Standards versus reality in voice assessment: facilitators, barriers, and protocol variability in Quebec clinical practice

Voice assessment is crucial in the diagnosis and management of voice disorders, yet clinical practice often diverges from standardized protocols due to contextual constraints. This qualitative study explored facilitators, barriers, and protocol variability in Quebec French-speaking Speech and Language Therapists' (SLTs) voice assessment practices. Semi-structured interviews were conducted with 11 SLTs specializing in voice therapy, and transcripts were analyzed thematically. Findings revealed strong facilitators such as interdisciplinary collaboration with Ear, Nose and Throat (ENT) specialists, access to imaging, professional peer networks, and continuing education. Barriers included limited access to specialized services, insufficient standardization, inconsistent acoustic measures, and gaps in training. Protocols were highly variable and flexibly adapted across pediatric, adult, and geriatric populations, as well as according to patient needs and local resources. Rather than deviations, these adaptations reflected clinical reasoning and patient-centred care in real-world contexts. The study highlights the need for co-designed, modular protocols that balance standardization with flexibility, improved interdisciplinary collaboration, equitable access to equipment, and linguistically adapted tools. Such an approach could bridge the gap between guidelines and practice, ensuring protocols remain both scientifically robust and clinically feasible.