The purpose of this study was to explore the nature of reduced patient awareness of oropharyngeal dysphagia. While patient awareness of dysphagia has been explored in individuals before participating in formal swallowing assessments, no studies have been identified in the literature that have explored awareness after patients have participated in an examination and received information about their dysphagia. In addition, the relationship between patient compliance and reduced awareness, as well as the application of stages of change in this population were explored.
Twenty-one inpatients and outpatients, newly diagnosed with oropharyngeal dysphagia, participated in this study. A retrospective analysis found that 40% of participants demonstrated reduced awareness of their dysphagia before participating in a videofluoroscopic swallowing examination. Reduced pre-examination awareness of dysphagia occurred most frequently in those with general medical diagnoses versus neurological or structural diagnoses. Reduced pre-examination awareness was not significantly associated with a reduced cough response following aspiration.
Exploration of post-examination patient awareness of dysphagia, the primary intent of this study, revealed that 19% of patients demonstrated reduced awareness of their dysphagia, even after receiving specific verbal and visual information regarding their diagnosis. Reduced post-examination awareness of dysphagia occurred equally in those with structural and neurological diagnoses and was not noted in those with general medical diagnoses. Reduced post-examination awareness was not significantly associated with a reduced cough response following aspiration. Consistent with the literature on reduced patient awareness of deficit, patient awareness of dysphagia was modality specific. That is, some patients with reduced awareness of dysphagia demonstrated awareness of other deficits and vice versa. Overall, participants demonstrated more awareness of concomitant speech impairments than dysphagia and less awareness of concomitant cognitive impairments than dysphagia. No significant relationship between general cognitive impairment and reduced patient awareness of dysphagia was found.
Exploration of diet compliance in inpatient participants revealed no instances of noncompliance, while hospitalized, from the day of the swallowing examination until the day of participation in the study. However, only 67% of these patients requested permissible foods or drinks when compliance was sampled during the study protocol, suggesting that inpatients with newly diagnosed dysphagia may be less compliant if restricted items become accessible. No significant relationship between patient awareness of dysphagia and diet compliance, as sampled during the study protocol, was found in both inpatients and outpatients. The relationships between patient awareness of dysphagia and patient compliance for both swallowing strategies and exercise regimens were also not significant, though these analyses were limited by the small number of participants who had been prescribed strategies and independent exercise programs at the time of their study participation. Lastly, analysis of the relationship between patient compliance and action or post-action stages of change, revealed no significant association between these variables.