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Developing a care bundle for children who are eating and drinking with acknowledged risk: A Delphi study with speech
Heideh Langeroudi1, Georgina Feint2, Christina H Smith1
1Division of Psychology and Language Sciences, University College London, London, UK.
Insights
Speech and language therapists (SLTs) need guidance for managing children eating and drinking with acknowledged risks (EDAR). This study established consensus on core components for a paediatric EDAR care bundle, focusing on documentation, capacity, safeguarding, and person-centred care.
Area of Science:
- Paediatric healthcare
- Speech and language therapy
- Clinical guideline development
Background:
- Limited research and formal guidance exist for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR).
- SLTs often lack confidence due to the medical, ethical, and emotional complexities of paediatric EDAR cases.
- Existing care bundles in adult populations show positive effects, suggesting potential benefits for paediatric EDAR management.
Purpose of the Study:
- To achieve consensus among expert paediatric SLTs on essential components for a care bundle.
- To guide the management of children with acknowledged risks during eating and drinking.
- To address the need for standardized and confident practice in paediatric EDAR.
Main Methods:
- A two-round online modified Delphi technique was employed.
- An expert panel of UK-based paediatric SLTs across various settings was recruited.
- 36 statements on care bundle components were rated, with consensus determined by predefined criteria.
Main Results:
- A high response rate (88.6%) was achieved, with 31 of 35 participants completing both rounds.
- Thirty out of 36 statements reached high or very high consensus.
- Key areas with very high consensus included documentation, capacity, safeguarding, and person-centred care.
Conclusions:
- There is strong agreement among SLTs regarding the core elements of a paediatric EDAR care bundle.
- This consensus provides a foundation for developing a practical care bundle.
- The findings support improved management and confidence for SLTs working with children who are EDAR.
Background:
There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management.
Aims:
To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR.
Methods & Procedures:
A two-round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7-point scale (strongly agree to strongly disagree), and one open-box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean).
Outcomes & Results:
A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person-centred care.
Conclusion & Implications:
There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR.
What This Paper Adds:
What is already known on the subject There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person-centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work? This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR.
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