Palliative care is defined as the support provided by a healthcare team to enhance the quality of life for individuals, their families, and significant others facing challenges from life-threatening health conditions. The focus is on maximising comfort, reducing stress, alleviating symptoms, and improving overall quality of life, while still allowing for ongoing treatment. These goals aid both patients and caregivers, facilitating better outcomes through appropriate interventions, regardless of the medical diagnosis. Early referrals from the medical team enable thorough evaluations and recommendations for managing symptoms and complications—be they physical, psychosocial, or spiritual—beginning at the time of diagnosis and continuing through to the end of life, including during the grieving process (Spanish Ministry of Health, Social Policy, and Equality, 2014; National Institute for Clinical Excellence (NICE), 2004; World Health Organization (WHO), 2020).

Speech Language Pathologists (SLPs) are rehabilitation professionals certified to assess, diagnose, and treat individuals with disorders related to speech, language, cognition, social communication, and swallowing, in both paediatric and adult populations. In adults, these disorders can arise from traumatic brain injuries, strokes, neurological diseases, degenerative conditions, or cancer. The demand for SLPs is growing among patients experiencing severe communication and swallowing difficulties in palliative and end-of-life care (ASHA, 2018). SLPs play a vital role in the multidisciplinary palliative care team, assisting in the development of treatment plans and contributing to decision-making regarding modes of communication, oral feeding versus alternative nutrition and hydration, and tracheostomy placement.

Patients in palliative care often face significant speech, language, and swallowing challenges that overlap with their underlying medical conditions, necessitating the involvement of SLPs. Ineffective communication can hinder the expression of feelings, thoughts, needs, and wishes, leading to frustration for both patients and caregivers. SLPs are integrated into palliative care to prevent these issues and work collaboratively with other healthcare professionals, fulfilling several key roles outlined below:

Appropriate referrals

SLPs receive referrals from other medical professionals addressing concerns about patients in palliative care who exhibit difficulties with swallowing and communication.

Evaluation

SLPs evaluate patients’ swallowing, communication, and cognitive skills through detailed case histories and comprehensive standardized language tests. This ongoing assessment monitors patient changes pre- and post-intervention throughout the palliative continuum. Evaluations include oral motor and sensory function, as well as the structures of the mouth, pharynx, and larynx. Additional observations focus on breathing patterns, gag reflex, alertness, mental vigilance, orientation, comprehension (both auditory and written), and fatigue levels. SLPs review medical records to assess the severity of swallowing issues and nutritional status, which informs recommendations for further instrumental evaluations, such as videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluations of swallowing (FEES). They also differentiate between nonorganic functional disorders and organic conditions.

Intervention

SLPs provide evidence-based speech or language therapy tailored to the diagnosis, environmental demands, and individual challenges. The primary goals of intervention address both patient needs and caregiver suggestions, ultimately enhancing the quality of life for individuals in palliative care.

Advisory and consultancy: SLPs offer advice and guidance to patients and their families, helping them adapt to communication and swallowing strategies related to their medical conditions. They educate the interdisciplinary team on individualised treatment plans and assist patients in acquiring adaptive equipment. Services may include improving cognitive functions or providing education and counselling to family members about the nature of the disorder and expected recovery.

Since 2023, I have actively participated as a Speech Language Pathologist at AWH Special College, collaborating with IQRAA Palliative Care. In the past year, I have worked with over 20 patients suffering from severe neurological conditions, resulting in significant communication and swallowing impairments. Most referrals have been due to strokes, with a small percentage stemming from traumatic brain injuries, Alzheimer's disease, and rare degenerative conditions such as Duchenne muscular dystrophy. We visit patients every Wednesday, working as a multidisciplinary team alongside nurses, physiotherapists, and medical practitioners to improve patient outcomes.

During therapy sessions lasting 45 minutes to an hour, we conduct detailed assessments, and I provide referrals to AWH Special College with the help of dedicated volunteers. We discuss each patient’s needs, progress, and treatment plans with the medical team, ensuring appropriate referrals as needed. Our evidence-based approach aims to enhance communication skills, cognitive functions, and feeding and swallowing abilities. Caregivers are empowered to effectively communicate with patients and address their daily activities. With the support of family members and the multidisciplinary team, we have observed improvements in patients' communication skills and their ability to swallow preferred foods comfortably, boosting their confidence in participating in social activities.

As we look to the future, our goal is to continue touching lives and making progress while empowering emerging SLPs in their vital roles within palliative care services.

The author is Assistant Professor at AWH Special College in Kallai, Kozhikode