A retrospective cohort study of complex feeding decisions: Informing dysphagia decision-making through patient experiences.

Complex decision-making when dealing with situations such as feeding in the context of dementia, palliative care, and severe dysphagia is a complex clinical area for speech language pathologists (SLPs). The objective of this study was to provide an exploratory overview of complex feeding decisions, in order to highlight areas for improvement in clinical practice. A retrospective clinical chart audit of 82 participants was conducted within two hospital settings between 2012 and 2017 using an explorative approach. Complex feeding decisions were documented as "risk feeding" in 59.8% of instances and were most commonly made by the patient/family in consultation with the medical team (23.2%). Many of the complex feeding decisions were made without a multidisciplinary case conference (82.9%), without appropriate discussions with families regarding feeding decisions/options/alternatives (63.4%), and without relevant patient and family education (59.8%). Feeding decisions are ethically and clinically complex and therefore require a interdisciplinary and person-centred approach to discussion and education, as well as clear unbiased documentation. [ABSTRACT FROM AUTHOR]