Is it acceptable to video-record palliative care consultations for research and training purposes?: a qualitative interview study exploring the views of hospice patients, carers and clinical staff

Background: Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. Aim: To explore views of hospice patients, carers and clinical staff about whether videoing patient–doctor consultations is acceptable for research and training purposes. Design: We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark’s thematic analysis. Setting/participants: Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). Results: Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. Conclusion: Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent

Acceptability and design of video-based research on healthcare communication: evidence and recommendations

Objectives: To contribute to understandings about acceptability and risks entailed in video-based research on healthcare communication. To generate recommendations for non-covert video-based research on healthcare communication − with a focus on maximising its acceptability to participants, and managing and reducing its risks. Methods: A literature review and synthesis of (a) empirical research on participant acceptability and risks of video recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific). Results: 36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication: •Most people regard video-based research as acceptable and worthwhile, whilst also carrying risks. •Concerns that recording could be detrimental to healthcare delivery are not confirmed by existing evidence. •Numerous procedures to enhance acceptability and feasibility have been documented, and our recommendations collate these. Conclusion and practice implications: The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available

Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying

Objective: To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design: Conversation analysis of video- and audio-recorded consultations. Participants: Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting: Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results: Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce Ð then later further articulate Ð EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions: Through communicating Ð via open elaboration solicitations Ð in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue

Sediment mixing in aeolian sandsheets identified and quantified using single-grain optically stimulated luminescence

Post-depositional mixing processes are extremely common and often obscure a record of deposition in dune and sand sheet deposits. We show that the upper half metre of a dune in southeastern Australia is currently being turned over through bioturbation, but that single-grain OSL dating and contextual knowledge can be used to identify and model these modern mixing processes. In the sandy deposits investigated, mixing processes were observed to be acting to a predicable depth of ~50-60 cm. This observation was used to develop a conceptual framework that can be applied to buried deposits and used to temporally constrain the evolution of the landform and quantify rates of mixing. When our mixing zone conceptual framework was combined with the MAM we show that phases of significant dune aggradation occurred at ~29.9, ~18.3, ~10.3 ka, and continued through the Holocene. We also present an approach using single-grain OSL data to estimate downward mixing rates, which show a strong depth dependency and are coherent with previously reported mixing rates. Modern downward mixing rates indicate that the upper ~50 cm (Zone 1) will be completely turned over on millennial time scales. While caution needs to be used when interpreting archaeological and OSL data from bioturbated sandy environments, our results demonstrate that contextual knowledge and single-grain OSL data can resolve mixing processes and contribute to an understanding of landscape evolution

Real talk facilitator manual: Engaging patients with end of life talk

Video-based communication training- engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.Loughborough University / Nottingham University received funding from The Health Foundation and NIH

Real talk facilitator manual: Engaging patients with end of life talk

Video-based communication training Engaging patients in end of life talk. ‘Real Talk’ is a novel and flexible communication training resource designed to use in face-to-face training events. It features real-life video recordings of UK hospice care, and learning points based on cutting-edge communication science. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions.Loughborough University; LOROS;The Health Foundation: NIH

Characteristics of the participants.

<p>Characteristics of the participants.</p

Real Talk facilitator manual

Real Talk comprises resources for teaching communication skills relevant to palliative and end of life care. Real Talk has been developed as part of a research programme, and aims to enhance the quality and effectiveness of evidence-based communication skills training in the area of end of life care. The research programme is called VERDIS, which refers to video-based research and training on supportive and end of life care interactions. The research approach we use is called Conversation Analysis. VERDIS has been supported by Loughborough University, the University of Nottingham, and grant funding from The Health Foundation and the NIHR

End of Award Report February 17TH 2016: VERDIS: Video-based communication research and training in supportive and palliative care

