1
|
Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
Collapse
Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| |
Collapse
|
2
|
Coates E, Zarotti N, Williams I, White S, Halliday V, Beever D, Hackney G, Stavroulakis T, White D, Norman P, McDermott C. Patient, carer and healthcare professional perspectives on increasing calorie intake in Amyotrophic Lateral Sclerosis. Chronic Illn 2023; 19:368-382. [PMID: 34935521 PMCID: PMC9999280 DOI: 10.1177/17423953211069090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals. METHODS Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF). RESULTS All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite). DISCUSSION To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunities.
Collapse
Affiliation(s)
- Elizabeth Coates
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Nicolò Zarotti
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Isobel Williams
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Sean White
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Vanessa Halliday
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Gemma Hackney
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Theocharis Stavroulakis
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
- Elizabeth Coates, Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | | |
Collapse
|
3
|
Koster E, Wadhwaniya Z, Namasivayam-MacDonald AM. Preliminary Study of the Effects of a Dysphagia Support Group on Quality of Life. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-23. [PMID: 37130039 DOI: 10.1044/2023_ajslp-22-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Dysphagia (swallowing difficulties) can greatly decrease quality of life for individuals with dysphagia and can lead to caregiver burden and third-party disability. Support groups have been shown to be effective in improving quality of life in a range of conditions, through allowing individuals to form connections with those with shared experiences and sharing and learning about relevant resources and coping skills. However, no research on the effects of dysphagia support groups on quality of life has been conducted. This preliminary study aimed to determine whether a virtual support group, facilitated by speech-language pathologists, could positively affect quality of life in similar ways for adults with dysphagia and their family caregivers. METHOD Pre- and postsupport group surveys were sent to participants to gain information about their dysphagia, demographics, and support group feedback (e.g., access to resources). Questions were mainly multiple choice, with three open-ended questions related to the support group. RESULTS Eight individuals participated in the surveys, with four completing both pre- and postsession surveys. Seven of eight individuals reported that they felt a support group could improve their quality of life, with the eighth being unsure. Qualitative data found the support group offered both informational (e.g., resource access) and psychosocial support (e.g., knowledge that they were not alone, emotional support). CONCLUSION These initial results suggest that a dysphagia support group could fill a gap in the health care system to offer more holistic support to individuals with dysphagia and their family caregivers.
Collapse
Affiliation(s)
- Emma Koster
- Rehabilitation Science - Speech-Language Pathology, McMaster University, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
4
|
Ultrasonographic and manometric study of the tongue as biomarkers of dysphagia in patients with amyotrophic lateral sclerosis. Neurol Sci 2023; 44:931-939. [PMID: 36367593 DOI: 10.1007/s10072-022-06486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The possibility of having methods to assess dysphagia in amyotrophic lateral sclerosis (ALS) patients in a minimally invasive manner could facilitate follow-up and allow performing of therapeutic interventions at earlier stages of the disease. The aim of the study was to analyze the role of tongue strength and thickness in ALS patients and their correlation with dysphagia and bulbar function. METHODS A sample of outpatients with ALS was evaluated for demographic and clinical features. Tongue thickness and strength have been measured for each patient, and quantitative and qualitative data of the videofluoroscopy swallow study have been analyzed. RESULTS Of the 38 ALS patients studied, 47.4% were women, and 26.3% had bulbar onset. The median time between symptom onset and the study was 24 months (IQR 11.5-48), and 55.3% of the patients were carriers of non-invasive mechanical ventilation. Tongue strength identified patients with impaired oral and pharyngeal transit and those with bolus residue scale (BRS) > 1 or penetration-aspiration scale (PAS) ≥ 3. In contrast, tongue thickness is only associated with impaired oral transit. Finally, anterior tongue strength ≤ 34 kPa and posterior tongue strength ≤ 34.5 kPa detected ALS penetrators/aspirators (PAS ≥ 3) and patients with ALS with post-swallow residue (BRS > 1). CONCLUSIONS Our results suggest that measures that assess the functionality (strength) of the tongue are more valuable than morphological measurements (thickness) for the follow-up of patients with ALS. Alterations of the anterior and posterior lingual strength correlate with the presence of bronchoaspiration and post-swallowing residue (BRS > 1).
