Eating and Drinking Decisions for Quality of Life

Aim

To improve patient centred decision making regarding eating and drinking for quality of life.

This project aims to increase the knowledge and understanding about the patients eating and drinking for quality of life.

Outcomes

• Increased knowledge and understanding of dysphagia in the palliative context for both clinicians (Speech Pathologists) and patients, family members and care-givers.
• Access to resources including educational materials for clinicians and patients, documentation templates to ease speed and efficiency, decision support-tools to provide a framework for complex decision making and a state-wide approach to dysphagia decision making in life-limiting conditions which ensures consistency of practice.
• Providing patients with the information they require, supports their autonomy and confidence in making decisions for themselves and their loved ones in relation to eating and drinking towards the end of life.

Background

Decisions regarding eating and drinking during palliative care can be complex and may significantly impact on an individual’s quality of life.

Speech Pathologists (SPs) may feel ill prepared and under-resourced to support patients to make these complex decisions

Outcomes

The Speech Pathology(SP) Department at Logan Hospital has developed resources and decision-support tools in the area of complex dysphagia management (including risk and comfort feeding). This has generated significant interest around the state and nationally from SPs, who identified limited resources to support dysphagia decision making in palliative care and other complex clinical areas. The project team has identified a number of current gaps, and is developing tools and resources for patients and clinicians within a clinical setting for state-wide scale and spread. The resource toolkit will educate and inform SPs and other professionals working in palliative care to support patients and care-givers to make decisions about eating and drinking in complex situations including end of life.

Discussion

Clinicians and consumers provided feedback on the project and the overall response was positive. A number of high quality resources were produced and received positive stakeholder feedback.

An iLearn Learning Module was developed and underwent several rounds of feedback, evaluation and re-design.

References

• Kelly K, Cumming S, Kenny B, Smith-Merry J, Bogaardt H. (2018). Getting comfortable with “comfort feeding”: An exploration of legal and ethical aspects of the Australian speech-language pathologist’s role in palliative dysphagia care.
• Lang A, Sommerville P, Nightingale S, Birns J. (2017). The FORWARD care bundle – Improving the care of patients feeding at risk. Clinical Nutrition.
• McHutchison L, Miles A, Spriggs D, Jayathissa S. (2018) Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia. Australasian Journal on Ageing.
• Miles A, Watt T, Wong W-Y, McHutchison L, Friary P. (2016). Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting. Gerontology & geriatric medicine.
• Palecek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL. (2010). Comfort Feeding Only: A Proposal to Bring Clarity to Decision‐Making Regarding Difficulty with Eating for Persons with Advanced Dementia. Journal of the American Geriatrics Society. 58(3):580-4.
• Royal College of Physicians and British Society of Gastroenterology. (2010). Oral feeding difficulties and dilemmas: A guide to practical care, particularly towards the end of life. London: Royal College of Physicians.
• Schwarz, Coccetti, Cardell (2019, online early access). Clinical decision making for complex feeding decisions: a national survey of current approaches and perspectives. Australasian Journal of Ageing.