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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

Harwood, Rowan H; O’Brien, Rebecca; Goldberg, Sarah E; Allwood, Rebecca; Pilnick, Alison; Beeke, Suzanne; Thomson, Louise; Murray, Megan; Parry, Ruth; Kearney, Fiona; Baxendale, Bryn; Sartain, Kate; Schneider, Justine

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 Thumbnail


Professor of Older Peoples' Care

Rebecca Allwood

Alison Pilnick

Suzanne Beeke

Megan Murray

Ruth Parry

Fiona Kearney

Bryn Baxendale

Kate Sartain

Justine Schneider


25% of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Healthcare professionals report lack of communication skills training.
To identify teachable effective strategies for communication between healthcare professionals and people living with dementia, and to develop and evaluate a communication skills training course.
We undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using co-production and multiple pedagogic approaches. We ran a pilot, followed by six courses for healthcare professionals. We measured knowledge, confidence and communication behaviours before, immediately-and one month-after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations.
General hospital acute geriatric medical wards; clinical skills centre.
We video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six healthcare professionals took part in a pilot course and 45 took part in the training.
Literature review identified 27 studies, describing ten communication strategies, with modest evidence of effectiveness. Healthcare professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask), and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, as king patients ‘to try’, offering help, or proposing collaborative action). Closings were more successful if the healthcare professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised two days, one month apart, using experiential learning, including lectures, video-workshops, small group discussion, simulation (with specially-trained actors) and reflection. We emphasised incorporation of previous expertise, and commitment to person-centred care. 44 participants returned for the second training day; 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was highly-rated in interviews, especially the use of simulation, real-life video clips, and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them a month after the course finished.
Data were from people with moderate to severe dementia, in an acute hospital, during healthcare professional initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias.
Future work
Further research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of healthcare communication.
Requests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality.

Journal Article Type Article
Acceptance Date May 18, 2018
Online Publication Date Dec 31, 2018
Publication Date Dec 1, 2018
Deposit Date Jun 7, 2018
Publicly Available Date Sep 10, 2018
Journal Health Services and Delivery Research
Print ISSN 2050-4349
Electronic ISSN 2050-4357
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 6
Issue 41
Pages 1-134
Keywords Dementia, aged, Conversation Analysis, Communication, General hospital, Health Care Professional, Communication Skills Training, Clinical skills, Experiential learning, Interdisciplinary learning, Evaluation, Feasibility study, outcome measures, systemati
Public URL
Publisher URL
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Additional Information Title of published article differs slightly from accepted manuscript.


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