The RCSLT has published a position paper on the use of thickened fluids in the management of eating, drinking and swallowing difficulty (dysphagia). In this podcast we speak with the team behind the paper.
We cover:
Interviewees:
Resources:
Link to the position paper:
https://www.rcslt.org/members/clinical-guidance/dysphagia/thickened-fluids
The interview was produced by Jacques Strauss, freelance digital producer.
The RCSLT has published a position paper on the use of thickened fluids in the management of eating, drinking and swallowing difficulty (dysphagia). In this podcast we speak with the team behind the paper.
We cover:
Interviewees:
Resources:
Link to the position paper:
https://www.rcslt.org/members/clinical-guidance/dysphagia/thickened-fluids
The interview was produced by Jacques Strauss, freelance digital producer.
Speaker Key (delete/anonymise if not required):
HOST: JACQUES STRAUSS
KATHLEEN: KATHLEEN GRAHAM
TRACY: TRACY LAZENBY-PATERSON
MYA: MAYA ASIR
LIZZIE: LIZZIE KING
MUSIC PLAYS: 0:00:00-0:00:05
HOST: Welcome to another RCSLT podcast. My name is Jacques Strauss.
In this episode of the podcast, we’re talking about an RCSLT position paper that looks at the use of thickened fluids. This paper was written in response to the large number of queries that RCSLT has received about this intervention. This is not a systematic review, though it does reference a number of systematic reviews. It’s the broad professional consensus of a group of expert dysphasia practitioners. And in this episode of the podcast, the authors of the paper are joining us to talk about the use of thickened fluids in a variety of areas and how their thinking has evolved.
I started by asking the panel to introduce themselves.
KATHLEEN: 0:00:50 My name’s Kathleen Graham. I’m a Speech and Language Therapist and Senior Project Manager for RCSLT.
TRACY: 0:00:54 My name is Tracy Lazenby-Paterson. I’m a Speech and Language Therapist and Team Coordinator in the Learning Disability Service in Edinburgh.
MYA: 0:01:04 My name is Maya Asir. I’m a Neonatal Speech and Language Therapist at Guys and St Thomas’.
LIZZIE: 0:01:07 I’m Lizzie King. I’m an Allied Health Professional Clinical Lead and Professional Lead for Adult Speech Therapy in Oxfordshire.
HOST: 0:01:15 Can we start at a very basic level and explain what thickened fluids are.
KATHLEEN: 0:01:24 Thickened fluids are one of a number of different interventions that can be used for people who have difficulties swallowing fluids. Thickened fluids are modification of any drinks that we might have, and this modification can be through the addition of a powder, which is usually bought over prescription. There’s also some new gels that are available, or modification [to it 0:01:53] in a more natural way, so some people might add pureed items to their drinks to make them thicker, specific foodstuffs that that make the drinks thicker.
Within speech and language therapy, so the use of thickeners, there are multiple reasons why people have used it in the past. The main one being that it travels more slowly than compared to normal or un-thickened fluids in the mouth. That gives the person a little bit more time to swallow it if their swallow’s a little bit delayed. And it also helps if people have some trouble with holding a drink within their mouth.
HOST: 0:02:34 Could each of you tell us a bit more about your practice, your use of thickened fluids, why this area is of interest to you, and how your thinking about the use of thickened fluids has evolved?
TRACY: 0:02:49 My journey with thickened fluids started really for me looking into the evidence about the benefits of thickened fluids about 15 years ago, as a way of supporting my recommendations. And the first revelation to me was that the literature did suggest that thickened fluids reduced aspiration penetration, but at the same time the thickened fluids did not improve those clinically meaningful endpoints that related to how my patients feel, function, and survive – like chest health, quality of life, hydration, and that, actually, thickened fluids could worsen these outcomes at times.
So, this isn’t to say that aspiration isn’t a problem, it can be lethal. But I realised that just the existence of aspiration of thickened fluids didn’t always lead to poor outcomes, like chest infections. And many of my patients were experiencing adverse effects, like dry mouth, UTIs, poor quality of life that I hadn’t attributed to thickened fluids.
I was gradually realising, though, that challenging and questioning myself and changing my mind and feeling more uncomfortable with that uncertainty and not knowing and accepting the potential for my recommendations to even make things worse, that was actually… those were clinical skills, and a normal part of real-life practice as practice changes.
