CommuniCare: Development, evaluation, and implementation of a generic Communication Partner Training using perspectives of people with aphasia and healthcare professionals

Aphasia is a language disorder as a consequence of stroke. People with aphasia experience difficulties with understanding and communicating with others, such as healthcare professionals. As result, people with aphasia have higher risks of receiving inadequate care, show worse rehabilitation outcomes, lower satisfaction rates, higher risks for adverse events and higher medical costs. International studies have shown positive effects on communication between people with aphasia and healthcare professionals (HCPs) after providing HCPs with Communication Partner Training (CPT). CPT is an umbrella term for interventions that are aimed at improving communication between people with aphasia and their conversation partners. CPT interventions often include training modules where HCPs learn to use supportive conversation techniques. Positive effects include an increase in the use of conversation techniques, increased satisfaction and participation of the person with aphasia and improved quality of life scores. However, although the implementation of CPT intervention was included in best-practice statements and evidence-based guidelines, there were no CPT interventions available that were developed for the Dutch or Flemish context. Also, due to underreporting of CPT interventions, lack of outcome measures and lack of implementation research, there was little understanding of how different intervention elements in CPT interventions produce different outcomes. In this PhD thesis, we aimed to develop and evaluate a CPT intervention that is applicable for the Dutch and Flemish context. The CPT intervention was named CommuniCare and was developed based on the needs and wishes of the users (HCPs) and end-users (people with aphasia and their relatives) (Chapter 1-4). Chapter 5 describes the CommuniCare intervention in detail. From 2018-2020, almost 300 HCPs were provided the intervention. The evaluation of CommuniCare was conducted by analyzing the mechanisms of change from HCPs' perspectives (Chapter 6). Different intervention elements in CommuniCare improved HCPs skills, capacities and confidence to use supportive conversation techniques during conversations. The main barriers included time constraints, remaining lack of confidence and lack of positive beliefs. Using implementation theory, participating healthcare centers developed implementation strategies to address these barriers. This PhD thesis provides recommendations for implementing CPT interventions in healthcare centers, in order to improve communication between HCPs and people with aphasia. Implementation strategies include leadership, the development of supportive tools, financial and organizational facilitation by management and a change in role of Speech-and Language Therapists (SLTs). We also provide recommendations on how to lay the foundations of good communication skills in early-career healthcare students. Examples include teaching SLTs to coach and support their colleagues, and providing student courses for becoming Implementation Support Practitioners

CommuniCare: Development, evaluation, and implementation of a generic Communication Partner Training using perspectives of people with aphasia and healthcare professionals

Aphasia is a language disorder as a consequence of stroke. People with aphasia experience difficulties with understanding and communicating with others, such as healthcare professionals. As result, people with aphasia have higher risks of receiving inadequate care, show worse rehabilitation outcomes, lower satisfaction rates, higher risks for adverse events and higher medical costs. International studies have shown positive effects on communication between people with aphasia and healthcare professionals (HCPs) after providing HCPs with Communication Partner Training (CPT). CPT is an umbrella term for interventions that are aimed at improving communication between people with aphasia and their conversation partners. CPT interventions often include training modules where HCPs learn to use supportive conversation techniques. Positive effects include an increase in the use of conversation techniques, increased satisfaction and participation of the person with aphasia and improved quality of life scores. However, although the implementation of CPT intervention was included in best-practice statements and evidence-based guidelines, there were no CPT interventions available that were developed for the Dutch or Flemish context. Also, due to underreporting of CPT interventions, lack of outcome measures and lack of implementation research, there was little understanding of how different intervention elements in CPT interventions produce different outcomes. In this PhD thesis, we aimed to develop and evaluate a CPT intervention that is applicable for the Dutch and Flemish context. The CPT intervention was named CommuniCare and was developed based on the needs and wishes of the users (HCPs) and end-users (people with aphasia and their relatives) (Chapter 1-4). Chapter 5 describes the CommuniCare intervention in detail. From 2018-2020, almost 300 HCPs were provided the intervention. The evaluation of CommuniCare was conducted by analyzing the mechanisms of change from HCPs' perspectives (Chapter 6). Different intervention elements in CommuniCare improved HCPs skills, capacities and confidence to use supportive conversation techniques during conversations. The main barriers included time constraints, remaining lack of confidence and lack of positive beliefs. Using implementation theory, participating healthcare centers developed implementation strategies to address these barriers. This PhD thesis provides recommendations for implementing CPT interventions in healthcare centers, in order to improve communication between HCPs and people with aphasia. Implementation strategies include leadership, the development of supportive tools, financial and organizational facilitation by management and a change in role of Speech-and Language Therapists (SLTs). We also provide recommendations on how to lay the foundations of good communication skills in early-career healthcare students. Examples include teaching SLTs to coach and support their colleagues, and providing student courses for becoming Implementation Support Practitioners

