June 2013 - April 2017
Stage one: Research Development Fund of the University of Nottingham Centre for Advanced Studies and Sue Ryder Centre for Supportive, Palliative and End of Life Care
Stage two: The Health Foundation Insight Award
- Dr Ruth Parry (PI) 1
- Dr Marco Pino 3
- Prof Christina Faull 2
- Dr Luke Feathers 2
- Prof Jane Seymour 1
- Kerry Blankley 2
- Dr Victoria Land 1
- Dr Laura Jenkins 1
- Prof Charles Antaki 3
- Dr Alexa Hepburn 3
- Joseph Ford 3
- Becky Whittaker 1
- The University of Nottingham
- LOROS, the Leicestershire and Rutland Hospice
- Loughborough University
- To identify communication practices that support collaborative decision-making through analysis of video-recordings of hospice consultations
- To design and develop training materials for shared decision-making in end-of-life care
- To pilot the training materials and undertake preliminary evaluation of their usability and acceptability
Stage one involves a stakeholder consultation with interviews of hospice users and staff to inform design of a protocol for making and using video recordings of doctor patient consultations in hospice settings.
Stage two involves audio or video recording up to thirty consultations involving experienced end of life care doctors, their patients and patients' significant others. These will be analysed using the social science approach 'conversation analysis'. Analysis will identify communication practices that facilitate effective communication and that facilitate contributions by patients and their significant others to healthcare decision-making conversations. The videos and their analysis will be used to design communication skills training materials which will be piloted within communication skills training courses and evaluated for their usability and acceptability.
Our long term intention is to gain further funding to support
- collecting and analysis of more video recordings, in particular, recordings of communication with nurses and other healthcare professionals, and;
- evaluation research on whether training resources based on video recordings of actual practice can enhance the effectiveness of communication skills training.
For more information download the logic model diagram
Stage of Development
Stage one, the stakeholder consultation is completed. One of its outcomes was a full protocol for a video-based study to examine doctor patient communication in a hospice, this was approved by ethics and governance committees, and recording consultations at the hospice followed. A paper describing the findings of the stakeholder consultation in which we interviewed patients, their significant others, and hospice staff is in preparation. We also reviewed existing literature and guidance, and produced a set of recommendations for good practice in video-based research and training in healthcare. This has been published on an open access basis, and is available here. The paper is designed to be useful for researchers and to those who provide ethics and governance oversight of research.
Stage two is complete – 37 consultations were recorded in the outpatient, inpatient, and day therapy services of one UK hospice. Recordings involved 37 patients, 17 accompanying relatives/friends, and 5 experienced palliative care doctors.
We have written and published findings about how experienced doctors navigate the dilemmas of raising the topic of the patients death.
We continue to analyse the recordings and writing reports about:
- How patients ask, and how doctors respond to ‘How long have I got?’ questions
- Communication practices involved in negotiating plans and decisions where the doctor’s and the patient’s preferences differ
- Advance planning – talking about and making plans for future scenarios given they are both unpredictable and ‘dreaded’
- Empathy – what does it look like? What does it do?
- How patients and doctors communicate about the nature of pain, and the effects of pain medications
We have built and piloted in several UK centres, a new training resource ‘Real Talk’. This is designed for use in face to face training events, and is based around clips from the recordings in cases where doctors and patients move towards talking about the patient’s illness progression and end of life, and in cases where patients ask ‘How long have I got’ questions. We undertook qualitative evaluation of its usability and acceptability via a mixture of semi-structured interviews, observations, and questionnaire survey. An interim report of our findings can be obtained by emailing firstname.lastname@example.org.
A report for journal publication is being repaired. We are also planning to apply for funds to refine the Real Talk DVD and to extend its use in communication skills training to more centres.