Dysphagia negatively impacts the quality of life of patients and may lead to malnutrition, dehydration, aspiration pneumonia and even death (Foley et al., 2009).

We, as speech-language pathologists, must be aware of the experience of living with dysphagia, as “swallowing problems evoke a host of distressing psychological responses such as anxiety, shame, embarrassment, fear, and reduced self-esteem” (McHorne et al., 2000). These distressing psychological responses may affect the overall quality of life and life satisfaction; and therefore, swallowing assessments must be completed in consideration of the direction and goals of care of the patient and family.

A palliative care team is vital in this aspect; deciphering patients’ wishes via medical orders for life-sustaining treatment, while providing an extra layer of support for the patient and family. Speech-language pathologists and palliative care professionals work together to effectively provide education and counseling to patients and their families regarding the progressive nature of a disease, dysphagia, and nutritional options. Nutritional options include oral intake, comfort feeds, and/or alternate means of nutrition/hydration. Information provided must be based on current research, following evidenced based practice. This collaboration and communication foster the patients cultural, spiritual, and personal ideas, promoting overall quality of life.

topics covered:

Role of the SLP on an interdisciplinary, palliative care team
Dysphagia, eating & QOL (Quality of Life) at the end of life
Role of ANH - Alternative Nutrition and Hydration in palliative care
Advanced Directives & Communication skills

Resources mentioned in the episode:

Website: https://deathoverdinnerhealthcare.org/
Book: Being Mortal by Dr. Gawande

research articles:

American Speech Language Hearing Association. (n.d.). End-of-Life Issues in Speech-Language Pathology. Retrieved from https://www.asha.org/slp/clinical/endoflife/

Baile, W. F., Buckman, R., Lenzi, R., Globber, G., Beale, E. A., Kudelka, A. P. (2000). SPIKES-a six-step protocol for delivering bad news: application to the patient with cancer. The Oncologist; 5, 302-311.

Cegelka, A. (2014). American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement. The American Geriatrics Society.

Slomka, J. (1995). What do apple pie and motherhood have to do with feeding tubes and caring for the patient?. Arch Intern Med; 155, 1258-1263.

McCann, R.M., Hall, W.J., Groth-Juncker, A. (1994). Comfort care for terminally ill patients; the appropriate use of nutrition and hydration. JAMA, 272, 12-63.

Slomka, J. (2003). Withholding nutrition at the end of life: clinical and ethical issues. Cleveland Clinic Journal of Medicine, 70 (6), 548-552.

Caitlin Saxtein, MS, CCC-SLP, BCS-S, is a medical speech-language pathologist at Peconic Bay Medical Center, part of the Northwell Health System. Caitlin received her Master of Science in communication sciences and disorders from Adelphi University. Caitlin holds Board Certification in Swallowing and Swallowing Disorders (BCS-S) with the American Board of Swallowing & Swallowing Disorders.

Caitlin currently works in acute care and has experience in subacute rehabilitation, outpatient, and home health settings. She is trained in Respiratory Muscle Strength Training (RMST), McNeill Dysphagia Therapy Program (MDTP), Lee Silverman Voice Treatment Loud (LSVT), Neuromuscular Electrical Stimulation (VitalStim and Ampcare), and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). She is a 5-time ASHA ACE Award recipient for continuing education. Caitlin also has an extensive background with East End Hospice, volunteering with this organization for nearly 15 years.

Caitlin is an active member of ASHA Special Interest Group 13 (Swallowing and Swallowing Disorders), the Dysphagia Research Society (DRS), New York City Dysphagia Study Group (NYCDSG), Long Island Speech-Language-Hearing Association (LISHA), and the New York State Speech-Language-Hearing Association (NYSSLHA).

Caitlin is a Speaker’s Bureau committee member of LISHA, the Co-Chair of the Adult/Medical Dysphagia Track for the 2020 NYSSLHA Convention, and Secretary of the Dysphagia Outreach Project, a 501(c)(3) nonprofit organization, whose mission is to collect and distribute dysphagia supplies and establish dysphagia awareness and education services.

Caitlin has been selected to present at the local, state, and national level; including LIU Post to graduate speech-language pathology students, hosting continuing education conferences for 0.3 ASHA CEU through LISHA, NYCDSG, and Annual State Speech-Language-Hearing Association Conventions; Louisiana (LSHA), Florida (FLASHA), New Jersey (NJSHA), and New York (NYSSLHA). She was also selected to present at the American Speech-Language-Hearing Association (ASHA) 2019 Convention for two presentations. Caitlin was also featured as a guest speaker on the Swallow Your Pride Podcast, episode 098 and the Speech Uncensored Podcast, COVID Convos.

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