EDAR Approaches to Supporting Decision-Making in People with Dementia and Dysphagia: A Scoping Review

Le résumé fourni par la source

Rationale: Decision-making in individuals who have dementia and dysphagia (swallowing difficulties) is complex and ethically fraught often because quality of life overrides medical intervention and the client, in the advanced stages of the disease, loses the capacity to make decisions about their care. Since the inception of an Eating and Drinking with Acknowledged Risks (EDAR) protocol over a decade ago, various frameworks have been developed to support decision-making in this context. The aim of this review is to explore EDAR approaches to establish the components to support decision-making for clients presenting with dementia and dysphagia whilst understanding the enablers and tensions within this process. Method: A scoping review was conducted with a search strategy applied via EBSCO Host to the MEDLINE, CINAHL, SCOPUS, and Academic Search Premier (ASP) databases. The search data was presented using a PRISMA flowchart with 34 publications selected for inclusion in the scoping review, comprising 25 studies from the bibliometric databases, and nine pieces of grey literature from a Google Scholar search. Results: All included papers were critically reviewed to identify three themes: decision-aids, capacity/choice and communication processes. These broad themes were interrogated using subthemes. Conclusions: What this scoping review lays out is a discussion on the core components, from evolving EDAR approaches, that support decision-making in clients with dementia and dysphagia. Organisational agreement on frameworks, policies and terminology forms the foundation for an effective pathway. Collaboration and MDT problem-solving, focussing on the clients personal, social, cultural preferences are integral whilst documentation and handover are essential to optimising care. Despite the barriers around terminology, gaps in documentation during transfers of care and the contention around EDAR policies, what this review makes explicit is having a multidisciplinary framework in place to improve decision-making for individuals with dementia and dysphagia, has been found to be beneficial.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.