Collapse
|
5
|
Weaver MS, Geppert CMA. Sometimes a difficult decision to swallow: Ethical dilemmas when patients with dysphagia who lack capacity want to eat. J Pain Symptom Manage 2023; 65:e97-e102. [PMID: 36272543 DOI: 10.1016/j.jpainsymman.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Meaghann S Weaver
- VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA; Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Cynthia M A Geppert
- VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA; Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| |
Collapse
|
6
|
Ball LJ, Geske JA, Burton E, Pattee GL. A clinical bulbar assessment scale (CBAS) for amyotrophic lateral sclerosis. Muscle Nerve 2022; 66:694-701. [PMID: 36217681 DOI: 10.1002/mus.27738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Comprehensive and valid bulbar assessment scales for use within amyotrophic lateral sclerosis (ALS) clinics are critically needed. The aims of this study are to develop the Clinical Bulbar Assessment Scale (CBAS) and complete preliminary validation. METHODS The authors selected CBAS items from among the literature and expert opinion, and content validity ratio (CVR) was calculated. Following consent, the CBAS was administered to a pilot sample of English-speaking adults with El Escorial defined ALS (N = 54) from a multidisciplinary clinic, characterizing speech, swallowing, and extrabulbar features. Criterion validity was assessed by correlating CBAS scores with commonly used ALS scales, and internal consistency reliability was obtained. RESULTS Expert raters reported strong agreement for the CBAS items (CVR = 1.00; 100% agreement). CBAS scores yielded a moderate, significant, negative correlation with ALS Functional Rating Scale-Revised (ALSFRS-R) total scores (r = -0.652, p < .001), and a strong, significant, negative correlation with ALSFRS-R bulbar subscale scores (r = -0.795, p < .001). There was a strong, significant, positive correlation with Center for Neurologic Studies Bulbar Function Scale (CNS-BFS) scores (r = 0.819, p < .001). CBAS scores were significantly higher for bulbar onset (mean = 38.9% of total possible points, SD = 22.6) than spinal onset (mean = 18.7%, SD = 15.8; p = .004). Internal consistency reliability (Cronbach's alpha) values were: (a) total CBAS, α = 0.889; (b) Speech subscale, α = 0.903; and (c) Swallowing subscale, α = 0.801. DISCUSSION The CBAS represents a novel means of standardized bulbar data collection using measures of speech, swallowing, respiratory, and cognitive-linguistic skills. Preliminary evidence suggests the CBAS is a valid, reliable scale for clinical assessment of bulbar dysfunction.
Collapse
Affiliation(s)
- Laura J Ball
- Speech-Language Pathology, Mississippi University for Women, Columbus, Mississippi, USA
| | - Jenenne A Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth Burton
- Speech-Language Pathology, Madonna Rehabilitation Institute, Lincoln, Nebraska, USA
| | - Gary L Pattee
- University of Nebraska Medical Center, Neurology Associates, PC, Lincoln, Nebraska, USA
| |
Collapse
|
7
|
Suzuki M, Kimura Y, Otobe Y, Koyama S, Terao Y, Kojima I, Masuda H, Tanaka S, Yamada M. The effect of care receivers' dysphagia severity on caregiver burden among family caregivers. Geriatr Gerontol Int 2022; 22:870-875. [DOI: 10.1111/ggi.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mizue Suzuki
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tokyo Japan
| | - Yosuke Kimura
- College of Science and Engineering, Health and Sports Technology Course Kanto Gakuin University Yokohama Japan
| | - Yuhei Otobe
- School of Medicine, Department of Rehabilitation Science Physical Therapy Course, Osaka Metropolitan University Habikino Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tokyo Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tokyo Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tokyo Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tokyo Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation School of Health Sciences, Tokyo University of Technology Tokyo Japan
| | - Minoru Yamada
- Faculty of Human Sciences University of Tsukuba Tokyo Japan
| |
Collapse
|
8
|
Lisiecka D, Kearns Á, Bonass A. A qualitative systematic review of family caregivers' experiences of artificial nutrition and hydration at home: A meta-ethnography. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:717-736. [PMID: 35439344 PMCID: PMC9543238 DOI: 10.1111/1460-6984.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Artificial nutrition and hydration (AN&H) may be provided to individuals in the home environment, and family caregivers are often involved in the management of this intervention. This experience can have multiple consequences for families. AIMS The aim of this meta-ethnography is to explore and synthesize the personal experiences of family caregivers providing care to a person receiving home AN&H. METHODS & PROCEDURES A comprehensive search of the literature was conducted without any time limitations applied. Seven stages of meta-ethnography were followed. Public and patient involvement was incorporated into the development of the line of argument synthesis in this review. This review is reported following the eMERGe guidelines and it was registered in PROSPERO. MAIN CONTRIBUTION A total of 22 studies were included representing the experiences of 336 family caregivers. Two main themes emerged: (1) sink or swim, being thrown in at the deep end; and (2) professional support as a bedrock. The first theme represents the