Oesophageal screening in videofluoroscopic swallow studies: Perspectives from the multidisciplinary dysphagia team to refine the clinical pathway

Background

Videofluoroscopic swallow studies (VFSS) are multidisciplinary swallowing assessments led by speech-language therapists (SLTs). The purpose of oesophageal screening in VFSS is to guide further diagnostic assessment and treatment of possible oesophageal abnormalities. Yet, internationally standard protocols and clinical pathways for oesophageal screening in VFSS have not been established.

Aim(s)

The aim of this study was to refine and optimise oesophageal screening in VFSS at one Australian metropolitan hospital by incorporating expertise of the multidisciplinary dysphagia team.

Methods and Procedures

Focus groups/semi-structured interviews were conducted with SLTs, radiologists (RADs), gastroenterologists (GEs), referring medical officers (MEDs) and medical radiation technicians (MRTs, also known as radiographers) working in VFSS. Interview questions explored oesophageal screening approaches, interpretation and reporting practices, GE referral criteria and clinical recommendations. Data were analysed via qualitative content analysis to determine meaning units, sub-categories, and categories.

Outcomes and Results

Twenty-six health professionals were interviewed (n = 8 SLTs, n = 6 RADs, n = 5 MEDs, n = 4 MRTs, n = 3 GEs). Four categories were identified: (1) oesophageal screening in VFSS adds clinical information but has limitations; (2) specific knowledge, skills and organisational factors are needed to optimise oesophageal screening, including in procedure, interpretation, reporting, GE referral pathway and intervention selection; (3) multidisciplinary consensus is needed regarding normal versus abnormal oesophageal transit and GE referral criteria; and (4) patient context, preferences and reported symptoms should primarily guide dysphagia decision-making. Each category had several component subcategories. The local clinical pathway (also known as care pathway or care map) for oesophageal screening in VFSS was refined by incorporating multidisciplinary dysphagia team expertise.

Conclusions and Implications

There was a willingness from the multidisciplinary dysphagia team to refine the local clinical pathway for oesophageal screening in VFSS. Detailed clinical pathways that guide workflow and decision-making should be considered when introducing oesophageal screening into VFSS protocols.

WHAT THIS PAPER ADDS

What is already known on the subject

• Despite the recognised benefits of including oesophageal screening in VFSS, there has been limited uptake of oesophageal screening protocols internationally. Implementation research is needed that supports clinicians to embed oesophageal screening into routine VFSS practice.

What this study adds

• This is the first published study that explores in-depth the perspectives of the multidisciplinary dysphagia team regarding oesophageal screening in VFSS.

What are the clinical implications of this work?

• This study proposes a clinical pathway refined by the multidisciplinary dysphagia team to support clinicians in embedding oesophageal screening and its findings into routine dysphagia practice.