Functional patient stratification for sensory- and swallowing-related acceptability of oral dosage forms: an evidence-informed conceptual framework.

Oral dosage forms are widely used, but unpleasant sensory experiences, oral residue, swallowing difficulty, and dysgeusia can reduce acceptability, dose completion, and adherence. This narrative and conceptual review examines patient heterogeneity in sensory- and swallowing-related acceptability and proposes a functional patient-stratification framework for oral formulation design. The framework organizes formulation-relevant barriers into three axes: baseline bitterness sensitivity, oral and swallowing burden, and taste mismatch with dysgeusic distortion. The framework is intended to translate biological and clinical variability into testable formulation hypotheses, rather than to define validated clinical subgroups. We discuss how dominant barriers may inform optimization goals, endpoint selection, and formulation strategies, including dynamic bitterness control, reduction of oral residue and swallowing burden, and management of abnormal taste qualities. Key translational challenges include fragmented assessment tools, provisional cutoffs, limited validation, regulatory uncertainty, industrial feasibility, and equitable access. Prospective, population-specific, and product-specific studies are needed to determine whether stratification-informed formulation decisions improve acceptability, willingness to repeat dosing, medication completion, or long-term adherence.