Authors (including presenting author) :
Cheung SMM(1), Lam MK(1), Lam YL(1), Lo HK(1), AuYeung TW(2), Tse CM(2), Woo CC(2), Lai YL(2)
Affiliation :
(1)Speech Therapy Department,POH
(2)M&G Department,POH
Introduction :
There is an increasing trend that patients and families would not prefer tube feeding at the late stage of diseases even they were suffered from marked swallowing impairment. Consideration of patient’s QOL and dignity dominants over treatment outcomes for these groups of patients, mostly geriatric patients. There is evidence showing feeding tubes would not improve survival or reduce risk of aspiration.1, 2 Hand feeding becomes the leading choice recently. Facing such change, frontline colleagues would encounter challenges on case management. They might be afraid of feeding patients with aspiration risks due to the potential medical-legal consequences. Some would be irritated by the time-consuming feeding tasks when dealing with those who were not willing to eat. Also, education information regarding choice of feeding mode is not sufficient for patients and families.
Objectives :
1. To enhance patients’ QOL and promote their dignity at the late stage of diseases.
2. To facilitate the informed choice of feeding mode by patients and/or families.
3. To share the duties and responsibilities in managing patients with swallowing/feeding disorders.
Methodology :
All medical wards were invited to participate in the Careful Hand Feeding Program. Core disciplines include speech therapists, medical physicians and nurses. It was commenced phase by phase from Mar17 to now. A standardized workflow with identified patient selection criteria was established. Education to public was enhanced through printed resources. A series of training seminars and feeding skills training sessions were offered to nurses and PCAs. Trial run of program started in 2 medical convalescence wards in Mar18 and Apr18. It further extended to all medical wards in Sep18. Careful Hand Feeding Program would be evaluated in two ways, caregivers’ satisfaction and professional quality of life of nurses. A service satisfaction survey and ProQOL 5 were employed.
Result & Outcome :
Over 90% of the caregivers reported satisfaction with the Careful Hand Feeding Program. There was no significant difference in professional quality of life score in nurses with the commencement of program using Wilcoxon Signed Rank Test (p >.05).
A program-based management approach on swallowing/feeding disordered patients would have positive impact on both service recipients and service providers. It does not only help promoting patients’ QOL and dignity at the late stage of their life journey, it also clarifies the roles and duties of different disciplines, and shares the burdens and responsibilities among team members.
