JCPSLP Vol 20 No 3 November 2018

Nutrition, swallowing, mealtimes: Recipes for success

The “Dysphagia Kitchen” student learning experience From classroom to cookbook Simone Howells, Petrea Cornwell, Hollie Austin, and Cara Probert

Dysphagia intervention commonly utilises texture modification. However, this presents challenges for patients and caregivers who report that preparation of texture-modified meals is cumbersome, time consuming, costly and frustrating. Currently, few resources are available to remedy these challenges and many are costly and outdated. Speech- language pathologists (SLPs) educate and support patients and caregivers, as well as food service staff, in the implementation of modified textures. Preparing SLP students for this area of the workforce is important. This article presents a two-phase “Plan, do, study, act” quality improvement cycle undertaken by SLP students in the development of a dysphagia-friendly cookbook. It begins with students experimenting with recipe design, presenting the recipes to staff and peers for auditing during a kitchen learning experience, and progressing with recipe testing to development of a cookbook. Beyond the Blender: Dysphagia Made Easy is a free, downloadable cookbook for patients, families and SLPs. D ifficulty swallowing, known as dysphagia, is a condition managed by speech-language pathologists (SLPs) across a range of population groups (adults and paediatrics) and a variety of settings (e.g., hospitals, community health centres, schools) (Speech Pathology Australia, 2012). Dysphagia can cause serious health issues, including malnutrition, dehydration, choking, and aspiration pneumonia (Lancaster, 2015). Dysphagia intervention commonly involves making changes to the patient’s food and fluid, as texture and fluid modification can make swallowing easier and safer (Steele et al., 2015). This may involve altering the food to be softer, smoother or smaller, and the fluids thicker. Making these necessary changes to food and fluid can ultimately help to prevent development of aspiration pneumonia. This means that, for most patients, the decision to modify food or fluid is a means of maintaining health status but it is not without its challenges.

Broadly, dysphagia can result in changes to the enjoyment of, and satisfaction with food and drink (Davis, 2007) and changes to a family’s way of life. It is not uncommon for people with dysphagia and their caregivers to report changes to patterns of eating out, socialising and family rituals including social events, cooking and shopping (Ekberg et al., 2002; McQuestion, Fitch, & Howell, 2011; Miller, Noble, Jones, & Burn, 2006; Nund et al., 2014a, b). Some family members may opt not to eat with or in front of the person with dysphagia for fear of upsetting them by eating foods that cannot be consumed safely (Davis, 2007; Nund et al., 2014b). One of the biggest challenges patients and caregivers have reported is that the preparation of texture-modified meals is often cumbersome, time consuming and can be costly (Davis, 2007; Johansson & Johansson, 2009; McQuestion et al., 2011; Nund et al., 2014b; Ottosson, Lauell, & Olsson, 2013; Patterson, Rapley, Carding, Wilson, & McColl, 2013). Further, caregivers have reported feelings of frustration about finding foods the person with dysphagia can safely eat and making modified foods appetising (Nund et al., 2014b; Patterson et al., 2013). It is clear from the voices of patients and caregivers in these research studies that many do not feel confident or well equipped to successfully modify textures and fluids in line with SLP recommendations. This may stem from a lack of practical information and demonstration provided by SLPs, but may also be due to a lack of easily accessible information and recipes on food and fluid modification. Indeed, as part of the current project, an online search was conducted to determine how many recipe books are available for people with dysphagia requiring texture modification, and less than 10 such resources were found internationally. Most were not freely available, instead requiring the patient with dysphagia and their family to be further financially impacted by the dysphagia diagnosis. Also, most were greater than 15 years old, and therefore not reflective of current Australian or international dysphagia standards or terminology. Additionally, these recipes were not reflective of the cultural diversity of Australia, nor current cookbook aesthetics and accessibility options (e.g., internet download). It is clear that a key role for SLPs lies in educating and equipping the patient and family to modify foods and fluids into textures that are safe for the patient with dysphagia to consume. This may involve supporting caregivers to modify foods that were once loved and shared as a family into something texture modified, or supporting the person responsible for cooking meals to create new recipes.

KEYWORDS COOKBOOK DYSPHAGIA RECIPE STUDENT EDUCATION TEXTURE MODIFIED

THIS ARTICLE HAS BEEN PEER- REVIEWED

Simone Howells (top) and Petrea Cornwell

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology