Dysphagia Management and End of Life
Dysphagia is a common concern at the end of life (EOL). Dysphagia is one of many factors examined when multidisciplinary professionals develop palliative care plans with patients approaching/in EOL. The American Speech- Language Hearing Association (ASHA) supports the facilitative role of the Speech-Language Pathologists (SLP) when serving individuals with dysphagia at end-of-life (ASHA,n.d.). It is within the scope of an SLP to educate families and patient’s who face dysphagia at EOL and provide all options for dysphagia management. According to ASHA, SLPs should keep in mind that what may be best for the patient clinically, may not be accepted as best for the patient’s quality of life. There is a widespread agreement that the goal in EOL care is to facilitate comfort and professionals must ultimately and ethically facilitate the wishes of the patient/family relating to EOL.
A December 2019 study discusses the effects of food, drink and the fasted state on healthy adults and adults at EOL.
Recognize social and cultural influences when developing a plan that respects patient & family's wishes. It is vital that SLPs consider the emotional and the psychosocial issues faced by their patients & families (ASHA) when engaging in dysphagia management discussions for patient’s approaching EOL.
Ensure patient/ family goals and wishes early in patient’s care regarding food and drink, continue to check in as goals and wishes may evolve over time. (Kershner et al., 2019)
Initiate education early, and provide ongoing education regarding what to expect with eating and drinking at the end-of-life. (Kershner et al., 2019)
Advocate for frequent and effective oral care to facilitate oral comfort.
Educate your team. Once there is a greater understanding of how the end-of-life impacts swallow physiology and experience with eating/ drinking, then the medical team will become better equipped to support the patient's quality of death.
References
Kershner, Annette N. Askren and Marnie, et al. “Eating, Drinking, and Comfort at End-of-Life: Promoting a Quality of Death.” ASHA Wire, 24 Dec. 2019, pubs.asha.org/doi/abs/10.1044/2020_PERSP-19-00183.
End of Life. (n.d.). Retrieved April 20, 2021, from https://www.asha.org/slp/clinical/endoflife/
