Lately, it seems like every time an SLP turns around, there’s another post or CE course on patient choice in dysphagia management-as it should be. We tend to think of patient choice as choosing to eat and drink, despite “risk” (more on “risk’ in an upcoming Modified Monday-stay tuned), but this isn’t always the case. This week’s clip is a great example of patient choice and why it’s so important to really ask and thoroughly discuss patient perspectives.
This patient is status post partial glossectomy, with fairly extensive resection, including part of the back and base of tongue. You can see there is very little base of tongue retraction, lots of difficulty with bolus propulsion and incomplete airway closure. Where this gets into patient perspective is actually what the patient says next to our Michigan SLP(no audio-you’ll just have to trust me). Prior to the study, our MBS Envision SLPs do a pretty thorough chart review, and-since we actually are completing the study in the facility (not off site or in a van)-they are also able to spend a fair amount of time talking to the treating SLP, nursing, respiratory therapists, etc. During this prep time, the SLP mentioned that even though the patient was NPO, they had been giving the patient water at bedside, and nursing later told her that the family was bringing some food for pleasure-but that the patient wasn’t really taking advantage of it, even though they were really encouraging the water.
During the study, after several attempts at bolus propulsion and swallowing, the patient finally exclaimed “I’m just not going to be able to swallow this! I keep trying for everyone, but I can’t do it, and it’s no fun!” In this case, the patient perspective was not what we might expect, but for this patient swallowing was just so very difficult that it was more stress to the patient than not eating or drinking. After talking more to the patient, all caregivers agreed to stop offering water unless the patient asked, give the patient more time to heal, and to continue to work on the exercises with the facility SLP. Taking patient perspective into our planning is crucial-and better for the patient. Even if we think we know what they want, they might surprise us-and lead us to an even better plan of care.