Swallowing problems are reported to be a common finding in patients who receive palliative care. In existing literature, the incidence of swallowing problems is mostly described in small numbers of patients at the start of the palliative phase. As we hypothesized that the incidence of dysphagia might increase as the palliative phase progresses, this study describes the incidence of swallowing problems and related problems in 164 unsedated patients at the end of the palliative phase, defined by the last 72 h before their death. To determine the incidence of swallowing problems and related problems, questionnaires were completed bereaved by relatives and nursing staff. Our data shows that in the palliative phase the incidence of swallowing problems can be as high as 79 %. A significant correlation was found between swallowing problems and reduced psycho-social quality of life as assessed by nursing staff (ρ = −.284). Overall the nursing staff rated the incidence and severity of swallowing problems (and related problems like frequent coughing, loss of appetite, and problems with oral secretions) lower than the relatives. This study suggests that incidence of swallowing problems at the end of the palliative phase is high and that these difficulties may not only result in discomfort for patients, but also can raise concern for caregivers. More information and education on management of swallowing problems in palliative settings might be needed for both relatives and nursing staff. However, the data also suggest that any intervention should be proportional to the level of distress caused by the intervention.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Aday LA. Designing and conducting health surveys. San Francisco: Jossey-Bass Publishers; 1996.
Chui YY, Kuan HY, Fu IC, Liu RK, Sham MK, Lau KS. Factors associated with lower quality of life among patients receiving palliative care. J Adv Nurs. 2009;65(9):1860–71.
Ferris FD. Last hours of living. Clin Geriatr Med. 2004;20(4):641–67.
Gourdji I, McVey L, Purden M. A quality end of life from a palliative care patient’s perspective. J Palliat Care. 2009;25(1):40–50.
Jocham HR, Dassen T, Widdershoven G, Halfens RJ. Quality-of-life assessment in a palliative care setting in Germany: an outcome evaluation. Int J Palliat Nurs. 2009;15(7):338–45.
Langmore SE, Grillone G, Elackattu A, Walsh M. Disorders of swallowing: palliative care. Otolaryngol Clin North Am. 2009;42(1):87–105.
Pollens R. Role of the speech-language pathologist in palliative hospice care. J Palliat Med. 2004;7(5):694–702.
Raijmakers NJ, Clark JB, van Zuylen L, Allan SG, van der Heide A. Bereaved relatives’ perspectives of the patient’s oral intake towards the end of life: a qualitative study. Palliat Med. 2013;27(7):665–72.
Ripamonti CI, Farina G, Garassino MC. Predictive models in palliative care. Cancer. 2009;115(13 Suppl):3128–34.
Roe JW, Leslie P, Drinnan MJ. Oropharyngeal dysphagia: the experience of patients with non-head and neck cancers receiving specialist palliative care. Palliat Med. 2007;21:567–74.
Stringer S. Managing dysphagia in palliative care. Prof Nurse. 1999;14(7):489–92.
Tada T, Hashimoto F, Matsushita Y, Terashima Y, Tanioka T, Nagamine I, et al. Investigation of QOL of hospice patients by using EORTC-QLQ-C30 questionnaire. J Med Investig. 2004;51(1–2):125–31.
Veerbeek L (2008) Care and quality of life in the dying phase. The contribution of the Liverpool Care Pathway for the Dying Patient. Thesis. Rotterdam: Erasmus University/University Medical Center Rotterdam.
Voogt E, van Leeuwen AF, Visser AP, van der Heide A, van der Maas PJ. Information needs of patients with incurable cancer. Support Care Cancer. 2005;13(11):943–8.
WHO. Palliative care: the solid facts. Copenhagen: World Health Organization; 2004.
WHO. Better palliative care for older people. Copenhagen: World Health Organization; 2004.
Yamagishi A, Morita T, Miyashita M, Sato K, Tsuneto S, Shima Y. The care strategy for families of terminally ill cancer patients who become unable to take nourishment orally: recommendations from a nationwide survey of bereaved family members’ experiences. J Pain Symptom Manag. 2010;40(5):671–83.
Conflict of interest
The authors have no conflicts of interest to declare.
About this article
Cite this article
Bogaardt, H., Veerbeek, L., Kelly, K. et al. Swallowing Problems at the End of the Palliative Phase: Incidence and Severity in 164 Unsedated Patients. Dysphagia 30, 145–151 (2015). https://doi.org/10.1007/s00455-014-9590-1
- Deglutition disorders
- Palliative care