Do’s and Don’ts in Mealtime Management for People with Oropharyngeal Dysphagia: A Modified Delphi Consensus Study from the Italian Society of Deglutology

Background: Meals are central to daily life, health, and social participation, yet their safety and enjoyment can be compromised in people with oropharyngeal dysphagia (OD). Despite the broad impact of OD on physical and psychosocial well-being and daily functioning, structured guidance for comprehensive mealtime management in clinical practice is lacking. To address this gap, a set of expert consensus-based “Do’s and Don’ts” covering four meal-related domains was developed. Methods: A modified Delphi consensus study promoted by the Italian Society of Deglutology involved a multidisciplinary panel of 53 experts in OD and related disciplines. Experts developed “Do” and “Don’t” statements across four domains: nutrition-focused diet prescription, meal preparation, mealtime experience, and patient and caregiver education. After panel conveners’ review, 61 statements underwent two rounds of online voting using a 3-point ordinal scale plus an additional option ‘unable to express an opinion’. Consensus was predefined as ≥75% agreement. Statements were revised between rounds based on participants’ comments to ensure clinical accuracy and practical applicability. Results: The response rate was 85% for Round 1 and 97.8% for Round 2. After Round 2, 57 of 61 statements (93.4%) reached the consensus threshold (≥75% agreement). Conclusions: Mealtime management in OD should be individualized and person-centered, balancing swallowing safety, nutritional requirements, quality of life, and enjoyment of eating. Management should extend beyond compensatory strategies alone to include the social and relational dimensions of meals. Active involvement and education of patients and caregivers are essential to support therapeutic adherence and daily implementation of recommendations. Interprofessional collaboration and multimodal educational strategies are crucial to ensuring a coordinated, safe, and effective nutritional approach to OD care.

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Journal
Nutrients
Published
2026-10-04
DOI
https://doi.org/10.3390/nu18193268
Primary Topic
Dysphagia Assessment and Management
Type
article
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article

Do’s and Don’ts in Mealtime Management for People with Oropharyngeal Dysphagia: A Modified Delphi Consensus Study from the Italian Society of Deglutology

Gaia Pellegrini, Aurora Ninfa, Emanuele Cereda, Irene Battel et al.
Nutrients
Dysphagia Assessment and Management
article

Do’s and Don’ts in Mealtime Management for People with Oropharyngeal Dysphagia: A Modified Delphi Consensus Study from the Italian Society of Deglutology

Gaia Pellegrini, Aurora Ninfa, Emanuele Cereda, Irene Battel, Francesco Mozzanica, Marco Ramaioli, Umberto E. S. Barillari, Carlo Pedrolli, Alessandra Bosetti, Antonella Cusimano, Nicole Pizzorni, Chiara Piscitelli, Maria Giulia Montecchi, Francesco D’Abrosca, Bruno Fattori, Cristina Reverberi, Jessica Barsotti, Sara Rocca, Arianna Valeria Bai, Alessandro Galazzi, Daniele Farneti, Antonio Schindler, Stefano Doratiotto, Massimo Spadola Bisetti, Stefano Usaï, Federica Lucia Galli, Michela Barichella, Beatrice Travalca Cupillo, Antonella Delle Fave, Maria Luisa Fiorella, Luca Parisi, Giovanni Ruoppolo, Maria Rosaria Barillari, Amelia Santoro, Patrizia Maruzzi, Elvira Verduci, Sergio Riso, Irene Vernero, Claudia Paola Bruna Dellavia, Lucia Zannini, Ramona Silvana De Amicis, Monica Bianchi, Silvia Gnecchi, Luca Morelli, Anna Colombo, Elisabetta Genovese, Paola Castellini, Antonio Amitrano, Isabella Koch, L Gervasio, Alessandro Selvagio, Valentina Lamon, Federica Cenci, Benito Michelizza, Chiara Stracquadanio
article en

Abstract

Background: Meals are central to daily life, health, and social participation, yet their safety and enjoyment can be compromised in people with oropharyngeal dysphagia (OD). Despite the broad impact of OD on physical and psychosocial well-being and daily functioning, structured guidance for comprehensive mealtime management in clinical practice is lacking. To address this gap, a set of expert consensus-based “Do’s and Don’ts” covering four meal-related domains was developed. Methods: A modified Delphi consensus study promoted by the Italian Society of Deglutology involved a multidisciplinary panel of 53 experts in OD and related disciplines. Experts developed “Do” and “Don’t” statements across four domains: nutrition-focused diet prescription, meal preparation, mealtime experience, and patient and caregiver education. After panel conveners’ review, 61 statements underwent two rounds of online voting using a 3-point ordinal scale plus an additional option ‘unable to express an opinion’. Consensus was predefined as ≥75% agreement. Statements were revised between rounds based on participants’ comments to ensure clinical accuracy and practical applicability. Results: The response rate was 85% for Round 1 and 97.8% for Round 2. After Round 2, 57 of 61 statements (93.4%) reached the consensus threshold (≥75% agreement). Conclusions: Mealtime management in OD should be individualized and person-centered, balancing swallowing safety, nutritional requirements, quality of life, and enjoyment of eating. Management should extend beyond compensatory strategies alone to include the social and relational dimensions of meals. Active involvement and education of patients and caregivers are essential to support therapeutic adherence and daily implementation of recommendations. Interprofessional collaboration and multimodal educational strategies are crucial to ensuring a coordinated, safe, and effective nutritional approach to OD care.

NutrientsVol. 18(19)
University of Pisa (IT), University of Modena and Reggio Emilia (IT), Marche Polytechnic University (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Molise (IT), University of Applied Sciences and Arts of Southern Switzerland (CH), University of Milan (IT), University of Campania "Luigi Vanvitelli" (IT), AgroParisTech (FR), Université Paris-Saclay (FR), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Luigi Sacco Hospital (IT), Ospedale Santa Chiara (IT), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IT), Istituto Ortopedico Gaetano Pini (IT), Azienda Ospedaliero Universitaria Maggiore della Carita (IT), Fondazione Stella Maris (IT), Ospedale Infermi di Rimini (IT), IRCCS Istituto Auxologico Italiano (IT), LUM Jean Monnet University (IT), Ospedale dei Bambini Vittore Buzzi (IT), Ca' Foncello Hospital (IT), Ospedale Policlinico San Martino (IT), Ospedale San Giuseppe (IT), Policlinico San Matteo Fondazione (IT), ASST Fatebenefratelli Sacco (IT), Paris-Saclay Food and Bioproduct Engineering Research Unit (FR), University of Turin (IT), University of Bari Aldo Moro (IT), Sapienza University of Rome (IT)
Openalex Percentile: Top 7%
Dysphagia Assessment and Management
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