So, the more I reflected on the evidence and worked with patients and their families and my colleagues, the more opportunity I had to see the true impact of thickened fluids on patients’ lives, and discover that there are other things that I could do that may not have potential adverse effects.
MYA: 0:04:26 The paediatric side of things can be a little bit different. So, we, as a team and as a team in the hospital but also wider teams with other speech and language therapists in paediatric dysphasia, along the year and had several discussions about thickened fluids and the use, benefits, and maybe adverse effects. This conversation comes up frequently about thickened fluids because it does tend to be the most commonly used in intervention, but more so in older children.
So, I’m a neonatal speech and language therapist now, and currently my patients are on the neonatal unit, so I wouldn’t use thickened fluids in that population.
What we found in our practice, and when we see patients when they leave the hospital and are maybe seen under the community teams and then maybe we see them again because they’re back in the hospital or they come [inaudible 0:05:28] clinic [inaudible 0:05:30] there was some anecdotal benefits that families might report. For example, they stopped having chest infections or there’s something about their health that is better.
But obviously, there were some times where it wasn’t successful in the way that, for example, they weren’t prepared in a… it wasn’t practical for the family to prepare them, so they stopped using them, or they didn’t show benefit so they were stopped.
But also in paediatrics, we might have less options in what intervention you might recommend, because they are children, so there might be some techniques that you can use with an adult, but you would only be able to use with a child who’s older and cognitively able to follow these specific instructions, or it might not be practical for the family. Again, it’s about comparing these different interventions, their benefits, and also the level of practicality they might have. There’s no point of recommending something that is practically impossible for a family to implement.
LIZZIE: 0:06:38 Around four years ago, I became interested in the changing evidence base and discussions that were happening around perhaps thickened fluids weren’t the panacea that we thought they were. I worked briefly in an acute trust in Bristol, and I was interested in how if you were placing a patient/inpatient on thickened fluids, there was an ask that you had to justify that with your rationale when you handed over the patient. And I thought that was interesting; it made me think about my practice personally.
Then I moved into a community team as a clinical lead in Oxfordshire. And there were a number of practices in that setting that I became a little bit concerned about, and a lot of that was about this over reliance of thickened fluids.
One of the things that we would do very frequently is even before an assessment, so someone had been referred because they were, say, coughing on [thin 0:07:27] fluids, we might recommend over the telephone that that patient was placed on thickened fluids whilst awaiting assessment.
Another thing that we had within our setting was that we had a policy in a community hospital where non speech and language therapists or non dysphagia trained practitioners were able to thicken fluids if a patient was coughing.
Another aspect that came to my attention was we had a number of incidents where we’d had some readmissions of people who were dehydrated in the community. A pattern seemed to be that they were people who were placed on thickener without an assessment. It became really clear that we were using perhaps this treatment that had a potential for harm. But were we really examining how we were using that treatment and how we were introducing it to patients as part of their management of eating and drinking?
Certainly, I was starting to feel a bit unsure about my own practice. So, the first thing that I did was to introduce that to the team and circulated some evidence, and we started talking about those aspects. A particular thing that we focused on was triaging of referrals and trying to understand the problem better. And that typically was coming out the fact that if people were coughing when they were drinking, we seemed to automatically think that putting them on thickened fluids was the best thing. And I think that’s really common, or has certainly been that we have made that lifelong pervasive decision to recommend thickened fluids and it’s hung on this incorrect equation that coughing means that aspiration is happening, and if aspiration is happening then a pneumonia will occur. And that correlation isn’t direct; we’re learning to understand that isn’t direct and that we need to unpick that a bit better.
HOST: 0:09:12 I think we’re beginning to see an answer to this question. But Kathleen, I thought it might be helpful to ask this directly: what prompted RCSLT to develop this position paper on thickened fluids?
KATHLEEN: 0:09:28 Round about 2019, we started to have increased enquiries from members at RCSLT asking what our position was on thickened fluids. They weren’t quite sure around the evidence base, that potentially their service would only use thickened fluids, that they didn’t use any other intervention in dysphagia, or that their service never used thickened fluids and they wanted to be able to use it in appropriate circumstances. So, they were really looking to us for guidance and support around the use of thickened fluids.
Obviously, the pandemic delayed things. But in the beginning of 2023, we prioritised this as an area that members really needed some input with. So, we started to look around at the other professional bodies to try and understand if they had a position on this within the mutual recognition agreement, so the mainly English-speaking countries. They hadn’t released a position on thickened fluids. Indeed, they were very interested to hear about the work we were doing and the results of it.
