Exploring Practice Approaches and Opinions of International Speech and Language Therapists in the Assessment and Management of Oropharyngeal Swallowing in Adults on High-flow Nasal Oxygen: A Focus Group Study.
Andrea Hanratty, Claire Mills
PMID 42707016WHAT IT FOUND
Therapists assess swallowing in adults on high-flow oxygen by considering the patient's stability and readiness rather than using a standard screening tool.
They rely on bedside exams but vary widely in using instrumental assessments due to access and patient fluctuation, citing a lack of evidence.
Key findings
01None of the participants used a formal dysphagia screening tool, and there was no consensus on whether screening is appropriate for this population.
02All participants performed bedside swallowing assessments, but they expressed concern about the reliability of these exams in critically ill patients.
03Use of instrumental assessments like FEES varied significantly by country, with some clinicians preferring them for confidence and others citing barriers like transport, staffing, or patient instability.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is qualitative and reports opinions and experiences, not clinical outcomes or efficacy. Participants were recruited via convenience and snowball sampling, which may not represent all SLTs in critical care. All participants were female, which may limit the generalizability of perspectives. Focus group dynamics can lead to conformity bias, where dominant voices influence others. The study did not collect detailed demographic data beyond experience and country. The findings reflect practice at a specific time (2023) and may change as new evidence emerges.
Declared interests
The authors declared no conflicts of interest. One author is funded by an NIHR Postdoctoral Fellowship, but the views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
The easy way to misread this
Do not interpret these findings as evidence that bedside assessment is unsafe or that instrumental assessment is superior. The study reports therapist opinions and practices, not patient outcomes. The variability in instrumental use reflects logistical and systemic barriers, not necessarily a lack of clinical judgment.