Person-centered Communication Research Articles

Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for Cardiovascular Disease.

Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships. Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC. We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations. This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.

Is elderspeak communication in simulated hospital dementia care congruent to communication in actual patient care? A mixed-methods pilot study.

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed-methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care. A 3-part mixed-methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within- and across-case coding. Three simulations using different modalities (manikin, role-play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio-recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed-rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged. The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient. Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient. Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person-centred communication training in nursing staff. Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia. This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person-centred communication. STROBE. No Patient or Public Contribution.

Understanding patients’ perspectives of clinical communication within a Major Trauma Centre

Clinical communication between major trauma patients (MTP) and healthcare professionals is extremely complex. Multiple demands are placed on specialist multi-disciplinary teams (MDT) and patients in all stages of treatment. Patient-staff clinical communication has an integral role in MTP healthcare experiences, supporting them with a range of physical and psychological difficulties post-injury. This study aimed to understand MTP perspectives of clinical communication within a MTC through qualitative semi-structured interviews. Twenty participants were purposively sampled from an outpatient follow-up clinic and interviews were analysed using a pluralistic qualitative approach. Three themes were conceptualised from the data; “Challenges to speaking up” “Conversations left me feeling” and “Strategies need to be clinical but tailored”. Patients often found it challenging to speak up due to feelings of vulnerability, confusion, and challenges navigating medical terminology. Patients spoke of not wanting to burden staff and family members playing a role in patient-staff communication, but these challenges require further exploration. Patients highlighted the positive (feel reassured, cared for, and human again) and negative (feeling like an object, angry, confused, and dependent) emotional impact of staff communication. Patients also described the benefits of being provided with written information, clear explanations of injuries and person-centred communication. MTP require multiple options to communicate and address psychological difficulties. Greater training on the emotional impact of conversations, skills to respond to psychological distress and communication guidance for staff, is needed to improve clinical communication with MTP.

Implementation of the German CSNAT-I to support family caregivers in palliative home care: Evaluation results

Implementation of the German CSNAT-I to support family caregivers in palliative home care: Evaluation results Abstract. Background: Supporting family carers in palliative home care mostly lacks a systematic approach. In a three-year model project, the Carer Support Needs Assessment Tool Intervention (CSNAT-I), an evidence-based person-centred approach for family caregiver support, was implemented and evaluated in three project regions in North Rhine-Westphalia. Aim: To present the implementation process and factors that impacted on it. Methods: The German CSNAT-I was adapted and subsequently implemented by six hospice services and specialised home palliative care teams with the assistance of champions. The evaluation was based on Normalization Process Theory (NPT) using a mixed methods evaluation design. Results: The German CSNAT-I was used across service boundaries, but routine implementation could not be fully achieved within the relatively short implementation timeframe. Staff members were convinced of the approach's significance, and feedback from family caregivers was generally positive or non-specific. The practice of caregiver support evolved, and the importance of family caregivers received increased attention. Barriers emerged in person-centred communication with family caregivers and within organizational routines. Conclusion: The implementation showed that the person-centred intervention has the potential to enhance caregiver support in the German palliative home care setting. Implementing the CSNAT-I requires a cultural shift within the services.

Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study

ObjectiveVulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' ‘perinatality’ plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. MethodsThe study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). FindingsConcerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. ConclusionWe identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.

PERSON-CENTERED COMMUNICATION AND APATHY IN NURSING HOME RESIDENTS WITH DEMENTIA

Abstract Apathy is prevalent in dementia and is associated with poor health outcomes. Communication is fundamental for daily caregiving activities. Person-centered communication has positively impacted some neurobehavioral symptoms, but its impact on apathy remains unclear. This video observation study examined the association between healthcare workers’ use of person-centered communication and apathy in nursing home residents with dementia. Three videos, three to ten minutes each, were recorded for each resident to capture daily caregiving interactions. Healthcare workers’ communication was transcribed and segmented into phrases. Communication was coded phrase-by-phrase via video observations using the Person-Centered Behavioral Inventory. Communication was categorized as none, person-centered, non-person-centered, or others. Apathy was coded second-by-second via video observations using the Person-Environment Apathy Rating. Concurrent correlations and ANOVA were used for analysis. A total of 17 residents with dementia and apathy and 21 healthcare workers (e.g., certified nurse assistants, activity staff, and nurses) were recruited from three nursing homes. Results showed that caregiver communication approach had widely mixed correlations with second-by-second apathy scores across all videos (averaged r=0.09, range: r=-0.18 to r=0.54). Further ANOVA analysis showed that using person-centered communication, as compared to other communication approaches, had mixed associations with apathy; 19.6% showed significantly lower apathy, 35.7% showed significantly higher apathy, and 44.6% showed no significant associations. Overall, healthcare workers’ communication approach can potentially impact apathy for residents with dementia. Future research that examines the sequential associations between communication and apathy is needed to guide intervention development to reduce apathy and improve dementia care in nursing homes.

