Title: VAlidation of the Mcast CommunicAtion Screening Tool (VAMCAST): improving patient access to communication support during mental capacity assessments.
Funder: Department of Health and Social Care

Abstract: This study will produce a valid and reliable communication screening tool for NHS healthcare professionals (HCPs) to use to ensure stroke survivors receive individualised communication support to make decisions and participate in mental capacity assessments. Background Poor communication between HCPs and patients with communication difficulties is associated with inadequate care and reduced patient participation in decision-making (1). 100,000 UK inhabitants have a stroke annually (2); 64% will have impaired communication (3). HCPs are legally required to support patients to make decisions and to assess their decision-making (mental) capacity if indicated (4). HCPs without specialist training in communication disorders cannot identify and support communication needs accurately (5) and do not reliably refer to speech and language therapists (SLTs) for specialist support (6-7), as recommended by NICE (8). Consequently, patients with communication difficulties may be excluded from decision-making. Aims and objectives This cross-sectional psychometric study will finalise the design of the Mental Capacity Assessment Support Toolkit (MCAST) Communication Screening Tool (CST), by establishing CST s construct and criterion validity, intra- and inter-rater reliability, and fidelity of its use by HCPs. Methods Four participant groups will be recruited: i) community-dwelling stroke survivors (n=100); ii) hospital inpatients diagnosed with stroke (n=75); iii) SLTs with experience of working in stroke services (n=11); iv) HCPs working in stroke services (n=17). Construct validity will be measured by comparing CST outcomes for group (i) with outcomes on validated language assessments. Criterion validity will be measured by comparing CST outcomes for 28 group (i) participants with expert SLT judgement (group iii). Intra-rater reliability will be measured by comparing CST outcomes for group (i) when tested at two time-points. Inter-rater reliability will be measured by comparing CST outcomes obtained by 9 SLTs (group iii) while observing video-recordings of 10 group (i) participants being tested using CST. Data will be analysed using intra-class correlation coefficients. Fidelity of use will be established by training 15 HCPs (group iv) to use CST and observing each screen up to 5 patients (group ii). Quantitative and qualitative fidelity data will be collected using an observational checklist and semi-structured interviews. Data will be analysed using descriptive statistics and thematic analysis (9) and used to refine the CST training manual and administration instructions. Data collection will be discontinued when 80% HCPs demonstrate 100% required behaviours on the fidelity checklist. A PPI group will contribute to study design and delivery. Timelines The study will run for 30 months from 01/04/22. Recruitment will take place in months 7-18 (group i); 16-24 (group ii); 16-21 (groups iii and iv). Data will be collected in months 7-23 (psychometrics) and 17-25 (fidelity) and analysed in months 17-28. PPI and dissemination activities will occur throughout with main outputs finalised by month 30. Impact and dissemination Use of CST will increase patient involvement in decisions, which is associated with superior health outcomes, increased patient and family satisfaction, and reduced costs (10). Study outputs will be disseminated using publications and meetings targeting patients, HCPs and academics. CST will be distributed freely to HCPs after the study.

Lay abstract: Helping patients with communication problems to make decisions What is the problem? The Mental Capacity Act (2005) says that healthcare staff need to help patients to make decisions. These may be important decisions about treatment or leaving hospital. Patients who have communication problems due to conditions such as a stroke need specific help. The law says staff need to make information about decisions easier to understand. Staff also need to help patients to talk about decisions more easily. Research shows that many staff do not know how to help these patients to make decisions. They do not always ask speech and language therapists for expert help. Some staff assume wrongly that these patients cannot make decisions. This project aims to help staff to support patients with communication problems to make decisions. How will this project solve the problem? We have developed a new communication test. The aim of the test is to show staff when a patient has communication problems and how to help the patient to make a decision. No other communication tests do this. The test also tells staff when to ask a speech and language therapist for help. We need to do this research to find out if the test gives correct results and if staff can use it accurately. What will we do? We will ask 100 people living at home to take the communication test. These people will be stroke survivors who have communication problems. We will make videos of people taking the test. We will check the test gives the correct result for each person by: comparing the results with other communication tests; comparing the results with a speech and language therapist's expert opinion; using the test twice, to check it gives the same results at different times; checking the test gives the same results when different people use it. We will ask nine speech and language therapists to complete the test based on what they see in the videos. We will check staff can use the test accurately with patients by: watching how 15 healthcare staff use the test with 75 stroke survivors in hospital; interviewing staff about how they used the test; making changes to the test instructions; checking that staff can follow the new instructions more accurately. A group of patients and the public, including stroke survivors, have helped us develop this project. Stroke survivors and family members will help us manage the project. They will help us write reports and articles about the results. They will join us in talking to researchers, patients and the public about the communication test at meetings and conferences. When the research is over, we will make the test freely available to healthcare staff.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: STROKE