Abstract
Background: Dysphagia management is critical to reducing morbidity and enhancing patient quality of life. However, healthcare professionals (HCPs) face numerous barriers in service delivery and patient care integration.
Approach: Initiating a systematic review on dysphagia management and service delivery is essential because dysphagia, or difficulty swallowing, is a significant yet often overlooked health issue affecting people across age groups and medical conditions. This systematic review was initiated in order to improve patient outcomes, address workforce challenges, promote evidence-informed practices, enhance integrated care, align with global health goals, support the emotional well-being of HCPs and enhance integrated care.
We systematically reviewed qualitative, quantitative and mixed-method studies across multiple databases to identify themes influencing dysphagia service delivery. 67 papers were identified spanning 18 countries across the globe. The population included HCPs working with people with dysphagia, where they self-reported attitudes, barriers to and enablers to dysphagia management. The JBI Convergent-Integrated approach was used for synthesis and integration, where quantitative data is ‘qualitized’ (narrative interpretation) for integration. Thematic analysis was used to synthesise qualitative research and identify themes across multiple studies.
Population and findings were mapped against the nine pillars of integrated care: people-centred services, population health, comprehensive services, integrated care models, continuous improvement, evidence-informed practices, workforce sustainability, system partnerships, and health information sharing, highlighting strategies to promote a people-centred, integrated approach that aligns with the UN’s Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 17 (Global Partnership for Sustainable Development).
Results: The analysis revealed four critical themes underpinning dysphagia management:
1.Workforce Engagement and Education: Sustainable, proficient workforce training is essential. However, inconsistent training programmes and lack of professional development were barriers that limited dysphagia care, directly impacting SDG 3 by hindering the delivery of quality health services.
2.Evidence-Informed Organisational Processes: Accountability and evidence-based practices were facilitated by organisational support but often hampered by limited resource allocation and lack of standardised protocols, underscoring the need for strengthened accountability systems and transparent processes.
3.Emotional and Psychological Impact: Emotional strain on healthcare providers emerged as a barrier, affecting their engagement and quality of service delivery. Addressing this through emotional support systems and mental health resources aligns with SDG 3 by ensuring healthcare workers' well-being and capacity for patient-centred care.
4.Collaborative and Coordinated Care Approaches: Effective dysphagia management requires interprofessional collaboration and coordinated care strategies, particularly for complex cases. However, findings showed fragmentation in interdisciplinary teamwork. SDG 17 emphasises the importance of partnerships, which could serve as a framework for building stronger collaborative efforts.
Implications: This systematic review on dysphagia management emphasizes integrated, patient-centered care by addressing workforce education, accountability, emotional support, and collaboration. It advocates for solutions fostering workforce engagement, accountable service delivery, and interprofessional cooperation, aligning with SDGs and integrated care principles. Prioritizing these will improve dysphagia outcomes, enhancing patient care and supporting global health goals.