We quickly gathered that we need it to have a really mixed group of people together to try and decide what we need it to do to support our members. We’re a member-led organisation; it’s all about supporting our members.
So, we gathered together a working group and we wanted to have representation across all the different clinical areas, so head and neck cancer, learning disability, neonatal care, paediatric dysphagia, across all the different age ranges as well. And what we thought was really important was that we normally would only recruit one, at the most two, lead authors. But we really wanted to have a balanced view and input from the lead author, so we decided that we were going to have three to try and represent three different clinical specialisms.
And that’s why we decided we really wanted someone who worked with children, someone who worked with learning disability, and someone who worked in the adult acquired side of things, and we were lucky to get the three lead authors that we’ve got here today.
So, bringing that working group together then we were able to prioritise and come up with a plan of what we could do to help support members in their decision making.
It’s been quite an involved process. Every aspect where we would work with someone with swallowing difficulties, we’ve had someone in the working group who has represented that area. What we have also done as well is to have involvement with service user representative organisations. Places like the Stroke Association, the MNDA, professional networks – so the nurses critical care networks, and also the pharmaceutical companies.
Now, it might sound a little bit controversial to have included them in this, but what we really wanted to do was to inform them that we were doing this piece of work, but also give them the opportunity to highlight any areas within the work that we were doing that we potentially hadn’t considered. For example, there could be new research that they’re working on that wasn’t yet published that they wanted to make us aware of.
[Inaudible 0:12:58] all the groups that I’ve just mentioned, during different stages we consulted with them. But it was really key that we had a really balanced viewpoint on this and that we weren’t unduly influenced by any of those stakeholders. So, whenever we did consult with them, we would ask people: please, could you give us the evidence behind what you’re saying? And then we were able to judge whether that evidence was appropriate to include or not, or if we were missing things, or if actually it wasn’t appropriate to include in this. So, it meant that we got a much richer dialogue and discussion going through this whole process.
HOST: 0:13:46 Did anyone’s views evolve as you were working on this paper, or did you learn something new that was of interest?
LIZZIE: 0:13:54 What I was really interested about was the variability around the practice for using thickened fluids in dysphasia across different settings. And that really was quite significant and it struck me that, as Tracy’s alluded to, you have some services that don’t use thickened fluids at all, and you have many that use them quite significantly. So, that was something that struck me that we were tasked with a supportive document and guidance for a huge number of different clinical populations and practitioners. Yet, there were very much principles that came through that we felt were applicable to all of those areas.
HOST: 0:14:39 So, when it comes to the use of thickened fluids, it really does depend on the service that you’re accessing.
TRACY: 0:14:48 I think it’s not uncommon for us to see that in practices within our profession but in other professions allied to medicine and medicine itself that there is quite a lot of discrepancy across practitioners, across different clinical settings. It is less than ideal, but it actually just goes to show the amount of uncertainty that exists in biomedicine! And that there’s a lot of bias, but also a lot of viewpoints that influence clinical decision making. It’s not solely related on the evidence base – chiefly because the evidence base is often quite poor in a lot of areas.
KATHLEEN: 0:15:23 Yeah, I think one of the aspects that has come up during our discussions have been around when we’ve opened up dysphagia, and that it is multidisciplinary input for dysphagia. How do we communicate with those other people that are involved who might be, for example, prescribing thickener, or who might not understand the evidence base around it? How do we advocate for a better, more balanced understanding of the literature?
I think as well, something that Tracy spoke about earlier, around the understanding of how certain aspects of what we do become part of how we are seen and how we see ourselves. Many’s a time a speech and language therapist will be identifiable on the ward because they’ve entered carrying a tub of thickener. If you aren’t using it as much, or you’re using other things, how does that impact on how you view yourself? We’ve had people say to us, well, if we don’t use thickener, what else do we use? It’s going back to this is not everything that you are as a speech and language therapist working in dysphagia; this is one thing, and we need to be really clear on why you’re using it. But we can understand why some people might be reluctant to increase or decrease their usage of it because it’s so linked to their identity.
MYA: 0:16:58 It’s not uncommon to see differences in practice in different areas. And you said, yes, sometimes the service that someone receives might depend, unfortunately, on their postcode.