DOES WORKFORCE ROLE IMPACT LEARNING IN NURSING HOME EDUCATION? EVIDENCE FROM THE CHATO NATIONAL TRIAL

Abstract Nursing home residents rely on a variety of staff to meet their physical and psychosocial needs. Our communication intervention for nursing home staff—entitled CHATO—is currently being tested in a pragmatic clinical trial nationwide. All staff, regardless of role, are encouraged to participate to create a culture of person-centered communication. We analyzed differences in learning outcomes, and completion and satisfaction, among five staff roles including 274 aides (CNA, CMA), 180 nurses (LPN, RN), 52 administrators, 42 professional staff (social work, speech-, physical-, occupational-therapy), and 134 other non-care staff (dietary, custodial, transport). We compared changes in knowledge of effective person-centered communication, measured by (1) scores on the Changing Talk Scale (CHATS) and (2) ratings of video-based communication appropriateness, communication effectiveness, recognizing person-centered, and elderspeak communication. At baseline, aides and non-care staff had significantly lower CHATS scores than professional staff (p<.05). All roles demonstrated similar and significant knowledge gain with mean score increases ranging from 17.8-24.6 (p’s <.001). Similar patterns of changes were observed for communication ratings. The overall completion rate for enrolled staff was 82.6%, of whom only 6.2% reported dissatisfaction. The completion and satisfaction outcomes did not vary by role. These findings suggest that CHATO can be a useful education program for enhancing person-centered communication across different staff roles. Although baseline knowledge was higher in certain roles, the knowledge gains, completion rates, and satisfaction ratings did not vary by staff role. It is important to remember that all staff, not just direct care staff, benefit from education in nursing homes.

NURSING HOME WORKFORCE EDUCATION: DOES ONE SIZE FIT ALL? EVIDENCE FROM THE CHATO NATIONAL TRIAL

Abstract Educating the nursing home workforce to provide quality dementia care is a national priority. Staff education is usually provided to all staff in communities that vary in size, location, ownership, and resources with little consideration for diversity. To evaluate suitability for diverse staff, we compared learning outcomes for White, non-Hispanic staff and staff of diverse races and ethnicities who completed CHATO in year one. White non-Hispanic staff (N=402) scored higher on knowledge assessments than staff self-reporting other races and ethnicities (N=201) at baseline (mean=57.1% vs. 49.1%, p<.001). Both groups improved on post-assessment (by 19.0 and 23.1 percentage points, respectively, p<.001), Communication ratings indicated that at baseline White, non-Hispanic staff were more knowledgeable about effective (p<.001), appropriate (p=.008), and person-centered communication (p<.001) than diverse staff; while the latter recognized elderspeak better (p=.002). Both groups improved their communication ratings post-CHATO (p from .001 to <.001). While confidence in providing dementia care was similar between groups at baseline (p=.754), it improved only for White, non-Hispanic staff (p<.001). Intention to use learned skills in practice was higher for staff in the diverse group (p<.001). Diverse staff rated their satisfaction with the intervention lower (p <.001), suggesting that it was not tailored to their needs. These findings support the value of CHATO in increasing communication knowledge among diverse NH staff. However, lower satisfaction suggests the need to adapt CHATO to be more inclusive and culturally appropriate. Tailoring education may increase impact on outcomes and overcome disparities in dementia care common in NHs serving diverse populations.

IMPLEMENTATION AND EFFECTIVENESS OF VIRTUAL REALITY PROGRAMS IN LONG-TERM CARE SETTINGS

Abstract Virtual reality (VR) is an immersive technology that allows users to experience a computer-generated simulation of a three-dimensional environment. It is used in healthcare for education and training purposes, as therapeutic interventions, and for social engagement. However, there are few studies exploring the use of VR in long-term care settings. The purpose of this symposium is to share lessons learned on the implementation and effectiveness of VR programs in long-term care settings. All studies use the Consolidated Framework for Implementation Research to guide their exploration of the facilitators and barriers to implementation. They use qualitative methods, such as interviews, focus groups, and ethnographic observation, to collect data on the experiences of staff and residents participating in the programs. Study one highlights the critical need to engage decision makers to assess organizational readiness prior to creating an implementation strategy. Study two showcases the iterative process involved in translating an in-person, person-centered communication training into a VR training program for frontline healthcare workers. Study three features the benefits and challenges of using VR with older residents. Study four explores staff perspectives on facilitators and barriers to adopting VR in long-term care. The studies highlight the potential benefits of VR in enhancing communication skills, social engagement, and support for residents’ personhood. They also identify factors for successful implementation, such as staff champions, sufficient technological infrastructure, and organizational support for infrastructure and human resources. The studies offer valuable insights for researchers and practitioners working to implement novel VR interventions in long-term care settings.