experiences from the very start of home AN&H when the family caregivers may be overwhelmed with the level of skills they have to acquire. With time, family caregivers perceived the benefits, but also the challenges, associated with managing home AN&H. If a person receiving home AN&H was able to continue with some oral intake, it had a positive impact on family caregivers' experiences. The second theme represents the influence of professional support on the lived experience of family caregivers managing home AN&H. This support should be individualized, comprehensive, and co-created with the family caregiver and the person receiving home AN&H. CONCLUSIONS & IMPLICATIONS This review concluded that caring for a person receiving home AN&H can be very challenging for family caregivers. Family caregivers require personalized support from a multidisciplinary team of healthcare professionals to acquire skills, competence and confidence in this new role. Speech and language therapists are important members of this multidisciplinary team because they can facilitate a continuation of oral intake as appropriate. WHAT THIS PAPER ADDS What is already known on the subject AN&H has an impact not only on the person receiving it but also on the wider family and family caregivers. Healthcare professionals have a role in supporting people living with AN&H. What this paper adds to existing knowledge This review presents a rigorous qualitative evidence synthesis that adheres fully to the eMERGe guidance for reporting of meta-ethnography. Within this meta-ethnography a current caregiver was consulted during the creation of the line of argument synthesis to provide a unique perspective to the review process. This review synthesized the current body of evidence that explores the lived experience of home AN&H (any type) for family caregivers, identifies where professional support is required and highlights current gaps. What are the potential or actual clinical implications of this work? Family caregivers require personalized support from a multidisciplinary team of healthcare professionals to adjust to living with home AN&H. This support assists people living with home AN&H in perceiving benefits and developing more positive experiences. Speech and language therapists are important members of the multidisciplinary team supporting individuals with home AN&H and their family caregivers as they can facilitate a continuation of oral intake as appropriate.
Collapse
Affiliation(s)
- Dominika Lisiecka
- Department of Nursing and Healthcare SciencesSchool of Health and Social SciencesKerry CampusMunster Technological UniversityTraleeIreland
| | - Áine Kearns
- Department of Speech & Language TherapySchool of Allied HealthUniversity of LimerickLimerickIreland
| | - Aisling Bonass
- Department of Speech & Language TherapySchool of Allied HealthUniversity of LimerickLimerickIreland
| |
Collapse
|
9
|
Ling A, Herbert F, Wright B, Richfield E. Terminal Choking in Parkinson's Disease. J Pain Symptom Manage 2022; 63:e757-e764. [PMID: 35081446 DOI: 10.1016/j.jpainsymman.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Ling
- ST5 Palliative Medicine (Specialist Trainee) (A.L.), Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, United Kingdom.
| | - Fiona Herbert
- ST5 Geriatric Medicine (Specialist Trainee) (F.H.), Care of the Elderly, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Bethany Wright
- Consultant in Palliative Medicine (B.W.), St Peter's Hospice, Brentry, Bristol, United Kingdom
| | - Edward Richfield
- Consultant in Geriatric Medicine (E.R.), Medicine for Older People, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| |
Collapse
|
10
|
Vargas García MA, Grajales Gómez LD, Delprado Aguirre F. Percepción del cuidador principal sobre los factores limitantes del uso de las consistencias en la alimentación del paciente con disfagia: revisión sistemática. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.78284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La modificación de la consistencia de los alimentos consiste en la reconfiguración de la textura del alimento para inhibir de los riesgos en el transporte del bolo alimenticio que presentan los pacientes con disfagia. En el manejo dado en casa a la disfagia, la manipulación, preparación y apoyo del alimento está a cargo de un familiar/cuidador principal que, ocasionalmente, no conoce ni interpreta consideraciones para el manejo de las consistencias El objetivo de esta revisión sistemática fue indagar documentalmente los factores limitantes de la estrategia de modificación de consistencias como recurso de acompañamiento y apoyo a la atención de la disfagia. Para ello se siguió la metodología PRISMA, realizando una búsqueda en las bases de datos ScienceDirect, Biblioteca Virtual para la Salud (BVS) y Scielo para identificar artículos publicados entre 2016 y 2021. Se seleccionaron 9 estudios en inglés y español, que cumplieron con todos los criterios de inclusión y vinculan la percepción del cuidador principal en relación con la modificación de consistencias para el abordaje de la disfagia. Esta revisión sintetiza los datos más actualizados sobre el manejo de consistencias por parte del cuidador en siete categorías de trabajo relacionadas con el conocimiento de la disfagia, evidencia de signos y síntomas, comprensión de la estrategia de modificación de consistencias, costos, factor biopsicosocial de la alimentación, estado psicosocial del paciente y acompañamiento profesional. Se proponen estudios a futuro para profundizar en estas temáticas.
