Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

Abstract

Purpose In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). Methods We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. Results Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme “normal swallowing vs difficulty swallowing” as the highest priority. Conclusion This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.

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

“…This could assist in overcoming challenges associated with meal preparation and selection, given many carers have reported to resorting to trial-and-error methods (Howells et al, 2021a;Nund et al, 2014aNund et al, , 2014c. Knowing how to select and prepare dietary recommendations has been established as a core educational component through a Delphi method with patients, caregivers, and clinicians (Ghaddar et al, 2022), and having access to educational resources may increase confidence and reduce associated burden (Rangira et al, 2022). Indeed, caregivers in prior studies have indicated wanting modified food recipes (Howells et al, 2021b), and a recent pilot randomised clinical trial involving 22 stroke patients found that attending a 6-week food preparation program (i.e., performing oral motor exercises, identifying thickeners and food textures, practising meal preparation) was associated with better self-perceived dietary and psychosocial well-being (Lin et al, 2021).…”