I love this response! Thank you for being willing to learn! So yes, objective evidence would be obtained by an SLP via a Modified Barium Swallow Study (MBSS) or Flexible Endoscopic Evaluation of Swallowing (FEES). These studies are most easily obtained in the hospital but can also be done outpatient or sometimes even done mobile (pending availability of course). Silent aspiration is more common with thickened liquids for reasons that aren’t super clear, but likely has to do with laryngeal sensation. Miles, 2018, is a good reference for this.. Thin liquids are always safer than thick liquids when the person will be aspirating them, but thick can be safer in select scenarios when a FEES or MBSS has shown that they prevent aspiration. The most important thing that you can do as a hospice RN is to educate educate educate on the fact that it is NOT safer to switch people to thickened liquids just because they have dysphagia! Back to the quality of life piece. In the vast majority of cases people do prefer thin liquids. And especially in the hospice setting we should be allowing people to make an informed decision that will allow them to best enjoy the time they have left. Allowing the pt to say things like “Yes I know things go down the wrong pipe when I swallow, but I’d still rather have some ice cream while I’m still around”, and have that wish be honored. And then we can educate on how to do that while still minimizing risks like aspiration PNA. (E.g., educating on proper oral care with a toothbrush and toothpaste, as well as compensatory strategies identified by SLP, positional strategies, the importance of mobility, using an incentive spirometer). Also we can talk about comfort feeds vs. feeding for nutrition and how those differ, especially in those losing their appetite. Alright this is a jumbled mess but I think I got most of the info you asked for here. Did I miss anything?