High quality staff-patient communication is central to compassionate, effective healthcare. There has been limited progress towards generating robust evidence about the precise structure and functioning of healthcare communication. This impedes development of effective interventions and their evaluation. Conversation analysis, which relies on audio- and video-recordings of naturally occurring healthcare episodes is making rapid advances, particularly in generating evidence about communication in primary care medicine. The conversation analytic approach was used in this study to generate underpinning knowledge about the structures and functioning of healthcare communication behaviours in specialist palliative care, and to design associated staff communication skills training materials. In this study, we focused on communication in specialist palliative care provided in a hospice. Good communication is central to high quality effective care for people nearing the end of life and their friends and relatives [1, 2]. Poor communication is associated with distress and complaints [3, 4]. Also, we know that one particular element of communication in this domain - discussing and making plans and decisions about future care - influences place of death, and aggressiveness of care [5, 6], but little is known about precisely how staff can support patients to engage with such sensitive, challenging discussions, and about how to do so in an empathic manner. Thus we studied decision-making communication and communication associated with empathy – a quality highly valued by patients and their companions [7]. We know that patients and professionals are reluctant to address sensitive issues and decisions about the future and that practitioners’ uncertainty about how to talk with patients and family members about these is an important obstacle [8]. In an international survey of 90 palliative care experts, 80% wanted more evidence-based guidance on optimal communication strategies to improve decision-making practice [9]. There is already an established communication skills training programme for healthcare professionals – the ‘Connected’ advanced communication skills training programme, which is based within regional cancer networks, and funded through local commissioning [10, 11]. This kind of training is primarily delivered to staff who work in oncology and specialist palliative care. Systematic reviews indicate these courses have some positive effects [3], but that these are confined to two particular behaviours: trainees’ expression of empathy and question-asking behaviours. Unfortunately, no benefits have been shown in terms of patients’ communication behaviours and their perceptions of communication quality; also evidence about long-term effectiveness is contradictory [3]. Furthermore, current training is based upon limited evidence: little derives from direct observations [10], and most is specific to cancer patients [11]. There is good reason to anticipate stronger effects were it grounded in more detailed evidence about communication behaviours and skills [10, 12-14]. This study aimed to generate such detailed evidence, with data and analysis not solely confined to discussions with people with cancer. Video-based research on communication is relatively new within healthcare research, but is already developing a track record of yielding useful findings, for instance, it has identified specific communication practices that enhance patient satisfaction [15], and that increase vaccine uptake rates [16]. Video-based conversation analytic research has also led to design of communication training and interventions that have been shown to be effective in improving healthcare consultations – for instance in enabling primary care patients to express more of their concerns within consultations with doctors [12], and people attending HIV clinics to express their concerns more succinctly and readily [17]. Thus we know that video-based research on recordings of ‘real’ patients and professionals yields benefits to patients. However, it is not yet known whether using video-recordings of ‘real’ rather than simulated interactions in communication training increases its effectiveness and thus leads 5 to improvements in staff-patient communication; we will address this important question within the research programme of which the current study forms part. In this study we sought to generate evidence about how experienced, specialist hospice doctors communicate with patients and their accompanying friends/relatives, and design staff communication training materials aiming to pass on those skills to less experienced, less specialist staff. The resultant materials include video-clips of real interactions (where all participants permitted this use of their recordings); these were piloted in communication skills training at 11 sites and a preliminary evaluation conducted on trainees’ and trainers’ perspectives on perceived value, acceptability and usability

Addressing possible problems with patients’ expectations, plans and decisions for the future : one strategy used by experienced clinicians in advance care planning conversations

Abstract Objective Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients’ expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients’ expectations, plans or decisions. Methods Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions. Results Eleven episodes involving five doctors were found. In all of these we identified a ‘Hypothetical Scenario Sequence’ where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients’ expectations and plans. Conclusion Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients’ preferences whilst preparing them for possible difficulties and inevitable uncertainties. Practice Implications Where professionals judge it appropriate to raise problems about patients’ preferences, plans and decisions, this sequence can manage the associated risks