About
An informed consent tool for dysphagia care.
A digital companion to the Informed Consent Process Checklist from the Dysphagia Outreach Project. The form covers capacity, disclosure, understanding, and signatures in the order an SLP would work through them at the bedside.
Purpose
Patients with dysphagia are often presented with texture-modified diets as a directive rather than a choice, and are rarely consented for the associated risks and quality-of- life impact. This tool helps SLPs disclose options plainly and document the conversation.
It is not a substitute for clinical judgement, facility policy, or legal advice.
Key principles
Patient autonomy
The decision belongs to the patient or their legal representative. Practitioners present information without bias and respect the right to choose — and to change their mind.
Informed decision
All risks, benefits, and alternatives are communicated in plain language the patient can understand, with room for questions and clarifications.
Voluntary consent
The patient must not be coerced or pressured. They have the right to decline, to ask for time, and to change their mind at any future point.
Capacity first
Decision-making capacity is assessed before the consent process can proceed. When capacity is absent, the chain of surrogate decision-makers applies.
Documentation
Thorough documentation protects the patient and the clinical team, and ensures continuity of care across disciplines and shifts.
Source
Built on the DOP Informed Consent Checklist
The Dysphagia Outreach Project is an SLP-led education initiative on evidence-based dysphagia care. Their Informed Consent Process Checklist organizes the workflow into preparation, meeting, and documentation — the same structure this form follows.
Important disclaimer
This tool is a clinical aid and does not constitute legal advice. The completed form must comply with your state’s laws, your facility’s policies, and the standard of care in your jurisdiction. Practitioners are responsible for confirming that their consent process meets all applicable requirements. No guarantees are made about the results of any treatment outcome.
Further reading
- American Speech-Language-Hearing Association (2023). Code of Ethics. asha.org/policy.
- Horner, J., Modayil, M., Chapman, L. R., & Dinh, A. (2016). Consent, refusal, and waivers in patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical practice. American Journal of Speech-Language Pathology, 25(4), 453–469.
- Leslie, P., & Lisiecka, D. (2020). Ethical issues in dysphagia management. Seminars in Speech and Language, 41(3), 257–265.
- O'Keeffe, S. T., Leslie, P., Lazenby-Paterson, T., McCurtin, A., Collins, L., Murray, A., Smith, A., & Mulkerrin, S. (2023). Informed or misinformed consent and use of modified texture diets in dysphagia. BMC Medical Ethics, 24(1).
- Parth Shah, A., Thornton, I., Turrin, D., & Hipskind, J. E. (2023). Informed consent. StatPearls [Internet]. StatPearls Publishing.
- Barstow, C., Shahan, B., & Roberts, M. (2018). Evaluating medical decision-making capacity in practice. Am Fam Physician, 98(1), 40–46.
Start a consent form
Capacity, disclosure, understanding, signatures, and post-meeting documentation.