Advocating for FEES: How to Explain the Swallow Study and Earn Patient Buy-In

1. 1

   Present a strong rationale for FEES

   Help patients understand why this test will change their care — not just what it is.

2. 2

   Use comforting, non-threatening language

   Words shape the experience. Slide, glide, guide, gently, safe — these are the words to reach for.

3. 3

   Emphasize patient and caregiver autonomy

   Patients have every right to decline. Framing the test as a choice they make builds trust and improves participation.

Patients may have concerns like:

Patients most often decline because the test sounds frightening, they've had a bad experience with a prior procedure, or they don't understand why it matters. Your goal: replace uncertainty with trust by explaining clearly, calmly, and empathetically — and by telling them exactly what will happen.

Much of a patient's anxiety comes from not knowing what will happen. Walking them through the steps in plain language removes most of the fear. Here's what to expect during a FEES:

• You stay awake and seated the whole time — there's no sedation.
• A numbing spray or gel may be used in the nose for comfort.
• A very thin, flexible camera is gently guided through the nose to view your throat.
• You'll swallow saliva first, then eat and drink small amounts of regular food and liquids.
• The clinician watches your swallowing on a screen in real time.
• It usually takes about 15–30 minutes and uses no X-rays or radiation.
• You can pause or stop at any point.

Most patients feel only mild discomfort — a brief tickle or pressure in the nose. Some may have a momentary gag or watery eyes. Serious reactions are rare. Being honest that experiences vary, while reassuring that the procedure is generally well-tolerated, builds trust.

Some patients may experience genuine pain or significant discomfort during a FEES due to differences in anatomy and individual pain thresholds. Be honest — emphasize that everyone's experience varies, but the procedure is generally well-tolerated.

Adapt these phrases to each patient and family. They're starting points, not scripts.

• Explain the purpose: “This test helps us see how your swallowing muscles are working so we can make your eating safer and easier.”
• Emphasize collaboration: “We'll go through this together. I'll be there with you during the test.”
• Give control: “You have every right to decline, but I would like you to make an informed decision after learning about this test. If you are open to giving it a try, you can pause or discontinue at any time.”

When a patient still declines, respect the decision and document it. Often, simply feeling heard — and knowing they can change their mind — brings them back to it later.