ORGANIZATIONAL READINESS FOR A VIRTUAL REALITY TRAINING PROGRAM CALLED BE EPIC-VR

Abstract An essential first step to implementing virtual reality programming in home care and long-term care settings is to assess organizational readiness by determining factors that enhance the likelihood of its successful implementation. Be EPIC-VR is one such virtual reality program that supports dementia-specific, person-centered communication training for frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research (CFIR), the current study aimed to identify factors influencing Be EPIC-VR’s implementation in home care and long-term care settings. Semi-structured interviews were conducted with nine managers from home care and long-term care settings in Canada. Transcripts from these interviews were analyzed using the Framework Analysis’ five-step ongoing, iterative process: familiarization, identifying a thematic framework, indexing, charting, and mapping/interpretation. Textual data were open-coded and organized deductively (using CFIR’s pre-set codes) and inductively (for emergent codes) into themes and subthemes. Four themes emerged as factors contributing to organizational readiness including 1) openness to virtual reality as a training tool, 2) staffing and training logistics, 3) organizational culture supporting staff development, and 4) external pressures for organizational sustainability. These findings will guide how the Be EPIC-VR implementation team collaborates with organizational decision makers to ensure that Be EPIC-VR is a good fit for those organizations, to prepare for its implementation, and to optimize the likelihood of success. The study findings offer valuable insights for researchers and practitioners working to implement new virtual reality interventions in home care and long-term care settings.

PATIENT AND CARE PARTNER QUESTIONS AND CLINICIAN RESPONSES DURING INITIAL OUTPATIENT PALLIATIVE CARE APPOINTMENTS

Abstract Person-centered palliative care (PC) requires person-centered communication. This study characterized questions asked by persons with neurologic illnesses and their care partners and PC clinicians’ responses. We analyzed audio recordings from 38 initial outpatient PC appointments to characterize questions stated by patients and care partners. Based on previous research, we identified two question types: direct questions (typically-phrased, stated to obtain or clarify information) and indirect questions (declarative statements, not phrased as a typical question, made with information seeking intent). We rated the completeness of clinicians’ responses on a 4-point scale ranging from 1 (completely addressed question and provided additional information) to 4 (no response). We also coded features of clinicians’ responses, including offers of support or action and unprompted recommendations. Patients and care partners asked both direct (n = 442; 79.6%) and indirect (n = 113; 20.4%) questions. More than 60% of all questions were about symptoms, treatment, and lifestyle issues. Clinicians responded to 90.9% of direct questions and 90.2% of indirect questions; their responses to both question types were similar in completeness (median = 1, mode = 1). Clinicians’ responses to direct questions included more offers of support or action compared to responses to indirect questions (17% v. 11%). Responses to indirect questions included more unprompted recommendations compared to responses to direct questions (21% v. 9%). Persons with neurologic illnesses and their care partners use different question types to obtain information during PC appointments. Implications include the need for clinician training to effectively respond to different question types and topics.

BE EPIC-VR: TRANSLATING AN IN-PERSON, PERSON-CENTERED COMMUNICATION TRAINING PROGRAM INTO VIRTUAL REALITY

Abstract Be EPIC is a dementia-specific, person-centered communication training program for frontline healthcare workers that uses simulations with trained actors, reflection, and feedback. Scaling Be EPIC is limited by resource and methodology demands of recruiting and training actors and consistency of delivery across sites. Virtual reality (VR) is a promising solution to the problem of scaling Be EPIC because it provides interactive, realistic, and consistent simulations. However, there is limited research on implementing VR to train frontline healthcare workers. Guided by the Consolidated Framework for Implementation Research, the current study used an effectiveness-implementation hybrid design to compare simulation experiences of Be EPIC-VR with Be EPIC-in person and real-world clinical encounters. The study also explored factors that can influence the future implementation of Be EPIC-VR in long-term care home settings during the pre-implementation period. Six frontline healthcare workers who completed the Be EPIC in-person version with trained actors also completed the same assessment simulation in VR, followed by an interview. Thematic analyses revealed two themes that contributed to the simulation’s realism: the immersive nature of the virtual environment and the accuracy of the avatar’s visual, verbal, and behavioral characteristics. Moreover, the factors influencing the successful implementation of VR simulations in long-term care home settings include sufficient technological infrastructure and workplace personnel who can assist with Be EPIC-VR implementation. The findings highlight the potential to scale Be EPIC using VR and provides insights into the iterative process involved in translating an in-person training into a VR training program.