Feasibility of a communication program: improving communication between nurses and persons with aphasia in a peripheral hospital

Background: Difficulty in communicating (due to aphasia) can have serious consequences for patients in health care settings. Communication Partner Training is effective for improving communication between people with aphasia and health care professionals. Aim and Objective: This study aims to evaluate the feasibility of developing and introducing a Communication Program which focuses on improving communication between nurses and persons with aphasia in a peripheral hospital setting. Methods & Procedures: A mixed-methods feasibility study was conducted with a pre-test post-test design in the quantitative part and two focus group discussions in the qualitative part. Nurses received training for communicating with persons with aphasia. In the pre-test and post-test, nurses filled in a questionnaire for barriers and facilitators and a feasibility questionnaire. Nurses’ attitudes towards the Communication Program were further explored in two focus group discussions. Outcomes & Results: Forty six nurses took part in the training sessions. Most nurses were satisfied about the Communication Program (24/30) and intended to continue using it (25/30). Almost all nurses saw positive effects for patients with aphasia (27/30), such as an increase in the ability to communicate. However, nurses reported that using the program was time consuming and that they still often experienced frustration when communicating with persons with aphasia. Conclusions: Improving communication with persons with aphasia via the Communication Program seems feasible and valuable according to nurses. Nurses probably need more support during implementation of the Communication Program, mainly due to time barriers and the complexity of communicating with persons with aphasia. Further research should focus on revising the program, training health care professionals with different educational backgrounds, and assessing the implementation of this communication partner training in health care settings

How do healthcare professionals experience communication with people with aphasia and what content should Communication Partner Training entail?

Purpose: Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods: The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results: Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions: According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP. Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level

Evaluating communication partner training in healthcare centres: Understanding the mechanisms of behaviour change

Background Communication between people with aphasia and their healthcare professionals (HCPs) can be greatly improved when HCPs are trained in using supportive conversation techniques and tools. Communication partner training (CPT) is an umbrella term that covers a range of interventions that train the conversation partners of people with aphasia. Several CPT interventions for HCPs have been developed and used to support HCPs to interact successfully with people with aphasia. Aims The objective of this study was to identify the mechanisms of change as a result of a Dutch CPT intervention, named CommuniCare, in order to evaluate and optimise the intervention. Methods & procedures A total of 254 HCPs from five different healthcare centres received CommuniCare. An explorative qualitative research design was chosen. Two interviews were conducted with 24 HCPs directly after and 4 months after receiving the training that was part of CommuniCare. Two conceptual frameworks were used to deductively code the interviews. HCPs’ perspectives were coded into a four-part sequence following CIMO logic: the self-reported use of supportive conversation techniques or tools pre-intervention (Context), the intervention elements (Intervention) that evoked certain mechanisms (Mechanisms), resulting in the self-reported use of supportive conversation techniques and tools post-intervention (Outcomes). The Capabilities Opportunities Motivation–Behaviour (COM-B) model was used to fill in the Mechanisms component. Outcomes & results Three themes were identified to describe the mechanisms of change that led to an increase in the use of supportive conversation techniques and tools. According to HCPs, (i) information, videos, e-learning modules, role-play, feedback during training and coaching on the job increased their psychological capabilities; (ii) information and role-play increased their automatic motivations; and (iii) information, videos and role-play increased their reflective motivations. Remaining findings show HCPs’ perspectives on various barriers to use supportive conversation techniques and tools. Conclusions & implications HCPs in this study identified elements in our CPT intervention that positively influenced their behaviour change. Of these, role-play and coaching on the job were particularly important. HCPs suggested this last element should be better implemented. Therefore, healthcare settings wishing to enhance HCPs’ communication skills should first consider enhancing HCPs’ opportunities for experiential learning. Second, healthcare settings should determine which HCPs are suitable to have a role as implementation support practitioners, to support their colleagues in the use of supportive conversation techniques and tools

Ways to improve communication and support in healthcare centres according to people with aphasia and their relatives: a Dutch perspective

Background There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives