Complex Feeding Decisions

Miles, Anna; Watt, T; Wong, Wei-Yuen; McHutchison, Louise; Friary, Philippa

doi:10.1177/2333721416665523

Cited by 29 publications

(16 citation statements)

References 26 publications

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“…A portion of the Go‐zone statements focused on improving communication, such as receiving timely updates regarding dysphagia status and management plans, understanding reasons behind clinical decisions, and obtaining consistent information from both SLPs and dietitians. This suggests that patients and caregivers in Singapore experienced communication breakdowns during healthcare interactions, which is congruent with the international literature (Govender et al., 2017; Miles et al., 2016; Nund et al., 2014a). For example, a study conducted in New Zealand reported that families were confused about dysphagia recommendations due to conflicting information provided by healthcare professionals (Miles et al., 2016).…”

Section: Discussionsupporting

confidence: 86%

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

Poon,

Ward,

Burns

2023

Intl J Lang & Comm Disor

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BackgroundPerson‐centred services are inherently related to patients/caregivers’ needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change.AimThis study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers.Methods & ProceduresUsing concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement.ResultsTwelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers’ access to support at home, increasing patients and carers’ access to educational resources, and improving service quality and access through technology.ConclusionThese findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers.WHAT THIS PAPER ADDSWhat is already known on this subject Little is known about patients and caregivers’ experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements.What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers’ access to support at home, increasing patients and carers’ access to educational resources, and improving service quality and access through technology.What are the clinical implications of this work? This research highlights the importance of considering the consumers’ perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.

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Section: Discussionsupporting

confidence: 86%

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

Poon,

Ward,

Burns

2023

Intl J Lang & Comm Disor

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“…Families were involved in decision‐making, but they did not always agree with the health professionals' views. Similar communication breakdowns are reported elsewhere 19,20 . This suggests the need for open dialogue between families and professionals where all available options are discussed and the nature of the decision‐making process is clear, with roles and responsibilities of each party identified 9 …”

Section: Discussionsupporting

confidence: 54%

“…Similar communication breakdowns are reported elsewhere. 19,20 This suggests the need for open dialogue between families and professionals where all available options are discussed and the nature of the decision-making process is clear, with roles and responsibilities of each party identified. 9 Health professionals in this study were generally positive about their communication with schools and families.…”

Section: Discussionmentioning

confidence: 99%

Health professionals' perceptions of complex feeding decision‐making in school‐aged children

Jackson

Wong

Miles

2021

J Paediatrics Child Health

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Whilst prevalence of paediatric feeding disorders is high amongst children in specialist schools, there is little guidance for professionals supporting families with a child feeding orally with established risk of aspiration. We sought perceptions of the complex feeding decision-making process amongst health professionals supporting families in the specialist school setting in New Zealand. Methods: An observational, cross-sectional, national online survey of speech-language therapists was followed by in-depth interviews with seven health professionals associated with one specialist school. Results: Survey responses from 32 speech-language therapists showed inconsistency in assessment processes and how family, children and school staff are involved in feeding decisions, with 71% reporting a doctor had been involved. Respondents were not confident in their ability to predict aspiration risk, with 41% reporting that they could often determine risk, 41% sometimes and 16% never. Sixty-three percent of respondents indicated that level of risk was written in a report for a child and 50% reported that every child at high risk had a management plan. Speechlanguage therapists valued professional supervision, but it was not always available. Health professionals were broadly positive about the collaborative nature of decision-making in most but not all situations. They described communication, access/institutional and emotional barriers to timely, shared decision-making. Conclusion: These findings demonstrate variability in how families are supported to make complex feeding decisions. Health professionals identified a need for clearer processes and strengthened communication between family, school and health professionals. Trusting relationships are critical if all families are to be well-supported.

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“…This choice can be referred to as risk feeding or eating and drinking at risk. Despite the clarity in the literature, as outlined above, the decision-making process regarding whether to introduce tube feeding or to eat and drink at risk continues to remains a challenge for professionals as well as the individuals concerned and/or their carers [11].…”

Section: Introductionmentioning

confidence: 99%

“…Decisions on nutritional options as a person approaches the end of life are ethically complex, particularly if the individual lacks decision-making capacity [11]. The lack of guidance around decision-making can compromise quality and safety of care, resulting in poor patient outcomes and increased length of in patient stay [13].…”

Section: Introductionmentioning

confidence: 99%

An Acute Model of Care to Guide Eating & Drinking Decisions in the Frail Elderly with Dementia and Dysphagia

Hansjee

2018

Geriatrics

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People with dementia frequently develop dysphagia (swallowing impairment), which causes them to be at high risk of aspiration pneumonia, resulting in hospital admissions. These individuals are advised against alternative nutrition and hydration as this does not eliminate the risk of developing chest infections. The purpose of this study was to establish the impact on length of stay by having a protocol to guide eating and drinking despite aspiration risks (risk feeding). A risk-feeding protocol was developed and implemented in a hospital setting. The quality improvement methodology of Plan-Do-Study-Act (PDSA) was employed to evaluate the impact of a protocol on the length of stay in patients with dementia and aspiration pneumonia. Annual audits (2016–2018) on the time taken from admission to when a route of nutrition was established were conducted, with adaptations made to the protocol. There was a reduction in nutrition planning times with each year. On closer evaluation of the data, improved nutrition planning times for this cohort impacted on a shorter length of stay. Having a model of care in place to guide feeding decisions in dementia coordinates care, as demonstrated in timely decision-making. For patients who are admitted with aspiration pneumonia and dementia, a decreased length of stay is evident.

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Complex Feeding Decisions

Cited by 29 publications

References 26 publications

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

Health professionals' perceptions of complex feeding decision‐making in school‐aged children

An Acute Model of Care to Guide Eating & Drinking Decisions in the Frail Elderly with Dementia and Dysphagia

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