Table 2 Summary of recommended approach to informed consent for modified texture diets (MTDs)

General approach

As with other healthcare interventions, use of MTDs requires informed consent

The person’s values and preferences should be elicited and reflected in all discussions

Staff who provide information and seek consent must have sufficient knowledge themselves of the information that needs to be conveyed and the requirements for informed consent

Information provision

The information provided must be accurate and balanced, and this requires consideration of the quality of evidence that MTDs will be successful in achieving clinically meaningful endpoints that are important to a patient, and of the uncertainty regarding benefit

It is not acceptable to focus on the potential benefits and downplay the potential harms from MTDs

An adverse effect on quality of life and enjoyment of eating and drinking is as important an issue for discussion with patients as any physical effects of MTDs

Patients cannot make appropriate decisions for themselves if the information that they are given by professionals is flawed and unbalanced

Voluntariness of decisions regarding modified texture diets

For consent to be valid it must be given freely and voluntarily

People must be supported to understand that they are the decision makers and can make their own choices, including the choice to refuse to consent to MTDs

The voluntariness of patients’ decisions is questionable if they are told ‘you must’ when ‘you might consider’ is more appropriate

Having capacity to make decisions regarding modified texture diets

The burden of proving a lack of capacity to take a specific decision always lies upon the professional who is challenging capacity

Unless based on accurate and balanced information, inappropriate judgements and recommendations may be made by substitute decision makers

Improvements needed

Research is required to examine in greater detail current informed consent processes in different settings

There is a need for staff to reflect on their current practice regarding use of MTDs with an awareness of the currently available evidence and through the ‘lens’ of informed consent

A significant change in practice is needed in those residential care settings where there is insufficient access to SLTs and where staff may recommend or even impose MTDs without an adequate understanding of the issues involved

Professional bodies and guidelines regarding management of dysphagia should be clear about the need for informed consent before use of MTDs is advised