The Essential Role of Speech-Language Pathologists in End-of-Life Swallowing Intervention: A Narrative Review

Background: Speech-language pathologists (SLPs) are essential in the intervention of dysphagia, particularly at the end of life (EoL), where their guidance can significantly improve patients' comfort and quality of life. However, despite a growing recognition of their importance in this palliative setting, SLPs continue to face obstacles for consistent involvement on the palliative care team. Method: This narrative review examines the scope and challenges of SLP involvement in EoL swallowing intervention. A literature search was conducted across PubMed, CINAHL, and Scopus between March and April 2024, supplemented by guidelines from the American Speech-Language-Hearing Association. Fourteen articles were selected, focusing on SLPs' roles in adult swallowing intervention specifically at the EoL, barriers to SLPs' practice, and impacts on quality of life. Results: Three primary themes emerged: diet texture adjustment, compensatory swallowing strategies, and patient and caregiver education. The review also identified significant barriers to SLP involvement, including inconsistent practices, limited resources, legal concerns, and a lack of interdisciplinary integration. Discussion: The review highlights the critical, yet often overlooked, role of SLPs in enhancing quality of life for those at the EoL through tailored swallowing evaluations and recommendations. Addressing barriers such as inconsistent guidelines and inadequate training in palliative care is crucial for maximizing SLP contributions in this area. Advocacy for the SLP role in EoL care, along with the development of standardized practices, is essential for improving quality of life outcomes. Limitations: The review is constrained by a limited research base, lack of standardization in practice guidelines, and challenges in generalizing findings. More research is needed to establish uniform guidelines and better integrate SLPs into EoL care teams.