Luke Feathers

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: 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–then later further articulate–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–via open elaboration solicitations–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.

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.

TRANSFORMING END OF LIFE CARE THROUGH CLINICAL TEMPLATE DESIGN AND TRAINING

National evidence suggests that whilst up to 67% patients wish to die in their own home, only 21% of patients actually do so. Recent Leicester City data reviewing emergency admissions and mortality suggests that recognising those patients who are not going to recover is inadequate in both primary and secondary care. Current systems and skills appear to be failing dying patients and their families, with local financial modelling also suggesting significant savings if appropriate care arrangements had been anticipated and implemented. To improve care for this vulnerable patient group, a local enhanced service (LES) was commissioned and an innovative three strand approach developed in conjunction with local providers and experts. Firstly, a clinical template for an Emergency Health Care Plan (EHCP) was created, using unique macros developed collaboratively with palliative care physicians, geriatricians and IT experts. This SystemOne template allows care plans for pre-defined conditions to be completed quickly and efficiently, providing outline plans for core clinical event scenarios which can be used to aid both completion and provide depth and breadth to the EHCP which is generated by the template. Secondly, locality mentors and practice end of life care champions were appointed with a training programme developed with the local Consultants in palliative medicine. Thirdly, extensive evaluation of the impact of the project on both patient and clinician needs, with baseline, peri- and end-point analysis planned and costed from the outset. This abstract seeks to demonstrate the collaborative work behind the template, and the benefits of its use to practising clinicians, as already evidenced by its recent expansion to neighbouring CCGs.