PSYCHOMETRIC PROPERTIES OF THE CHANGING TALK ONLINE TRAINING PROGRAM EVALUATION SCALE FOR LONG-TERM CARE STAFF

Abstract The Changing Talk (CHAT) intervention educates long-term care staff about elderspeak and person-centered communication strategies. The online version of CHAT training is a national trial to reduce behavioral symptoms in long-term care residents with Alzheimer’s Disease and other dementias. The development and validation of program evaluation scales are important for ensuring valid intervention evaluation. Using item response theory to assess the satisfaction of the CHATO program by staff, we tested for unidimensionality and local independence. Confirmatory factor analysis showed that there was redundancy between two items, based on the best fitting unidimensional model (Root Mean Square Error of Approximation=0.134, Comparative Fit Index=0.999). The IRT parameters showed that the highest discriminating item was the “The information in the course was clearly presented,” which also showed the highest range of difficulty parameters for the response choices. Other items in the scale were: “This course enhanced my knowledge of the subject matter,” “The information was a good refresher for me,” “I can use this training in my job,” “The resources listed in the course were useful for my job duties,” “The video clips were useful in helping me learn course materials,” “I would recommend this course to others,” “The learning activities were useful in helping me learn course materials,” and “I was satisfied with this course overall.” Differential item functioning due to race/ethnic, language, and educational achievement were examined to test for the presence of measurement noninvariance. This program evaluation scale may be utilized in other pragmatic trials as a valid measurement tool.

Responses of Persons Living With Dementia to Caregiver Validating Communication: A Secondary Analysis.

Background and Purpose: Good communication between persons living with dementia and their caregivers is one important consideration when fostering a positive relationship and improving the effectiveness of care. Care can be a challenge if the person living with dementia does not feel understood or fails to cooperate with care. The individual may feel disrespected and may resist assistance. Validation therapy is a person-centered method for communicating with persons living with dementia that involves validating the experiences, feelings, and reality of an individual to encourage cooperation or provide for safety. The purpose of this study was to identify frequencies of four behavioral responses (cooperation, apathy, resistiveness, and distress) from persons living with dementia when validation communication strategies were used during care activities. Methods: This was a secondary analysis of homecare videos (n = 41) of family caregivers interacting with a person living with dementia during daily care. Behavioral coding was used to examine the relationships between validating communication and the response of a person living with dementia. Caregiver use of specific validation techniques in their communication (affirmation, acknowledging emotions, and verbalizing understanding) was coded along with subsequent responses of the person living with dementia (resistiveness, distress, apathy, or cooperation). Results: Affirmations produced an 11% probability of a cooperative response by the person living with dementia. Caregiver verbalization of understanding resulted in a 6% probability of cooperation, and silence was associated with an 8% probability of cooperation. Nonvalidating communication behaviors were associated with negative reactions. Implications for Practice: Effective person-centered communication between caregivers and persons living with dementia improved cooperation with care and decreased distress. Affirmations and verbalizing understanding were two types of validating communication more likely to elicit a cooperative response and can improve care quality, decrease caregiver burnout, and mitigate challenging behavioral responses in persons living with dementia.

Dementia and communication.

People with dementia of all stages and subtypes can experience challenges with communicating. Therefore, it is vital that community nurses working with people with dementia have an understanding of the ways in which communication might be challenged, and that they have skills in communicating effectively. This article presents an overview of the ways in which dementia might impact on communication and offers the model of person-centred dementia care as a way of communicating effectively. The use of person-centred communication in practice is illustrated through a case study approach, highlighting the practical approaches that can be used by community nurses in their practice.

The patient’s first point of contact (PINPOINT) – protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses

BackgroundA major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions.MethodsProject PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses.DiscussionThis research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care.Trial registrationClinicalTrials.gov Identifier: NCT06067672.

