EPISODE · May 7, 2026 · 34 MIN
Risk Feeding, Informed Consent & Prandial Aspiration with Dr Shaun O'Keeffe
from Dysphagia Research Bites · host Dysphagia Bites
The guidelines say to manage risk. But what if the guidelines are the problem? In this episode of Dysphagia Research Bites, Dr Shaun O'Keeffe and I unpack his critique of the Royal College of Physicians' guidance on eating and drinking difficulties, and we ask the question that too few clinicians are asking: is our fear of aspiration actually driving good practice, or just driving restriction?In this episode we cover:The difference between aspiration and aspiration pneumonia, and why conflating them causes harmWhy dietary modifications and thickened fluids are not evidence-based strategies for preventing pneumoniaThe BOLUS Framework and why Shaun takes issue with how it frames riskWhy "unsafe swallow" is a term that needs to goThe evidence, or lack of it, behind nil by mouth orders for dysphagic patientsInformed consent, patient choice, and why quality of life has to be part of the conversationWhy the profession is at a crossroads between risk-averse practice and evidence-based careThe article this episode is based on:O'Keeffe, Shaun & Murray, Aoife & Leslie, Paula & Collins, Lindsey & Lazenby-Paterson, Tracy & Mccurtin, Arlene & Mulkerrin, Siofra & Smith, Alison. (2021). Aspiration, risk and risk feeding: A critique of the royal college of physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing. 1-10. 10.3233/ACS-210031. For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com
What this episode covers
The guidelines say to manage risk. But what if the guidelines are the problem? In this episode of Dysphagia Research Bites, Dr Shaun O'Keeffe and I unpack his critique of the Royal College of Physicians' guidance on eating and drinking difficulties, and we ask the question that too few clinicians are asking: is our fear of aspiration actually driving good practice, or just driving restriction?In this episode we cover:The difference between aspiration and aspiration pneumonia, and why conflating them causes harmWhy dietary modifications and thickened fluids are not evidence-based strategies for preventing pneumoniaThe BOLUS Framework and why Shaun takes issue with how it frames riskWhy "unsafe swallow" is a term that needs to goThe evidence, or lack of it, behind nil by mouth orders for dysphagic patientsInformed consent, patient choice, and why quality of life has to be part of the conversationWhy the profession is at a crossroads between risk-averse practice and evidence-based careThe article this episode is based on:O'Keeffe, Shaun & Murray, Aoife & Leslie, Paula & Collins, Lindsey & Lazenby-Paterson, Tracy & Mccurtin, Arlene & Mulkerrin, Siofra & Smith, Alison. (2021). Aspiration, risk and risk feeding: A critique of the royal college of physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing. 1-10. 10.3233/ACS-210031. For clinical resources and evidence-based dysphagia education beyond the podcast, head to: www.dysphagiabites.com
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Risk Feeding, Informed Consent & Prandial Aspiration with Dr Shaun O'Keeffe
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