VOICE (Videoing to improve communication through education)

Aim: People with dementia and those who work with them can experience difficulties in communicating and interacting. Dementia causes forgetfulness, word-finding difficulties, problems understanding, misinterpretation, and difficulty in controlling emotions. Often, these problems are increased by an admission to hospital, due to change of environment, unfamiliar faces, intensive questioning and activity, and the illness or injury for which they were admitted.

The VOICE study looked at how healthcare professionals could improve their knowledge, confidence and skills at communicating with patients with dementia. It led to the development of an evidence-based communication skills training course.

**"2019 training course now available - click here for more information**

To develop the training course, the researchers analysed video of conversations between experienced healthcare professionals speaking to hospital patients with dementia to identify successful communications strategies and language. Two areas of communication caused particular problems. Making requests and ending the conversation. Requests were often refused. Things that helped included making requests direct and simple, speaking with a high level of authority, and trying to make the task sound easier. To end a conversation satisfactorily the healthcare professional had to make it clear this was happening, to make an explicit arrangement rather than more commonly used phrases like ‘see you soon’, and making sure that body language matched the words used.

The training course was developed involving input from carers of people living with dementia, communication and educational experts, experts at working with actors in education and clinicians experienced in the care of people with dementia. The resulting course focused on learning through simulated exercises in which actors trained in issues around dementia communication took on the roles of patients.

The course was run six times between January and May 2017 and was attended by 44 healthcare professionals, including doctors, nurses, and therapists.

To evaluate the success of the training, the researchers undertook a study of the healthcare professionals' confidence, knowledge and use of the communication skills before and after the course via questionnaire. They were also videoed during a role play exercise before and after training in a scenario where they either had to persuade a 'patient' to get out of bed or to drink some water as though they were dealing with a real patient. These videos were rated by researchers, and people with dementia and their family carers to see if the way they did it changed.

The researchers followed up with participants one month after the second day of the course.  Participants said they remembered the skills they were taught, were using them in their work and found the skills were helpful in their role. Analysis of the videos highlighted a tension: the healthcare professionals could appear more controlling, bossy and dominating. We have had to explicitly warned that it was important to be compassionate and being person centred, but argue that misunderstanding  often leads to conflict or argument, and benefits no-one.

The researchers say, the process of experiential learning means that one month may not have been long enough for the participants to demonstrate all the new communication skills on the course.

Research funding(s): The study was funded by the National Institute of Health Research (NIHR).

Lead researcher(s): Professor Rowan Harwood, consultant geriatrician and professor of geriatric medicine at Nottingham University Hospitals NHS Trust.

Partners: The study was organised by Nottinghamshire Healthcare NHS Foundation Trust, working in close partnership with Nottingham University Hospitals (NUH) NHS Trust, the University of Nottingham and University College London (UCL).

Timescales: The project grant ran from June 2015 to November 2017.