A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study

Abstract

Background Twenty-five per cent of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Health-care professionals report a lack of communication skills training. Objectives To identify teachable, effective strategies for communication between health-care professionals and people living with dementia, and to develop and evaluate a communication skills training course. Design We undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using coproduction and multiple pedagogic approaches. We ran a pilot, followed by six courses for health-care professionals. We measured knowledge, confidence and communication behaviours before, immediately after and 1 month after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations. Setting General hospital acute geriatric medical wards and two hospital clinical skills centres. Participants We video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six health-care professionals took part in a pilot course, and 45 took part in the training. Results The literature review identified 26 studies describing 10 communication strategies, with modest evidence of effectiveness. Health-care professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask) and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, asking patients ‘to try’, offering help or proposing collaborative action). Closings were more successful if the health-care professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised 2 days, 1 month apart, using experiential learning, including lectures, video workshops, small group discussions, simulations (with specially trained actors) and reflections. We emphasised the incorporation of previous expertise and commitment to person-centred care. Forty-four participants returned for the second training day and 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was rated highly in interviews, especially the use of simulations, real-life video clips and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them 1 month after the course finished. Limitations Data were from people with moderate to severe dementia, in an acute hospital, during health-care professional-initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias. Conclusions Requests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality. Future work Further research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of health-care communication. Study registration The systematic literature review is registered as CRD42015023437. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Expectations of nursing personnel and physicians on dementia training

“…The expectations for future training programs are mostly in line with the international literature about effective training programs [21]. Already existing well-developed and evaluated training programs, such as the “Getting to Know Me” program [10, 11], the “VOICE” training course [12], or the “PCTAH” program [20] can be used as potential examples of good science and practice for Germany and Greece.…”

Gaining access to unspoken narratives of people living with dementia on a hospital ward—A new methodology

“…Communication with people who have dementia has rarely been studied in this challenging environment. 7 Intergral to the method reported on here is that the narratives were shared in the contextual environment of their happeining -an acute medical ward -and thus did not rely on recall of past events. This narrative study aimed to explore and develop a method that forefronts movements, both big, small and micro, to bring an understanding to what a person is communicating when they cannot rely solely on words.…”

“…When a person with dementia is in an acute hospital they are in an unfamiliar environment, unwell and often without familiar faces around them. Communication with people who have dementia has rarely been studied in this challenging environment 7 . Intergral to the method reported on here is that the narratives were shared in the contextual environment of their happeining ‐ an acute medical ward ‐ and thus did not rely on recall of past events.…”

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

“…Common, in-themoment strategies used by care home and hospital staff were reported in qualitative studies, however their effectiveness was inconsistent (Backhouse et al, 2016;Handley et al, 2019). One hospital-based study on the impact of staff communication skills on people living with dementia's agreement to the completion of care tasks suggested an evidence-based structure for phrases that could be used to encourage residents to move to safe areas (Harwood et al, 2018). No research investigated when restraint could be ethically defensible or which type/s would be least restrictive.…”