Predictors of preparedness for recovery following colorectal cancer surgery: a latent class trajectory analysis

Aim With an interest in providing knowledge for person-centred care, our overall goal is to contribute a greater understanding of diversity among patients in terms of their preparedness before and up to six months after colorectal cancer surgery. Our aim was to describe and provide a tentative explanation for differences in preparedness trajectory profiles. Material and methods The study was explorative and used prospective longitudinal data from a previously published intervention study evaluating person-centred information and communication. The project was conducted at three hospitals in Sweden. Patient-reported outcomes measures, including the Longitudinal Preparedness for Colorectal Cancer Surgery Questionnaire, were collected before surgery, at discharge, and four to six weeks, three months, and six months after surgery. Clinical data were retrospectively obtained from patients’ medical records. We used latent class growth models (LCGMs) to identify latent classes that distinguish subgroups of patients who represent different preparedness trajectory profiles. To determine the most plausible number of latent classes, we considered statistical information about model fit and clinical practice relevance. We used multivariable regression models to identify variables that explain the latent classes. Results The sample (N = 488) comprised people with a mean age of 68 years (SD = 11) of which 44% were women. Regarding diagnoses, 60% had colon cancer and 40% rectal cancer. The LCGMs identified six latent classes with different preparedness for surgery and recovery trajectories. The latent classes were predominantly explained by differences in age, sex, physical classification based on comorbidities, treatment hospital, global health status, distress, and sense of coherence (comprehensibility and meaningfulness). Conclusion Contrary to the received view that emphasizes standardized care practices, our results point to the need for adding person-centred and tailored approaches that consider individual differences in how patients are prepared before and during the recovery period related to colorectal cancer surgery.

A78STEPS: Development of a communication skills framework for use in a broad range of simulation-based education

Effective communication is a vital skill in healthcare, whether discussing sensitive or challenging topics, explaining decisions, supporting colleagues, welcoming staff, de-escalating situations, reviewing accolades and complaints or building rapport. Many people find it difficult to initiate, hold, conclude and follow-up conversations. Simulation-based education (SBE) has been identified as an effective way to improve communication skills, however, a structured communication skills framework is necessary. A plethora of established communication skills frameworks [1-3] exist, each excellent within their own sphere. Our purpose was to develop a generalizable, transferable framework to suit the broad range of communications covered in SBE; a framework which can be repeated, practised, and easily memorized. Experts in communication skills, healthcare education, and SBE reviewed existing communication skills frameworks. The new framework’s foundations were key skills, within every conversation, between healthcare professionals and colleagues, patients or relatives/carers, or between non-healthcare professionals and colleagues/clients. Thematic analysis of data from participants of sessions from the previous five years identified these themes: Why, when, where and how to start a conversation The best time to have a conversation Showing empathy and listening (verbal and nonverbal skills) Providing support, without being solution orientated How to sense-check ourselves and others, after the conversation The STEPS framework was developed two years ago and has been used by our facilitators in SBE, to assist participants to be confident in structuring and having conversations. The five-step framework has a memorable mnemonic STEPS; Start, Time, Empathy, Provide-support, and Sense-check. STEPS has been well received by over 500 participants. They have reported that it is easy to remember and highly applicable to situations in and out of work. Post-intervention surveys showed significant improvement in learners’ confidence and perceived competence in holding conversations. Focus group discussions revealed that learners found the STEPS approach helpful in managing their own emotions and in creating an open dialogue with others. The STEPS approach is a generalizable communication skills framework that can be implemented in SBE activities to improve people’s understanding of structuring conversations. It has had a positive impact on participants particularly regarding their perceptions of having ‘challenging’ conversations. The STEPS approach can be used to guide healthcare and non-healthcare professionals in various settings and is a valuable tool in improving person-centred communication. STEPS helps people initiate, structure and navigate a conversation with kindness and in a way that makes constructive outcomes possible. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Barriers and Facilitators of a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program for Older Adults: Perspectives of a Multidisciplinary Care Team.

The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.

How Do Qualities of Supportive Conversations Affect Heart Rate Variability During Conversations About the Death of a Parent?

ABSTRACT This study examined the impact of person-centered communication on bereaved young adults’ physiological stress responses when they talked about the death of their parent. Heart rate variability – indexed by the standard deviation of the normal-to-normal intervals (SDNN), the root mean square of successive differences (rMSSD), and the heart rate variability index (HRVi) – was monitored before, during, and after the interaction as an objective measure of stress reactivity and recovery. The final sample included 69 subjects, and they conversed with research confederates who provided varying levels of person-centered support. The results showed that participants who received highly person-centered support experienced faster stress recovery, as indicated by increased HRVi, compared to those who received moderately or low person-centered support. Bereaved adults’ SDNN during the interaction was positively associated with subjective evaluations of cognitive reappraisal, emotional improvement, and support quality. The discussion highlights the significance of supportive interactions on physiological, psychological, and emotional well-being.