Speech therapy in palliative care and comfort feeding: current practice and way ahead

Background. Speech therapy is important in palliative care and end-of-life care of the geriatric population. Comfort feeding is an option for such patients, but there is no guideline for its operational and clinical practice. Thus, we surveyed the opinions of speech therapists on their role, clinical practice, and future development to formulate preliminary recommendations in dysphagia management and comfort feeding in patients on palliative care.Methods. An online survey of speech therapists in Hong Kong was conducted between February and March 2018. The survey comprised 14 questions to assess speech therapists’ understanding of palliative care, their current practice in comfort feeding, and their views on future development.Results. Of 70 speech therapists invited, 38 (54%) completed the survey. 89% of participants reported to have provided care to patients with dementia. The most common service provided was feeding and swallowing management (100%), followed by education to patients, their family and/or the multidisciplinary team regarding communication and swallowing difficulties (88.2%). There were diverse opinions on the practice of comfort feeding among speech therapists. Thus, 92.1% of participants agreed a need of development of practice guideline for palliative care.Conclusions. The practice of comfort feeding varies among different speech therapists, particularly in the frequency of follow-up and the recommendation on liquid consistency. To improve the standard of care for patients receiving palliative care or end-of-life care, development of an evidence-based guideline for comfort feeding is recommended

Development of salient medication reminders to facilitate information transfer during transition from inpatient to primary care: the Delphi process

Objective Transitional care is important to successful hospital discharge. Providing patients with a clear and concise summary of medication-related information can help improve outcomes, in particular, among older adults. The present study aimed to propose a framework for the development of salient medication reminders (SMR), which include drug-related risks and precautions, using the Delphi process.Design Identification of potential SMR statements for 80% of medication types used by older adult patients discharged from geriatric medicine departments, followed by a Delphi survey and expert panel discussion.Settings Medical and geriatric departments of public hospitals in Hong Kong.Participants A panel of 13 geriatric medical experts.Outcome measure A Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) points, scoring item relevance, importance and clarity. The minimum of 70% consensus was required for each statement to be included.Results The expert panel achieved consensus through the Delphi process on 80 statements for 44 medication entities. Subsequently, the SMR steering group endorsed the inclusion of these statements in the SMR to be disseminated among older adults at the time of discharge from geriatric medicine departments.Conclusions The Delphi process contributed to the development of SMR for older adult patients discharged from public hospitals in Hong Kong. Patient experience with and staff response to the SMR were assessed at four hospitals before implementation at all public hospitals