NCARE (Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-life Care)

The VOICE Study

The development and testing of a communication skills training intervention for healthcare professionals caring for people with dementia in acute hospitals NIHR HS&DR 13/114

Project Duration

1 June 2015 to 30 November 2017

An application for funding for a follow-on feasibility study is in process.


National Institute for Health Research, Health Services and Delivery Research

Project Staff

Chief Investigator:

  • Professor Rowan Harwood
    University of Nottingham, Nottingham University Hospitals NHS Trust


  • Dr Sarah Goldberg
    University of Nottingham
  • Rebecca O’Brien
    University of Nottingham
  • Rebecca Allwood
    Nottinghamshire Healthcare NHS Trust
  • Professor Alison Pilnick
    University of Nottingham
  • Dr Suzanne Beeke
  • Dr Louise Thompson
    University of Nottingham
  • Professor Justine Schneider
    University of Nottingham
  • Kate Sartain (PPI)

Staff Institutions

  • University of Nottingham
  • Nottingham University Hospitals NHS Trust
  • UCL
  • Nottinghamshire Healthcare NHS Trust


This research aimed to develop and test a communication training intervention for healthcare professionals (HCPs) caring for people with dementia (PWD) in acute hospitals. Improved HCPs communication skills will reduce distress and challenging behaviour, improve dignity and patient experience and their inclusion in decision making.

The objectives were to:

1. Analyse the structure of communication patterns used by HCPs communicating with PWD

2. Identify the communication skills that overcome the challenges of interacting with people with dementia

3. Train actors to simulate the communication of a person with dementia, in order to support the training and
    assessment of HCPs

4. Develop an intervention to effectively teach these communication skills to HCPs.


We video-recorded 41 conversations between 26 professionals and 26 people living with dementia, and analysed them to understand when problems arose and how skilled practitioners overcame them. We designed a 2-day communication skills training course, which we ran as a pilot, and then on six further occasions, including 45 staff from two hospitals. The course used a variety of teaching methods, including simulation (actors playing the part of patients). We evaluated the course.


We identified the structure of the interactions between HCPs and PWD. These included an opening, stating the purpose of the interaction, information gathering, the business phase (completing the task) and closing. Particular problems were identified when the HCP requested action from the PWD (particularly when the PWD refused care) and when the HCP ended the interaction. 

We identified the person centred, communication skills used by experienced healthcare professionals to ensure completion of care that was in the patient’s best interest, and to close the encounter. The course developed to teach these communication skills was evaluated in a before and after study.  It was found to improve confidence knowledge and communication behaviours.  Participants found the methods useful in practice and were still using them one month after the course.  The healthcare professionals particularly valued the simulation workshops. 


We identified a set of teachable communication practices and improved the communication skills of HCPs caring for PLWD.  Simulation was found to be a valuable method to achieve this. 

Final report of the study


  • O'BRIEN, REBECCA, BEEKE, SUZANNE, PILNICK, ALISON, GOLDBERG, SARAH E and HARWOOD, ROWAN H, 2020. When people living with dementia say 'no': Negotiating refusal in the acute hospital setting. Social science & medicine (1982). 263, 113188 - This paper is one of our PhD students and is related to hospital care of people with dementia.
  • Beaver J, Goldberg S, Edgley A, Harwood RH (2020) ‘Socialised care futility’ I the care of older people in hospital who call out repetitively: An ethnographic study. International Journal of Nursing Studies 107:103589
  • Pilnick, A, O’Brien, R, Beeke S, Goldberg S, Harwood R Avoiding repair, maintaining face: Responding to hard-to interpret talk from people living with dementia in the acute hospital.  Social Science and Medicine.  282: 114156
  • O’Brien, R., Goldberg. S., Pilnick, A. et al (2018) The VOICE study- A before and after study of a dementia skills communication course. PLOS One:
  • Pilnick, A., Trusson, D., Beeke, S, O'Brien, R., Goldberg, S, and Harwood, R.H. (2018). Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals,  BMC Medical Education. 18:
  • Harwood. R.H., O'Brien, R., Goldberg, S., Allwood, R., Pilnick, A., Beeke, S., Thomson, L., Murray, M., Parry, R., Kearney, F., Baxendale, B., and Sartain, K. (2018) 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, Health Services and Delivery Research. 6(41), 1-166
  • Allwood R., Pilnick, A., O'Brien, R., Goldberg, S., Harwood, R. and Beeke, S. (2017) Should I stay or should I go? How healthcare professionals close encounters with people with dementia in the acute hospital setting. Social Science and Medicine, 191: 212-225.

NCARE (Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-life Care)

University of Nottingham
School of Health Sciences
Queen's Medical Centre
Nottingham, NG7 2HA