Speech Therapy

What Can a Speech Therapist Offer in Palliative Care?

Speech therapy in palliative care provides essential support, with speech therapists helping patients communicate, even in the early stages of a diagnosis. We help patients express their wants and needs, enabling them to participate in their care and convey their values to both their families and healthcare team. If verbal communication deteriorates due to the disease process, we work with individuals to maintain meaningful communication and social interactions for as long as possible.

Another key aspect of our role is addressing swallowing difficulties. Eating and drinking hold deep significance for most people—I’ve yet to meet someone who didn’t consider it an essential part of life. In palliative care, we prioritise the patient’s values and expectations to ensure eating remains as safe and enjoyable as possible.

We also support families in modifying diets to help patients continue enjoying favourite foods. Food provides comfort for many, and we aim to preserve that comfort throughout the palliative journey.

Are there barriers faced by Speech Therapists in Palliative Care?

Many people mistakenly believe that speech therapists primarily work with children, but our scope is much broader.

One of the biggest challenges we face is being consulted late in the disease process, often when swallowing and communication difficulties are already severe. At this point, deterioration may have progressed to a stage where support is limited and enjoyment is compromised. For example, if a patient can no longer communicate clearly due to illness, it becomes difficult to determine their wishes regarding eating, drinking, and communication. In neurodegenerative diseases such as dementia or motor neurone disease, establishing alternative communication methods late in the disease can be particularly challenging.

Another misconception is that speech therapy is only about improving speech. In conditions like motor neurone disease, where speech will progressively decline, our focus shifts from “fixing” speech to providing adaptive support and communication alternatives.

Additionally, there is a widespread belief that feeding a sick person will improve their condition or extend their life. However, artificial nutrition and hydration (ANH) are not typically indicated at the end of life. These discussions with families can be complex but underscore the importance of understanding and respecting the patient’s wishes early on.

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

I once worked with a patient diagnosed with motor neurone disease early in her journey. During our initial conversations, we discussed the likelihood that she would eventually be unable to eat or drink by mouth and explored the risks and benefits of tube feeding. From the outset, she was adamant that she did not want a feeding tube under any circumstances. My role then became supporting her and her family as they processed and accepted her decision.

Ultimately, she passed away without ever receiving a feeding tube. Toward the end of her life, all she wanted was mashed potatoes and coffee, her favourite comforts. There was no judgment; our focus was on respecting her wishes. As long as she could enjoy those, we honoured what mattered most to her.

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

I always encourage patients and families to reach out early after receiving a serious illness diagnosis. This doesn’t mean committing to ongoing therapy but rather starting a conversation about what to expect, possible outcomes, and available support.

If swallowing is a concern, families should watch for signs of difficulty—such as choking, coughing after meals, or unusually long chewing times. If these signs are present, consulting a speech therapist can help reduce the risk of complications like aspiration pneumonia and unnecessary hospital admissions.

Lastly, I cannot overstate the importance of maintaining oral hygiene. It may sound minor, but oral hygiene plays a crucial role in swallowing safety. If someone has difficulty swallowing and aspirates food or drink into the lungs, the presence of bacteria in the mouth increases the risk of pneumonia. For this reason, I advise brushing teeth at least three times a day for those experiencing swallowing problems.

Author: Teresa Teixeira, Cape Town based Speech Therapist