Collapse
|
11
|
Rangira D, Najeeb H, Shune SE, Namasivayam-MacDonald A. Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:486-501. [PMID: 34962832 DOI: 10.1044/2021_ajslp-21-00249] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. METHOD Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. RESULTS The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. CONCLUSIONS These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.
Collapse
Affiliation(s)
- Daniella Rangira
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | | |
Collapse
|
12
|
Ninfa A, Crispiatico V, Pizzorni N, Bassi M, Casazza G, Schindler A, Delle Fave A. The care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping review. PLoS One 2021; 16:e0257683. [PMID: 34555044 PMCID: PMC8460009 DOI: 10.1371/journal.pone.0257683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Besides affecting physical health, Oropharyngeal Dysphagia (OD) entails limitations in daily activities and social participation for both patients and their informal caregivers. The identification of OD-related needs is crucial for designing appropriate person-centered interventions. AIMS To explore and map the literature investigating the care needs related to OD management of adult persons with OD and their informal caregivers during the last 20 years. METHODS A scoping review was conducted and reported following PRISMA guidelines. Five electronic databases and reference lists of eligible publications were searched for original works in English or Italian, published between January 2000 and February 2021. Two independent raters assessed studies' eligibility and extracted data; a third rater resolved disagreements. Extracted care needs were analyzed using a Best fit framework synthesis approach. RESULTS Out of 2,534 records preliminarily identified, 15 studies were included in the review and 266 care needs were extracted. All studies were conducted in Western countries. Research methods primarily consisted of qualitative interviews and focus groups (14 studies, 93.3%); head and neck cancer was the most frequent cause of patients' dysphagia (8 studies, 53.3%); caregivers' perspective was seldom investigated (5 studies, 33.3%). Both patients and caregivers primarily reported social (N = 77; 28.9%) and practical (N = 67; 25.2%) needs, followed by informational (N = 55; 20.7%) and psychological (N = 54; 20.3%) ones. Only patients reported physical needs (N = 13; 4.9%), while spiritual needs were not cited. CONCLUSIONS The recurrence of personal and social needs besides physical ones highlighted the manifold impact of OD on patients' and caregivers' lives. Larger and more focused studies are required in order to design tools and interventions tailored to patients' and caregivers' needs.
Collapse
Affiliation(s)
- Aurora Ninfa
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valeria Crispiatico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Marta Bassi
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
13
|
Li C, Qiu C, Shi Y, Yang T, Shao X, Zheng D. Experiences and perceptions of stroke patients living with dysphagia: A qualitative meta-synthesis. J Clin Nurs 2021; 31:820-831. [PMID: 34369025 DOI: 10.1111/jocn.15995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/22/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To systematically review and synthesise the findings of qualitative research exploring experiences of dysphagia from stroke patients' perspectives. BACKGROUND Poststroke patients with dysphagia are suffering from impaired physical functions and heavy psychological burden, and they are living with compromised quality of life. Through synthesising qualitative studies to fully portrait the experiences of poststroke patients living with dysphagia, we can care better for this population. DESIGN A systematic review and synthesis of qualitative studies reported by following ENTREQ. REVIEW METHODS Five electronic databases (CINAHL, Embase, PubMed, Web of Science and Cochrane Library) and three Chinese databases (CNKI, VIP and Wanfang) were searched from inception until January 2021. Qualitative studies were included if they were related to the experiences of poststroke patients with dysphagia. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise study quality. Data were synthesised using the Thomas and Harden method thematic and content analysis. RESULTS Five studies were included in the meta-synthesis. Four analytical themes were identified: life changes after dysphagia, coping with social events, rebuilding a normal life and limited professional services. CONCLUSIONS More attention should be given to psychological health and social interaction in poststroke dysphagia patients. Healthcare professionals, especially nurses, should make joint efforts to provide patients with dysphagia-related knowledge and long-term individualised support. To improve the quality of life of dysphagia patients, further research should implement high-quality interventions based on dysphagia experience and clinical treatment. RELEVANCE TO CLINICAL PRACTICE These findings outline the changes in poststroke patients with dysphagia. Nurses as the first-line force, should deliver comprehensive and individualised intervention for managing physiological and psychosocial symptoms of patients.
Collapse
Affiliation(s)
- Chen Li
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chunmei Qiu
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Shi
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tao Yang
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinmei Shao
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|