Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation.
Katherine A Hutcheson, Ella F Aldridge, Carla L Warneke and 9 others
PMID 38935170WHAT IT FOUND
A new swallowing severity tool was used in 93% of over 13,000 videofluoroscopy exams at a cancer center.
Clinicians recorded it accurately in almost all cases. It fits easily into existing workflows, though it cannot be used for patients with total laryngectomies or fistulas.
Key findings
01The DIGEST tool was documented in 93% of all videofluoroscopy exams over six years, with reporting rates staying above 90% across different cancer types and settings.
02When the tool was used, it was recorded correctly in 85% of cases, with errors in the grading logic occurring in less than 2% of records.
03The tool could not be applied to patients who had total laryngectomies or studies for fistula leaks, which accounted for most of the missing data.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a single-site study at an academic medical center that already had a culture of using standardized protocols and evidence-based tools, so results may not generalize to other settings. The tool was developed at this institution, and the principal investigator was one of the clinicians performing the exams, which could influence adoption rates. The study only looked at whether the tool was used and recorded correctly; it did not test if using DIGEST actually improved patient outcomes or clinical decision-making. Validity of the tool has only been established for head and neck cancer, but this study applied it to all cancer types, including those where the tool's accuracy is not yet proven.
Declared interests
The study was conducted at The University of Texas MD Anderson Cancer Center, where the DIGEST tool was developed. The principal investigator is an employee of the institution and performed a significant number of the exams included in the analysis.
The easy way to misread this
Do not interpret the high usage rate as evidence that DIGEST improves patient care or outcomes. This study only proves that clinicians can use the tool and record it accurately in their charts. It does not show that the tool leads to better swallowing management or that it is valid for cancer types other than head and neck.