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There is evidence for a correlation between effective physician-patient communication in consultations and improved adherence to treatment. Lack of time, limited communication training, growing administrative duties, and low recall of physicians' information and recommendations by patients are antagonists to effective physician-patient communication. In interviews with physicians, therapists, and patients, we first identify problems of current consultation practices and condense them in a problem scenario. We then use interview results to explore potential solutions, applying modern information technology such as digital medical assistants. Lastly, those potential solutions are condensed in an activity scenario that can be used for further design science research activities. This section presents an introductory "problem scenario" about current physician-patient consultations [30]. It is based on the literature analysis and interview results as described further below. Identified problems are italicized. Giovanni is 60 years old and immigrated from Italy to Switzerland 23 years ago. Since the death of his wife three years ago, he has been living alone in his small but attractive apartment in the countryside near Zurich. For three months, Giovanni has been suffering from recurring headaches. Three weeks ago, his general practitioner referred him to Dr. Smith, a neurologist. Both Giovanni and Dr. Smith remember this first consultation well. Giovanni came to the appointment rather nervously and wanted Dr. Smith to fully comprehend his stressful situation. He began to describe his illnesses, symptoms, and living conditions in detail. It took Dr. Smith much longer than planned to understand and

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10th World Research Congress of the European Association for Palliative Care (EAPC). Palliative Medicine, May 2018 32:1_suppl 3-330, doi: 10.1177/0269216318769196.

Background Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. Methods Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. Results We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. Conclusion This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. Trial registration The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).