Decision making: the role of the speech therapist in palliative care

Abstract

Introduction: Shared decision making is a person-centered strategy, seeking to align communication between health professionals and patients, along with individuals’ preferences, values and goals. Objective: To correlate the clinical findings of dysarthria, dysphagia and cognition with the health decision-making process of a patient with confirmed molecular diagnosis of Ataxia Telangiectasia, in end-stage palliative care. Method: An evaluation of dysarthria, dysphagia and cognition was performed by a speech language pathologist. Based on the results which presented in the evaluation, principles and guidelines of the health decision-making process were addressed, in order to help define the therapeutic process for patients in palliative care. Results: The patient presented ataxic dysarthria and moderate to severe oropharyngeal dysphagia. However, despite a significant risk of laryngeal aspiration for all food consistencies, the patient expressed a strong desire to maintain exclusive oral feeding. With regard to cognition, the patient presented normal cognitive functions for his age bracket and education level. Through a process of informed choice and multidisciplinary discussion, and based on principles of shared decision-making in health, we chose to prioritize the patient’s desire and to support oral feeding. Conclusion: Starting from the shared decision-making process and seeking to minimize the suffering of patients in palliative care, the speech language pathologist must take a new perspective on therapeutic decisions in order to favor and involve the patient and his relatives from the beginning of the diagnosis up to end-of-life decisions.