypothesize to be important/influential factors. In this case, we may want to include variables such as caregiver and care recipient age, gender, health status, and education level, and caregiver memory status, functional disability, and dysphagia status.
The regression analysis will then calculate the likelihood that caregiver burden is different based on each variable, when holding the rest constant. So, if we have two caregiver-care recipient dyads that vary *only* based on dysphagia status (same age, gender, health, etc.), is one caregiver more likely to experience burden than the other? And how much more likely are they to experience burden? We can then conclude that individuals caring for older adults with dysphagia are X times more likely to experience caregiver burden than individuals caring for older adults without dysphagia.
As we run the analysis, we will often start with all of the potential independent variables in the regression model. We then start removing them one by one until only those variables that do
significantly impact the dependent variable (when all else is held constant) are left – these are usually the complex tables you may see in the papers. Using the example above, we are then able to say that all of the remaining variables are independent predictors of caregiver burden when accounting for the other known factors influencing burden. (And spoiler alert – dysphagia was an independent predictor in both of our papers!)😉🤯
What’s the ONE thing you think is important for practicing clinicians to know/understand when reading research?
It is important to differentiate between statistical significance and clinical relevance or significance. I might find that test scores for the students in my 8 AM class are significantly better than test scores for the students in my 12 PM class. If I published these findings alone, students may be clamoring to get into my 8 AM class. However, you should question how different the scores are. It is entirely possible that the average for the 8 AM class is 88.8% and the average for the 12 PM class is 88.6%. Or the average scores are 99% and 96% – all still in the A range. Would either of these differences really be meaningful to the larger picture, particularly if you were not an early-morning person? To be a critical consumer of research means actually determining whether differences reported have functional value for our clinical practices.
What’s ONE thing you think is important for researchers to know/understand about clinical practice?
We must think about implementation science from the time we start designing a research study! There are so many policy, procedural, and practical barriers that exist in the clinical setting. We need to make sure we are designing assessments and treatments that are realistic. Effectiveness and efficacy are similar concepts, but the difference between benefits gained in an ideal laboratory setting and a real-world setting is vast. All good researchers/research teams should regularly be consulting with clinicians, if not working as clinicians themselves already.🙌
What is something you believe researchers could do better to #bridgethegap?
I think my answer above addresses this, but ultimately researchers must talk with clinicians – not at clinicians. Only through conversation can researchers really understand what are the current practice issues and needs and how can research be used to address those issues and needs.
What is something you believe clinicians could do better to #bridgethegap?
Perhaps have some patience with us researchers😊. As noted above, there are a lot of barriers to getting research up and running. We know the dream studies we want to do that would totally address current practice issues and needs, but we do not always have the resources or support to do it😕. So be patient as sometimes we need to first produce smaller bits and pieces that will lead to the final goal. And please partner with us! It is so great to be able to design and implement research studies with clinicians that can take place in clinical settings! That is definitely the quickest way to see more major change.😎
Can you provide your contact email if clinicians want to reach out? (Honors system for everyone to be respectful of your time)
Always happy to connect! I can be reached at sshune@uoregon.edu
Optimizing Swallowing and Eating for the Elderly (O-SEE) Lab
I cannot thank Dr. Shune enough for all her incredibly helpful contributions to our field and her responses to help us all!!❤️❤️
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