Assessing speech and language in children with cancer: An RCT comparing in-person assessment with assessment via telehealth.

INTERVENTION: A brief speech and language screening assessment (including a receptive language task, an expressive language task, and a speech task) will be administered to the subjects under 2 telehealth conditions: a) via real‐time video videoconferencing ‐ with visual and audio information transmitted over videoconferencing, and with printed information (e.g., assessment stimulus items) being transmitted from the therapist's computer to the child’s computer using remote access software. b) via internet‐based real‐time video – with visual information transmitted over the internet, audio information transmitted over speaker phone, and printed information (e.g., assessment stimulus items) being transmitted from the therapist’s computer to the child’s computer using remote access software. The children will also complete the screening assessment in‐person (comparator condition). The order of these 3 conditions will be random. Each screening assessment will take approximately 15 minutes, and the child will be assessed under all both telehealth conditions and also the in‐person condition (comparator) on one day. All conditions will be simulated at the Royal Children's Hospital (for the videoconferencing and internet‐based conditions the therapist will be located in another part of the hospital). The parent or caregiver will be present in the room with the child during all conditions. Similar but different receptive and expressive language screening tasks will be administered in each condition to avoid the test‐retest effect. As each assessment is very short (15 minutes duration), there will be no “wash‐out” period and the children will be assessed in each of the 2 telehealth conditions and also the comparator condition (in‐person) consecutively. Children will be divided up into two groups: the preschool‐aged group (3 – 5 years) and the school‐aged group (6 – 12 years). The screening assessment for the preschool‐aged group will consist of: a) The Diagnostic Screener and Oromotor Assessment subtests from the Diagnostic Evaluation of Articulation and Phonology (DEAP) (Pearson Clinical Assessment). This will be administered in both telehealth conditions and also the in‐person (comparator) condition. b) The Preschool Language Scale – 4th Edition Screening Test (PLS‐4 Screener) (Pearson Clinical Assessment). This will be administered in 1 condition only (random selection ‐ may be administered in either of the telehealth conditions or the in‐person (comparator) condition). c) Selected items from the Preschool Language Scale – 4th Edition (PLS‐4) (Pearson Clinical Assessment). Selected items will be chosen to mirror similar items in the screening test. Two different sets of items will be administered in the other two conditions (random selection). The screening assessment for the 6 – 12 years age group will consist of: a) The Diagnostic Screener and Oromotor Assessment subtests from the Diagnostic Evaluation of Articulation and Phonology (DEAP) (Pearson Clinical Assessment). This will be administered in both telehealth conditions and also the in‐person (comparator) condition. b) The Clinical Evaluation of Language Fundamentals – 4th Edition Screening Test (CELF‐4 Screener) (Pearson Clinical Assessment). This will be administered in 1 condition only (random selection ‐ may be administered in either of the telehealth conditions or the in‐person (comparator) condition). The comprehensive assessment for the preschool‐aged group will consist of: a) The Articulation and Phonology subtests from the Diagnostic Evaluation of Articulation and Phonology (DEAP) (Pearson Clinical Assessment). b) The Clinical Evaluation of Language Fundamentals Preschool – 2nd Edition (CELF‐P2) (Pearson Clinical Assessment). c) Selected items from the Clinical Evaluation of Language Fundamentals – 4th Edition (CELF‐4) (Pearson Clinical Assessment). Selected items will be chosen to mirror similar items in the screening test. Two different sets of items will be administered in the other two conditions (random selection). Following assessment under all 3 conditions the child will return on another day (within one month of the first day) for a comprehensive speech and language assessment. This will be administered in‐person. The comprehensive assessment for the school‐aged group will consist of: a) The Articulation and Phonology subtests from the Diagnostic Evaluation of Articulation and Phonology (DEAP) (Pearson Clinical Assessment). b) The Comprehensive Assessment of Spoken Language (CASL) (Pearson Clinical Assessment). CONDITION: children's cancer speech and language disorder PRIMARY OUTCOME: Cost. ; ; Measured by: a cost and feasibility analysis will be performed based on the participant accessing the assessment service via telehealth from their residential address or local hospital, or in‐person at a tertiary centre, including accommodation and travel costs from their residential address. Patient, caregiver and therapist satisfaction. ; ; Measured by: a survey will be developed specifically for use in this study. Patients, caregivers and therapists will be asked to complete the survey after each condition, and then after all 3 conditions have been administered they will be asked to rate their preference. The children will be asked to rate different aspects of the assessment as either ?good? ?ok? or ?bad?. The caregivers and therapists will be asked to rate different aspects of the assessment out of a 5 point scale, with 1 = strongly disagree, and 5 = strongly agree. Quality of audio and visual information. ; ; Measured by: ; a) number of times the patient or caregiver requests a repetition during assessment ; b) number of times the clinician requests repetition from the patient or caregiver ; c) number of breaks in audio signal ; d) number of breaks in visual signal ; e) total time to complete assessment. SECONDARY OUTCOME: Nil INCLUSION CRITERIA: Children with cancer who are already seen by a speech pathologist at the Royal Children's Hospital, Brisbane.