Decision-making case study – Oliver – Transcript
Now, Oliver, given what your support workers told me about your coughing and occasional choking episodes, and with the swallowing assessment that we did with you, we're going to have to move you to softer foods like purees and thicker drinks, and that should help with the coughing, choking from now on.
There are some alternative ways to eating which could help, but I think that they would be too hard for Oliver to cope with.
So I think it would be best for Oliver to move to textured, modified foods.
So that means that from now on, all foods need to be pureed and all drinks or liquids need to be thickened.
Let me take you through a list of what's acceptable and what's not in terms of food and drinks.
Yeah, Oliver, you got to give it a try.
At least try it.
I want Tacos.
I want Tacos.
I don't understand why, when he ate or drink anything, he doesn't seem to understand why it's necessary.
I mean, he's losing weight.
He's quite dehydrated, and I don't know what to do.
All right.
Does he have a formal decision maker?
No.
Oliver makes his own decisions.
He does.
Yeah.
Well, often he discusses major health issues with his family, but he knows what's going on.
As long as it's explained to him, he can make up his own mind.
In that case, I think it would be best that Oliver came in for another consultation.
I mean, it's clear he's not on board with the current approach.
Does Oliver have a preferred method of communication that might help the situation?
Oh, for sure.
Yeah, he uses picture cards and communication app.
I can e-mail you the details if you like.
That'd be great.
Thanks.
Oliver.
Would like to ask a couple of questions now.
OK, so I still suggest having purees and thickened drinks because that will really help reduce the risk of you choking, but you would like to try some other ways, is that correct?
Yes.
OK, here are some things that you can also try.
You can sit on some padding to help your posture when you're eating and drinking and then here just make sure that you don't eat and drink at the same time and then using these this special spoon and special cup.
How does that all sound?
Yes, I understand, but you do understand there is still a greater risk of you choking if we don't use texture modified food and drinks, Yes.
OK, sure.
It looks like you understand the risks.
Yes.
And will you be discussing this decision with your family?
I'll tell them what I decided.
OK, Sure.
Well, I would still like to check in on you from time to time, just to see how you're going with eating and swallowing.
Is that OK?
Yes.
Any other questions?
No.
Thank you.
You're welcome.
Yes, he understands the risks.
He did discuss them with his family and they are supportive of his decision.
That's great.
Let's book in a follow up appointment so we can monitor how those new strategies are working.
I tried them, it's my decision.
This case study video is one of two films (4-8 mins long) that aim to help students to better understand how they can work with people with intellectual disability and their supporters. The films focus on communication, and decision-making and consent when working with people with intellectual disability. The case study films were developed as part of a suite of education resources designed to support the Intellectual Disability Health Capability Framework. This case study film focuses on supported decision-making.
The script for this case study film was co-designed and stars an actor with intellectual disability. The film starts by showing a poor interaction between a person with intellectual disability and a health professional. The film then goes on to show ways that health professionals can support appropriate decision-making and consent with people with intellectual disability.
Please also see the other case study film, Intellectual Disability Health Capability Framework – Communication: Luca. The full list of resources is available at: Intellectual Disability Health Capability Framework and associated resources.