Training students to obtain informed consent from patients with a communication disability

Evaluation of an interprofessional education programme

Celia Woolf

Institute of Health Sciences Education Research Afternoon

QMUL 9th June 2010

Health professionals must involve patients / clients in decision making (e.g. DoH 2001, 2004)

Obtaining informed consent from people with communication disabilities (PWCD) can be challenging

Informed consent and communication disability

Health professionals often don’t involve PWCD properly in decision making (Byng et al, 2003; Law et al, 2005)

• lack of knowledge – communication strategies– professional responsibilities

• negative attitudes and assumptions (Fox & Pring, 2005)

Background

Background

• Communication disability is common– estimated 20% of population at some

stage in life (Law et al, 2007)

• Importance of interprofessional collaboration

SLT role to assist other health professionals to communicate with patients (DoH, 2001; DoH, 2004)

Exposure may not improve ability to communicate with people who have communication disability Training improves communication facilitation skills

(Kagan et al, 2001)

Background

Study Design• 3 interprofessional groups of final year students

– Speech & Language Therapy– Nursing (Adult, Child, Mental Health)– Medicine– Radiography– Midwifery (n = 26)

• Two training sessions for each group (2 x 2 hours)

• Led by a facilitator and co-trainers with communication disabilities

Evaluation• Pre- and post-training questionnaires

– knowledge– confidence

• Focus groups– Students– Co-trainers

• Written feedback from students

• Observation of training sessions

Training content

• Session 1– Patient experiences– Ethico-legal context – Communication disability– Communication strategies

– Allocation of informed consent scenarios

• Session 2

– Informed consent simulations• Orthopaedic surgery• Change of drug treatment for epilepsy • Barium swallow

– Feedback & discussion

Training content

Evaluation results

Questionnaire Results

• Explored changes in confidence and knowledge about informed consent and communication disability

• 5 point response scale Strongly disagree -------------strongly agree

• Administered pre and post training

Questionnaire Results

• Compared pre- and post-training responses

Repeated Measures ANOVA

• Highly significant increases in confidence and knowledge

Knowledge about Communication Support

1

2

3

4

5

Student Confidence

1

2

3

4

5

Focus group results

Focus group recordings transcribed verbatim

Thematic analysis using Framework approach

Overwhelmingly positive experience– Students particularly valued

• meeting and working with co-trainers • simulation and hands on approach• mix of theory and practice

Examples of written feedback

Thank you! I hope this course is offered to as many healthcare practitioners / students as possible. (Medicine)

Excellent overall. Really enjoyable and a great learning experience.

Feeling considerably more confident! Many thanks!

(Adult Nursing)

The training sessions have given me an insight on how to

communicate with people with communication difficulties and the importance of simplifying medical

terminology. (Diagnostic Radiography)

Examples of written feedback

Admirable co-trainers whose participation in the programme was paramount. Exceptionally wonderful and open people. (SLT)

This was a very positive and constructive experience that proved to be completely

relevant to my practice and personal development and I enjoyed meeting people that face difficulties when interacting and

communicating with health care professionals. (Adult Nursing)

[I enjoyed] the chance to work in an interprofessional context and discuss issues

which might come up in future practice. Great chance

for practical involvement. (SLT)

Conclusions

knowledge about informed consent

knowledge of communication strategies

confidence about obtaining informed consent

attitudes towards people with communication disabilities

Acknowledgements• CETL for project funding

• Project Team: Celia Woolf, Tom Penman, Mary Rogers

• Co-trainers: Carole, Catriona, Kim, Collette

• CONNECT the Communication Disability Network

• Westminster Learning Disability Partnership

• Student participants

• Statistical advice: Fiona Warburton, City University