Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

Abstract

1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.

Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review

“…Hypertension and diabetes are not only the risk factors for stroke, but also the risk factors for dysphagia in stroke patients [ 52 , 53 ]. The results of this study have showed that the incidence of dysphagia in ischemic stroke patients with hypertension and diabetes is significantly higher than that of patients without hypertension and diabetes, which may have a joint effect with chronic diseases affecting the overall function of patients, thereby increasing the risk of dysphagia.…”

Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

“…This study forms part of a series of studies [11][12][13] that aim to investigate how variation in assessment and management of dysphagia in acute stroke affects development of SAP. The aim of this interview study is to explore the experiences of people with swallowing difficulties following a stroke to give a more rounded picture of delivery of care and ensure that the perspectives of stroke survivors and their informal caregivers are included.…”

“…The aim of this interview study is to explore the experiences of people with swallowing difficulties following a stroke to give a more rounded picture of delivery of care and ensure that the perspectives of stroke survivors and their informal caregivers are included. We wanted to include the patient story of swallowing difficulties post-stroke as a way to better understand the patient experience of dysphagia assessment and management, as well as the views of the staff involved [13,14]. Including the patient story has the potential to highlight variations in practice from the perspective of the persons affected, thereby providing a more inclusive understanding of service delivery.…”

Research progress of clinical intervention and nursing for patients with post-stroke dysphagia

“…Although this review presents a growing consensus on the effectiveness of neurostimulation, physical techniques, and nutritional interventions in enhancing dysphagia recovery, there are still many problems and uncertainties to be explored. In essence, the severity of stroke is influenced by a variety of factors, and due to the complexity of therapeutic interventions, it is difficult to determine exactly what leads to recovery [ 87 ]. The studies reviewed here included both acute and chronic PSD patients, who naturally recover at different rates, making it difficult to determine the effectiveness of clinical interventions.…”