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

The  VOICE2 Study

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.

Project Duration

1st March 2022 to 31st December 2023


National Institute of Health Research, Health Services and Delivery Research

Project Staff

Chief Investigator:

  • Professor Rowan Harwood


  • Professor Sarah Goldberg, University of Nottingham
  • Dr Rebecca O’Brien, University of Nottingham
  • Professor Alison Pilnick, University of Nottingham
  • Professor Claire Surr, Leeds Beckett University
  • Dr Suzanne Beeke, UCL
  • Kate Sartain (PPI)
  • Dr Louise Bramley, Nottingham University Hospitals NHS Trust
  • Aquiline Chivinge, Nottingham University Hospitals NHS Trust
  • Dr Sue Haines, Nottingham University Hospitals NHS Trust
  • Professor Heather Wharrad, University of Nottingham

Staff Institutions

  • University of Nottingham
  • Leeds Beckett University
  • UCL
  • Nottingham University Hospitals NHS Trust


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.


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.

‘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.


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.

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.

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. 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.


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.

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