Title: Development and testing of communication skills training for hospital healthcare practitioners caring for people living with dementia to avoid or resolve episodes of distress and challenging behaviour (VOICE2): a mixed-methods study
Funder: Department of Health and Social Care

Abstract: Aim: We want to see what sort of communication helps avoid or resolve distress and challenging behaviours for people in hospital who have dementia, and then teach it to hospital staff._x000D_ _x000D_ Background: People who have dementia often get distressed when they are in hospital. They may behave in ways that families and staff find difficult, including agitation, aggression or calling out. People with dementia can find it difficult to make clear what they want to say or to understand others. The way we say things can calm or inflame a difficult situation, but this has not been studied in detail in this setting._x000D_ _x000D_ ‘Conversation Analysis’ is a research method which looks at the fine detail of the language we use, including ‘body language’, and the responses to it. In a previous study we analysed video recordings of real-life ward care to develop new advice on aspects of talking to someone with dementia. We used what we found to train ward staff and showed that it improved how they communicated in practice. However, staff told us they needed to know about what to do when people with dementia are distressed._x000D_ _x000D_ Design: We will video-record 50 episodes of care for people with dementia, which staff anticipate are going to be difficult, on 10 wards in 2 hospitals. We will use audio recording to maintain dignity if we include personal care. We will involve patients in decisions to take part and get agreement from patients’ families before we record anything. We will analyse the talk used and responses to it so we can identify communication that avoids or resolves distress in practice. We will use what we find to develop internet-based training materials, a communication skills training course, and a ‘train-the-trainer’ course to teach hospital clinical educators to deliver our course. We will do this with people with dementia, family carers, educators and hospital staff._x000D_ _x000D_ We will train educators from 3 hospitals and ask them to provide training to staff on 2 wards in their hospital. We will examine whether the educators deliver the course as we intended and whether it improves staff communication. We will measure trainees’ knowledge, attitudes and confidence before and after the course. We will observe real-life interactions between staff and their patients, rate them using a checklist of communication skills and patient reactions on an agitation scale. We will interview educators and staff to find out how the new skills help patients and any barriers to using them in practice._x000D_ _x000D_ We are a multi-professional team who regularly work with patients who have dementia and their families, putting us in an ideal position to do this valuable but sensitive research._x000D_ _x000D_ PPI: We are supported by PPI colleagues, who have actively engaged in developing this and previous research, and will help us develop, deliver and disseminate it._x000D_ _x000D_ Dissemination: This research accepts that you need special skills to look after someone who has dementia. We will identify explicit advice about how to communicate with a person who is at risk of distress. We will disseminate via academic journals and our professional and teaching networks. We will produce a website with training resources to support dementia educators to deliver communication skills courses. This has the potential for widespread and low-cost uptake, including in care homes and family care. There is high demand for this type of training, with the potential for substantial impact on patient experience and wellbeing

Lay abstract: Research question: Can we identify and teach communication skills to help healthcare practitioners (HCPs) avoid or resolve episodes of distress and challenging behaviour amongst hospital patients living with dementia (PLWD)? _x000D_ _x000D_ Background: PLWD often become distressed, especially when admitted to acute hospitals, which can lead to ‘behaviours that challenge’, such as agitation or aggression. We recently used a socio-linguistic research method called conversation analysis (CA) to reveal effective communication techniques around negotiating requests and ending an interaction with a PLWD. We developed a communication skills training course based on these findings. Trainees told us that they needed additional skills in managing distress and that a critical mass of staff on a ward should be trained for greatest effectiveness. _x000D_ _x000D_ Methods: We will undertake research in three phases: _x000D_ _x000D_ 1) We will use CA to identify specific and teachable communication practices that HCPs use to avoid, de-escalate or resolve distress and challenging behaviour. We will video record 50 interactions on 10 wards at 2 hospitals, involving PLWD in distress, who are prone to distress, or engaged in activities that may cause distress. CA will be used to reveal systematic patterns in the interactions and identify successful practices that HCPs use. _x000D_ _x000D_ 2) We will co-produce theory-based learning resources including interactive digital teaching, appropriate for registered and non-registered HCPs, which can be used face-to-face or in facilitated on-line courses. This will involve researchers, PPI, clinicians, staff representatives and educationalists. We will develop a portfolio of educational resources which will form a flexible communication skills training course and a train-the-trainers course to enable Trust clinical educators to deliver the training. _x000D_ _x000D_ 3) We will deliver the training in 3 NHS acute Trusts, recruiting and training 3 dementia educators from each, and evaluating the effectiveness of the training that they deliver, using mixed method, multiple case study methodology. We will evaluate at the levels of knowledge, confidence, communication behaviours, impact on patients, and family carer views. About 150 HCPs will be trained, focusing on 2 wards in each Trust. We will explore development of a ‘critical mass’ of trained staff and identify barriers and facilitators to delivering training and implementing the skills in practice. Evaluation will use a combination of questionnaires, interviews with educators, HCPs and ward managers, structured observations of care, and family questionnaires and conversations. _x000D_ _x000D_ Dissemination and impact: We will deliver new socio-linguistic knowledge, which will be presented at conferences and published in high impact journals. We will produce a website with digital teaching and learning resources to support dementia educators to deliver communication skills courses and a ‘train-the-trainers’ course. This has the potential for widespread and low-cost uptake. There is high demand for this type of training, with the potential for substantial impact on patient experience and wellbeing. We will identify and address factors that may help or hinder implementation. _x000D_ _x000D_ Timelines: Phase 1 (CA) over months 0-12, phase 2 (development) over months 7-16, and phase 3 (implementation and evaluation) over months 13-30, with 3 months analysis, reporting, disseminating and contingencies.

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