Tube feeding in advanced dementia: Insights from South African speech-language therapists

Abstract

Background: Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs’ perceived practices is warranted. Objectives: To qualitatively describe a sample of South African SLTs’ perceived practices regarding feeding tube placement in people with advanced dementia. Method: Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. Results: Three main themes were identified: (1) factors influencing SLTs’ decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs’ decision-making and (3) SLTs’ considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants’ decisions about tube feeding. Conclusion: Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs’ overall practices and ethical service delivery for people with advanced dementia and their families. Contribution: Factors and needs regarding SLTs’ decision-making about feeding tubes in people with advanced dementia are highlighted.

Keywords

• advanced dementia
• feeding tube
• speech-language pathologists
• oropharyngeal dysphagia
• palliative care
• qualitative research
• decision-making