Title: Enhancing staff-patient communication in palliative and end of life care
Funder: Department of Health and Social Care

Abstract: INTRODUCTIONIn order to improve communication between healthcare staff and people nearing the end of their lives; this research will: Identify communication skills used by specialist occupational therapists (OTs) and physiotherapists (PTs) Integrate findings with those from my research on hospice doctors' skills Design evidence-based, online training for non-specialist staff Conduct preliminary evaluation of the training's effects on staff-patient communication Generate knowledge to design and cost subsequent trial of the training Develop capacity and capability for rigorous communication research, and for designing effective, easy to implement interventions BACKGROUND High quality staff-patient communication is central to compassionate, effective healthcare. There has been limited progress towards generating robust evidence about the precise structure and functioning of healthcare communication. This impedes development of effective interventions and their evaluation. Conversation analysis, one of the applicant's main areas of expertise, is making rapid advances but these mostly centre around doctor-patient communication in US primary-care. NHS demand for care of people nearing the end of their lives is extensive and increasing: the 500,000 people dying in England and Wales in 2012 will be 590,000 by 2030. Hospices and specialists provide a small proportion of care, most is provided by non-specialists. 78% of bereaved relatives surveyed rated hospice-care excellent, but this fell to under 40% for hospital non-specialists. Increased emphasis in NHS provision that enables terminally-ill people to live independently for as long as possible has increased the significance of specialist therapists, whose communication skills I will investigate. Physical actions entailed in therapy require effortful participation and bring awareness of the deteriorating body to the surface, necessitating skilled, sensitive communication. The Francis and Neuberger reports have influenced public and policymaker recognition that staff-patient communication is central to a compassionate NHS, and an essential component of care for people nearing the end of their lives. Furthermore, communication involving effective discussion of future plans and decision-making in this healthcare context is known to increase quality and reduce healthcare costs, but requires advanced communication skills that are currently lacking. This Fellowship proposal will address these needs. PROGRAMME: THREE WORKPACKAGES 1. Underpinning research Objective To video-record specialist therapy sessions/consultations in order to map structures and functioning of communication, particularly regarding empathy and planning/decision-making 30 sessions/consultations involving 12 experienced therapists will be recorded, yielding 20 hours of data containing thousands of verbal and non-verbal actions. These will be analysed using conversation analysis. 2. Applications To design An online reusable learning object (RLO) teaching specific communication skills to non-specialist staff who care for people nearing the end of their lives A quantitative instrument for evaluating the RLO's effects An online toolkit for communication skills trainers RLO and toolkit design will entail stakeholder consultations and collaboration with education technologists. Developing and testing feasibility and reliability of the quantitative coding instrument will entail collaboration with US-based researchers who are leading the development of new methods for doing so. 3. Preliminary RLO evaluation To conduct quasi-experimental evaluation A controlled before-and-after study will evaluate the RLO's effects on behaviours of 30 staff-trainees and their patients, using the new instrument and existing measures (selected on the basis of systematic review work). This will provide preliminary evidence about effectiveness, and design and test recruitment, consent, data collection, and measurement procedures OUTCOMES Online, freely available communication training resources for NHS staff Publications about AHP and palliative care communication Groundwork for further research on assessing communication practices/behaviours in the NHS, and evaluating effects of interventions BENEFITS Patients and their companions will benefit from improved communication where staff apply findings and training. Better communication increases satisfaction and compliance, and reduces complaints. Production of evidence-based measurement tools and interventions to enhance staff-patient communication

Lay abstract: Skilled communication is central to achieving effective, compassionate healthcare for people nearing the end of their lives, as recently highlighted by findings of the Francis and Neuberger Reports.Using newly available approaches I will: Characterise communication skills used by end of life care specialist physiotherapists and occupational therapists, skilled in providing physical care in ways that communicate and respect dying people's dignity, autonomy and hopes Translate these into evidence-based online training for non-specialist NHS staff - these staff provide the majority of healthcare to those nearing the end of life Test whether this training improves staff-patient communication

Research activity codes: 7.2 END OF LIFE CARE
Health categories: GENERIC HEALTH RELEVANCE