# Dissemination and implementation of DIGEST™ as an evidence-based measurement tool for dysphagia in cancer

> **NIH NIH R01** · UNIVERSITY OF TX MD ANDERSON CAN CTR · 2024 · $611,768

## Abstract

ABSTRACT
Dysphagia (difficulty swallowing) is a highly prevalent and impactful condition with significant burden on the
healthcare system. Across the lifespan, dysphagia is associated with excess risk of mortality, increased length
of stay, aspiration pneumonia, and malnutrition thereby elevating medical costs and resource utilization. Not only
a health problem, dysphagia also adversely affects quality of life and daily function with disproportionate impact
on cancer survivors. Adoption of evidence-based methods into clinical practice lags decades behind discovery.
One such gap is adoption of evidence-based practices (EBP) by speech-language pathologists in dysphagia
management. Evidence-based dysphagia care begins with evidence-based swallowing evaluation. Significant
progress has been made in the field of dysphagia to develop evidence-based evaluation methods, with particular
emphasis on physiologic characterization of swallowing. The relative safety and efficiency of swallowing, that is
how well a food or liquid bolus is kept out of the airway and clears fully through the pharynx into the esophagus,
is a fundamental driver of clinical decision making – yet, remains inconsistently assessed and reported in clinical
practice. To address this gap, the investigators’ developed DIGEST™ (Dynamic Imaging Grade of Swallowing
Toxicity). DIGEST is an EBP tool to grade the severity of pharyngeal dysphagia based on results of a
radiographic (videofluoroscopic) modified barium swallow (MBS) study. DIGEST uses a basic flowsheet and
rubric (available open access via PMC) to summarize the patterns of penetration/aspiration and pharyngeal
residue observed on the MBS as markers of swallowing safety and efficiency. DIGEST is a pragmatic yet robust
measure validated in the head and neck cancer population, and adopted into routine practice at the PI’s institution
with over 11,000 MBS graded in the clinic using the methodology since development in 2016. Peer-reviewed
research shows adoption of DIGEST in external academic medical settings and federally funded clinical trials.
Despite this promise, several obstacles still limit widespread adoption in routine cancer care. These include
scalability to fit diverse clinical contexts outside the PI’s environment and uncertainty about best implementation
strategies. The long-term goal of this project is to improve dysphagia care and patient outcomes through reliable
adoption of DIGEST into routine clinical practice. Our central hypothesis is that DIGEST scales-up maintaining
validity in diverse cancer populations under common clinical practice variations with reliable adoption facilitated
by an active implementation strategy. The objective of this application is to use dissemination and
implementation (D&I) science to accomplish the following Specific Aims: 1) demonstrate validity of DIGEST in
diverse oncology populations and imaging acquisition protocols, 2) examine context and fidelity of natural
dissemination of DIGEST i...

## Key facts

- **NIH application ID:** 10774316
- **Project number:** 5R01CA271223-02
- **Recipient organization:** UNIVERSITY OF TX MD ANDERSON CAN CTR
- **Principal Investigator:** Katherine Arnold Hutcheson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $611,768
- **Award type:** 5
- **Project period:** 2023-02-15 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10774316

## Citation

> US National Institutes of Health, RePORTER application 10774316, Dissemination and implementation of DIGEST™ as an evidence-based measurement tool for dysphagia in cancer (5R01CA271223-02). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10774316. Licensed CC0.

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