A Retrospective Cohort Study of Complex Feeding Decisions

Abstract

Complex decision-making when dealing with situations such as feeding in the context of dementia, palliative care, and severe dysphagia is a complex clinical area for speech language pathologists (SLPs). The objective of this study was to provide an exploratory overview of complex feeding decisions, in order to highlight areas for improvement in clinical practice. A retrospective clinical chart audit of 82 participants was conducted within two hospital settings between 2012 and 2017 using an explorative approach. Complex feeding decisions were documented as “risk feeding” in 59.8% of instances and were most commonly made by the patient/family in consultation with the medical team (23.2%). Many of the complex feeding decisions were made without a multidisciplinary case conference (82.9%), without appropriate discussions with families regarding feeding decisions/options/alternatives (63.4%), and without relevant patient and family education (59.8%). Feeding decisions are ethically and clinically complex and therefore require a interdisciplinary and person-centred approach to discussion and education, as well as clear unbiased documentation.

Keywords::

• Dysphagia
• Patient-Centred
• Shared Decision-Making

Acknowledgements

Funding for this project was obtained from the Metro South Health Research Support Scheme Small Project Grant funded by the Study, Education and Research Trust Account (SERTA) (PARSS_2018_025)

Additional information

Notes on contributors

Maria Schwarz

Maria Schwarz is an advanced speech pathologist at Logan Hospital, QLD, Australia. She holds a Bachelor of Speech Pathology (Honours) and is currently completing her PhD at the University of Queensland.

Anne Coccetti

Anne Coccetti is the director of allied health at Logan Hospital, QLD, Australia. She previously held the position of director of speech pathology and audiology at Logan Hospital. She holds a Bachelor of Speech Pathology (Honours).

Elizabeth Cardell

Professor Elizabeth Cardell is the acting head of School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia. Professor Cardell holds a Bachelor of Speech Therapy and a PhD.

Tanya Hirst

Tanya Hurst is a speech pathologist at Mater Hospital, QLD, Australia. She holds a Master of Speech Pathology Studies and a Bachelor of Arts (Psychology).

Lucy Lyons

Lucy Lyons is the speech pathology lead at Mater Hospital, QLD, Australia. She holds a Bachelor of Speech Pathology.