Eating and Drinking with Acknowledged Risks (EDAR) in Older Adults: A Qualitative Study of the Experiences of Clinicians in Japan and the UK.
Yuki Yoshimatsu, Marianne Markowski, David G Smithard and 4 others
PMID 39537853WHAT IT FOUND
Clinicians in Japan and the UK described EDAR decisions as complex and often driven by seniority, family pressure, or legal fear rather than patient autonomy alone.
They lacked training and clear protocols. Support tailored to specific settings and professions is needed to help clinicians navigate these ethical dilemmas confidently.
Key findings
01Japanese clinicians were more likely to defer decisions to senior staff or side with family wishes, while UK clinicians tended to make decisions individually and then seek confirmation.
02Most participants reported limited training in EDAR and learned on the job, with many feeling that guidelines alone were insufficient without practical experience and support.
03Decision-making was heavily influenced by perceived risks, including legal repercussions and the conflict between 'doing no harm' and respecting patient autonomy.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was small (12 participants) and purposively selected, limiting generalisability. The study was exploratory, intended to shape a future quantitative phase, so themes may not capture the full range of clinician experiences. Self-reported attitudes may not reflect actual clinical behaviour. The comparison was limited to only two countries (Japan and the UK), which may not represent other cultural contexts.
Declared interests
Funding was provided by the Japanese Respiratory Society and the Great Britain Sasakawa Foundation. No specific conflicts of interest for the authors were declared in the provided text.
The easy way to misread this
Do not interpret this study as evidence that EDAR improves patient outcomes or reduces aspiration risk. This is a qualitative study of clinician perceptions and experiences. It describes the barriers clinicians face, such as legal fear and lack of training, but does not measure the effectiveness of EDAR itself.