Speech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

Metacognitive strategy training shows promise for reducing disability following stroke, but previous trials have excluded people with aphasia. Considering the high incidence of poststroke aphasia, it is important to determine whether people with aphasia can benefit from strategy training. The purpose of this study was to determine the feasibility of an adapted strategy training protocol for people with aphasia. We recruited 16 adults with mild-moderate aphasia from inpatient stroke rehabilitation. We examined recruitment and retention, intervention delivery and fidelity, participant engagement and communication, participant strategy mastery, and change in disability. Therapists demonstrated good fidelity to intervention elements. Participants demonstrated good engagement and fair communication. The sample achieved a mean Functional Independence Measure change of 21.8 ( SD = 16.2, Cohen’s d = .95), similar to matched controls without aphasia from previous trials. An adapted strategy training protocol appears feasible for people with aphasia in inpatient stroke rehabilitation. Future studies should examine the efficacy of this approach in larger samples.

Purpose Dysphagia is common in the last days of life (Bogaardt et al., 2015). Patients themselves, their families and caregivers, and health care professionals often struggle to deploy best practices in dysphagia management during this stage. Despite agreement that one's end-of-life should promote comfort, whether or not this is achieved can be unintentionally negatively impacted by the values of loved ones and health care workers, as well as health care workers' practice patterns. Importantly, we have yet to establish a comprehensive understanding of the patient experience at end-of-life to determine what truly entails “comfort” surrounding eating and drinking. Speech-language pathologists are increasingly consulted to address swallowing at end-of-life. It behooves the skilled clinician to have an understanding of the human condition in the final days to hours of life. Method In this piece, we explore the effects of food, drink, and the fasted state in both healthy adults and adults at end-of-life. We pose the thought-provoking question: Do food and drink contribute to a quality of death? Conclusion With this information, we work at the top of our license as providers who bring a unique, comprehensive understanding of such patients to the multidisciplinary comfort care team.

Purpose of reviewMedical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, ‘Poor PO intake. Please evaluate and treat.’ As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play.Recent findingsChanges to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os – each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life.SummaryIn this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.