In terms of, again, paediatrics versus adult services there are things that Lizzie and Kathleen mentioned that other professionals might also recommend thickened fluids that are not speech and language therapists, for example. But in paediatrics, that’s not something that that does happen. It is something that is recommended only by speech and language therapists after assessment. And so, we would not be recommended, for example, on the phone if someone’s coughing, or as you wait for an assessment use thickened fluids. So, that’s not practice that is common at all in paediatric settings. That’s a little bit different.
But what does happen that has an impact from a resource point of view is that, because resources are so reduced in a lot of areas for speech and language therapists, there’s a new tendency to discharge patients whilst they are on thickened fluids. So, they’re seen in the community, they’re recommended thickened fluids and then discharged, because that’s the intervention that they were given and they should continue with it. That can have a huge impact, because you are recommending an intervention that can have adverse effects. There is no one who is monitoring those adverse effects or the use of the thickened fluids or how they’re being used, how practical is, what the impact is on the family. And then there is no clear plan on when to assess stopping using them.
That’s something that [inaudible 0:18:47] population is starting to have an impact on from a resource point of view.
HOST: 0:18:51 We have spoken about this, but I wonder if just, in a nutshell, can you remind us why this is so important?
TRACY: 0:19:01 I think it’s important because we know that, generally, this is a controversial treatment that we talk about a lot. And I think, genuinely, speech and language therapists do what most health professionals want to do – their goal is to improve patient lives, improve their quality of life, as well as their safety.
The difficulty with thickened fluids is that, unlike possibly other treatments, there is quite a lot of growing evidence that patients dislike this treatment. They find it quite difficult to adhere to. Community level recommendations in general, particularly, are difficult to follow.
I think we’re conflicted as a profession because we are trying to recommend something that helps a patient, but at the same time we have to understand that we’re recommending a treatment that isn’t realistic in a lot of people’s lives.
KATHLEEN: 0:19:59 I think one of the other reasons why this has been so important is the feedback that we’ve got from members, particularly around research priority setting. RCSLT did an exercise several years ago to look at what were the priorities in particular areas. Across the clinical areas and age ranges that dysphagia therapists were working with, there was so much that we didn’t know and didn’t understand around the use of thickened fluids. And trying to recognise that member uncertainty around it, but also try and work towards how we could improve the evidence base.
The RCSLT is working with the NIHR towards funded calls around the use of thickened fluids to try and improve that evidence base as well. So, I think it is really important that we’re not only reviewing the current evidence base, but that we can all – whether it be through case studies or any other means – we can contribute towards developing that evidence base, particularly in areas that are underrepresented, like paediatrics and adult learning disability, for example.
HOST: 0:21:19 The big question: what does the position paper say?
KATHLEEN: 0:21:25 I think the key point to take away from the position paper is that it should be person-centred. There is not an equation whereby X-patient presenting with Y = level such and such of thickener. It needs to be an informed discussion and decision making process with that individual to ascertain what the potential risks and potential benefits mean to them at an individual level. And how, for example, people who take thickened fluids because it reduces the distress that they feel associated with coughing, is that their priority? Have you had discussions around… it may not reduce aspiration or penetration events – it might do – but what is the priority for that individual at that time, and how can we, as communication and swallowing experts, work to inform and support our service users to make informed decisions about their care?
LIZZIE: 0:22:39 Yeah, and I think it’s around risk management as well and the conversations around how we view, how we quantify, and how we report risk. And I think particularly in the area of dysphasia to thin fluids, that has really turned on its head in the last few years, but still remains a key underpinning rationale of why people make decisions about thickened fluids. And that ties in to being patient-centred because we’re looking at somebody that’s more than a medical body. We’re thinking about drinking as a basic function of humans to bring pleasure, to bring bonding. It’s got lots of these really important non-physiological effects of it.
And I think that that focus on, as Kathleen mentioned, rather than focusing on safety, do we need to re-address that balance and think more about, for example, if someone’s coughing, is that causing distress? And is that distress something that the patient is feeling, or that the professional is observing and perceiving, perhaps incorrectly sometimes?
HOST: 0:23:47 So, could we say that the position paper has succeeded if, whatever your position on thickened fluids, you at least take a moment to stop and think, why am I doing this? Am I sure it’s necessary? Have I spoken to the patient? So, it’s not just a standard go-to treatment?
