Chew on This: An Interdisciplinary Toolkit for Swallowing Support at the End of Life

Key Message: Discover tools for integrating speech-language pathologists (SLPs) onto palliative care teams, emphasizing their role in swallowing support at end of life. An interdisciplinary team from a Southern California national cancer center shares a model for training, competencies, and fostering strong collaboration between SLPs and palliative care providers.

Abstract: Background
Dysphagia is a common and often under-addressed concern at the end of life (1). Any disruption to swallowing can be profoundly devastating, impacting individuals’ autonomy, the ability to enjoy eating and drinking, and participate in social rituals, all of which are essential to dignity and quality of life (2). As the recognized experts in swallowing and communication, speech-language pathologists (SLPs) are uniquely positioned to support patients and families navigating these challenges. However, SLPs are frequently underutilized in palliative care due to barriers such as underdeveloped interdisciplinary collaboration, misconceptions that SLPs provide only rehabilitative care, and systemic issues related to billing, insurance, staffing, and training (3).

Approach
In response, a national cancer center developed a scalable, interdisciplinary approach to better integrate SLPs into end-of-life care. This presentation introduces a practical toolkit designed to foster deeper collaboration between SLP and palliative care teams. The toolkit includes training strategies, communication workflows, and clinical tools such as tailored order sets and educational resources, that support shared decision-making around eating and swallowing at the end of life.

Implications
Attendees will leave with actionable materials and a roadmap for building or enhancing SLP integration within their own institutions. Early outcomes suggest improved consult timing, stronger interdisciplinary relationships, and institutional adoption of SLP competencies as part of standard end-of-life care. By embedding SLPs into the fabric of palliative care, institutions can more holistically address the physical, emotional, and social dimensions of eating and swallowing, ultimately enhancing dignity and quality of life at the end of life.

References: 1. Tan, L. L. C., Lim, Y., Ho, P., et al. (2021). Understanding quality of life for palliative patients with dysphagia using the Swallowing Quality of Life (SWAL-QOL) questionnaire. American Journal of Hospice and Palliative Medicine, 38(10), 1172-1176.

2. George, R. G., & Jagtap, M. (2022). Impact of Swallowing Impairment on Quality of Life of Individuals with Dysphagia. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 3), 5473-5477.

3. Chahda, L., Carey, L. B., Mathisen, B. A., & Threats, T. (2021). Speech-language pathologists and adult palliative care in Australia. International journal of speech-language pathology, 23(1), 57-69.