Nutrition

What can a Speech Therapist offer in palliative care?

In the palliative care team, speech therapists often assist with communication, even in the early stages of a diagnosis. Patients are able to communicate their wants and needs, enabling them to participate in their care and express their values to their families and healthcare team. If verbal communication deteriorates due to the disease process, we can work with individuals to maintain communication and social interactions for as long as possible.

Another aspect of our role is addressing swallowing difficulties in patients. Eating and drinking hold significance for most people; I haven’t met someone who didn’t consider it an essential aspect of their life. In palliative care, we prioritize the patient’s values and expectations to ensure eating remains as safe and enjoyable.

We also support families in modifying diets to ensure clients can continue to enjoy certain foods. Food provides comfort for many of us, and we aim to maintain that comfort for palliative care patients. 

Are there barriers faced by Speech Therapists in Palliative Care?

Many people mistakenly believe that speech therapists primarily work with children; we do much more.

One of the biggest challenges as a Speech Therapist is being consulted late in the disease process, usually when swallowing and communication difficulties are severe. This late stage makes it challenging as deterioration may have progressed beyond enjoyment and is purely about support. As an example, if a patient can no longer communicate clearly due to illness, it becomes difficult to establish their wishes regarding eating, drinking, and communication. In neurodegenerative diseases (such as Dementia or Motor Neurone Disease), establishing alternative forms of communication when the patient is already vulnerable can be incredibly difficult.

Another misconception is that speech therapy focuses only on improving speech. Again, in conditions like Motor Neuron Disease, where speech progressively worsens, we primarily focus on providing support rather than “fixing” speech.

Additionally, there’s a common belief that feeding a sick person will improve their condition or prolong their life. Artificial nutrition and hydration (ANH) are not indicated at the end of life. This discussion with families can be complex but ties back to establishing the patient’s wishes early on.

Can you share an experience with a palliative care patient where speech therapy was helpful?

I had a patient with Motor Neuron Disease whom I saw early after diagnosis. During our conversation, I discussed the likelihood of her eventually becoming unable to eat and drink by mouth, as well as the risks and benefits of tube feeding. Right from the start, she was adamant that she did not want a feeding tube under any circumstances. My role then shifted to helping the family navigate their thoughts and emotions surrounding her decision.

In the end, she passed away without ever having a feeding tube. Towards the end of her life, all she wanted was mashed potatoes and coffee—no judgment, as it was her favorite comfort. As long as she could have those, we were valuing and respecting her wishes.

Can you share any tips with palliative care patients and their families?

I typically encourage patients and families to reach out early if someone has received a serious illness diagnosis. This doesn’t necessarily mean committing to weekly therapy sessions but instead initiating a discussion about what to expect, potential outcomes, and options for management and support. 

If the concern is swallowing difficulties, I recommend that families watch for signs indicating struggles. For instance- someone experiencing difficulty swallowing might appear to be choking, cough excessively after meals, or take an unusually long time to chew. In such cases, consulting a Speech Therapist can help reduce the risk of unnecessary hospital admissions due to potential pneumonia.

Finally, I stress the importance of maintaining oral hygiene. While it may sound trivial, oral hygiene is critical in swallowing safety. If you have difficulty swallowing and something enters your lungs while your mouth harbors bacteria, aspiration increases the likelihood of developing pneumonia. Therefore, I advise brushing your teeth at least thrice daily if you experience swallowing problems.

 

 

By: Teresa Teixeira

Cape Town based Speech Therapist