MYA: 0:24:05 Yes, absolutely. I think it would have achieved a lot if it just gets us to stop and think about why we are making this recommendation, and is it the right recommendation for this patient at this point in time, and do they understand what it entails and what it doesn’t?
HOST: 0:24:25 Tracy, if some people come to you and say, okay, if we’re not using thickened fluids, what should we do instead? What’s your response?
TRACY: 0:24:35 I’ll probably ‘answer/not answer’ this question! Because it’s a question that I often get when I’m perhaps doing presentations about thickened fluids. And I suppose one of the difficulties is that when a treatment is being investigated for being, say, superior over another treatment, the clinical decision is pretty straightforward. But a lot of treatments – and thickened fluids fits into this – lack sufficient evidence to justify an upfront recommendation without careful consideration.
So, it’s not a question of we have to replace it for something else, we need to find something better before we don’t use it. We have a whole host of tools in our toolbox that also have varying levels of evidence, sometimes poorer than thickened fluids, but where perhaps the profile of burdens isn’t as high as they are for thickened fluids.
Now, sometimes we may hear the argument – and I’ve used this argument before well – the absence of evidence is not evidence of absence. But this is a logical fallacy that that we’re arguing that our conclusion must be true because there’s no evidence against it. So, we’ve not got enough evidence of thickened fluids not working, so they must work. But that, unfortunately, doesn’t discharge us of the burden of proof! That’s not how the burden of proof works. So, the burden of proof for us rests with those of us who claim the intervention actually provides the benefits that we are saying, so it improves respiratory health, it improves hydration, it improves quality of life –clinically meaningful endpoints that matter to patients. If we’re not able to do that, for whatever reason, then it doesn’t mean that we need to scrap the treatment altogether. But it does mean that if we are choosing our treatment, particularly these treatments where there is an absence of convincing evidence of benefit, we have to be really careful. And we have to be guided by things like biological plausibility, which simply means can we confidently reason through existing knowledge that there is a very clear cause and effect relationship between thickened fluids and improved clinical benefit for patients? Can we measure the risk versus benefit profile? So, we need to consider the direct risk to the patient, i.e. adverse side effects. And can we evaluate the cost versus benefit profile? So, what is the investment for both that patient and the clinician to apply a therapy that’s not been proven to have a real clinical benefit to clinically meaningful endpoints?
So, it’s not about a right nor wrong answer, and that’s why it’s not as simple as saying, well, we need to replace it with something else before we don’t use it, or we need to use it all the time.
Again, it’s about looking, like Maya said, at the specific clinical situation, asking those questions that matter to that particular clinical scenario, and seeing if thickened fluids are part of that.
KATHLEEN: 0:27:36 Just to add, some people have approached us and said, why are you picking on thickened fluids? Why are you not looking at chin tuck or bolus size? And that was purely because this wasn’t what members highlighted to us as being an issue. So, if there was this level of member engagement or concern around other interventions then we would have looked at them. We specifically had to target this and work to support members within this one specific area.
HOST: 0:28:12 And because it can have these unpleasant side effects, then the burden of proof for this intervention is higher than others. So, there are people who say when I use thickened fluids, my patients seem to get better, or if I stop using thickened fluids my patients get sicker. What’s your response to that?
TRACY: 0:28:32 That is a common question that SLTs are concerned about, because of this perception that patients get better when they are on thickened fluids. But again, this comes back to us assessing how we know that a person is better. So, many people do get better on thickened fluids. Many health problems can improve. However, we don’t have the evidence to show that it’s actually the thickened fluids that make them better. A lot of cyclical illnesses – even serious conditions like cancer – appear to get better and worse on their own, even though they continue to spread and worsen over time. But often the worst symptoms are followed by a period of people starting to feel better no matter what’s done. And timing can have a really powerful effect. A patient is much more likely to sign up to something like thickened fluids when their symptoms are very bad. So, if they’re given thickened fluids when their symptoms start improving on their own, we’re very likely to believe that thickened fluids have a beneficial effect.
Similarly, if a person develops a chest infection after we remove thickened fluids, we’re much more likely to believe that that chest infection was caused by thin fluid aspiration. Whereas, there are many, many other conditions that can make people sick. But what else is happening here that might make somebody feel sick? So, being a detective, finding out whether or not they have a systemic spread of infection, whether or not they’ve had surgical procedures or medical procedures or medications. There are many, many conditions that increase a person’s risk of respiratory infection that may have nothing to do with thin fluid aspiration.
HOST: 0:30:06 I wonder if you have any final thoughts on the use of thickened fluids.
KATHLEEN: 0:30:11 I think, for me, it’s really that this is an overview across all the clinical areas and ages of thickened fluids and the management of dysphagia, and that you need to be aware of the evidence base in your specific clinical area as well. To interpret the information that that’s being provided in the paper within the context of what you know about your specific population, so whether that be within acute strokes, whether it be within progressive neurology, that this is not a replacement for understanding that evidence; this is an adjunct to it to help support decision making.
TRACY: 0:30:57 This position paper is not telling people what to do. Sometimes it’s quite tempting, particularly for me to want to just know a solution and be able to follow that and tick a box. But clinical practice is really grey and murky, and it’s never black and white, and it often depends on a lot of different scenarios. And this is one of the reasons why we intentionally not suggested to people that they should use thickened fluids or not use thickened fluids.
What is important is that we need to understand that the issue is very complex, that it relies on understanding a lot of issues that we may not understand very well from personal experience, thinking of how the lungs respond to aspiration, and knowledge about a person’s medical history, and knowledge about the circumstances around an aspiration event. Often, we don’t have time to sit down and think about this in such detail.
But when the consequences are that there is a potential for our interventions to cause harm, and the evidence has told us that there is a potential for this intervention to cause harm, I think it’s our duty as health professionals to evaluate this treatment.
MYA: 0:32:05 Generally in dysphagia, most of the evidence that we have out there is in adult populations, so we have even less evidence in paediatrics. But we are all used to, as clinicians, to extrapolating information from the evidence that we do have available and applying it the best we can to our populations. But also always using the resources that we have [inaudible 0:32:29] other medical professionals that might be able to discuss the these impacts that Tracy was mentioning on, for example, the complex relationship between aspiration and respiratory health.
TRACY: 0:32:39 It is okay for us to be uncertain about this. We don’t have to be certain about this treatment because the evidence is uncertain. But what is really an important message for us, not only we need to feel comfortable with that, but we also need our patients to feel comfortable with that. And this is why even more so patients need to be at the centre of decision making around this uncertain treatment, that they know about the uncertainty and they can make decisions based on that knowledge.
MYA: 0:33:07 As well, that the patients or families that we are working with and recommending, or maybe giving fluids as one of the options is that they have an idea of what the aim is, and then they can monitor the impact [inaudible 0:33:20] beneficial impact that we were hoping for. For example, whether it started because someone was coughing, and then [inaudible 0:33:28] evaluating that they stopped coughing. Was that the main reason? Is it because of [inaudible 0:33:33] having recurrent chest infections that those stopped? Is it because their lungs are showing some changes on CT scans and do we see an improvement?
So, if they’re aware of the reason and what to look out for in terms of is this making a difference or not and is this giving the having the benefit that we hoped for [inaudible 0:33:48] that would be really helpful in them making those decisions.
HOST: 0:33:53 Presumably making these decisions with the rest of the MDT who can help evaluate whether it’s, in fact, having the desired impact.
MYA: 0:34:01 As speech and language therapists we don’t have the skills to evaluate all of this on our own.
LIZZIE: 0:34:10 Obviously, as been mentioned, it’s a very complex… a grey area, and this piece of work has tried to bring together a lot of uncertainty into some meaningful guidance and direction and hopefully has also got across that there really can be a role for thickened fluids in the management of eating and drinking. Certainly, around aspects such as the social implications of coughing. Coughing can be extremely distressing for people. It can reduce people’s fluid intake. So, I think used using in the correct way, in a judicious way, in a thoroughly assessed way thickened fluids can certainly and will continue to have a role in the management of dysphagia.
But I think it’s also important to note that speech and language therapists are so much more than just recommending thickened fluids! We have a huge toolkit of things that we can do to improve patients’ lives.
HOST: 0:35:06 A very big thank you to the authors for joining us. In the show notes you can find various links – one to the position paper, as well as other resources, including material that you can use with patients and families when deciding whether to use thickened fluids or not.
If you do find this podcast useful, we ask that you share it with your colleagues. Give us a rating or get in touch about areas that you would like covered.
The work that the Royal College of Speech and Language Therapists does helps advocate for SLTs and their patients, as well as developing the professional practice through research and position papers, like the one we discussed today.
Until next time, keep well.
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