When did you first introduce the innovation?
More than 24 months ago
Please describe the innovation you have developed
1 in 2 people in the UK are expected to develop cancer in their lifetime (CRUK, 2015) and practitioners working in both specialist and non-specialist health and social care settings are likely to encounter people with cancer. The programme was developed in 2011 to provide practitioners with the opportunity to critically examine the wider cancer agenda and the impact of cancer care on those affected by the disease. As a cancer diagnosis and treatments can cause considerable distress, effective communication skills are fundamental to effecting quality in cancer care. The innovations within the module involve: 1) Experiential learning of advanced communication skills; 2) the incorporation of a model of advanced communication skills training known as ‘Connected’ originally developed by the National Cancer Action Team; 3) collaboration with local cancer and clinical networks.
At Validation permission was granted by, MCCN and NCAT to incorporate the 2 day ACST course into the module on a collaborative basis.
The course uses trained actors to simulate challenging communication scenarios identified by each of the participants. These are video recorded and playback is used to stimulate formative feedback, discussion and self-awareness regarding the impact of facilitating skills and blocking behaviours on the actors in role. This is a profound learning tool which although challenging to participants, promotes deep learning. The aim is to help HCPs to communicate effectively in the complex and often challenging situations they face when dealing with people affected by cancer.The assessment involves a video recorded OSCE of a simulated communication challenge using actors, plus a critique of personal skills used.
What prompted you to develop this innovation?
In 2000, the NHS Cancer Plan (DH, 2000) stated that: ‘There will be new joint training across professions in communication skills.Advanced communication skills training will form part of continuing professional development programmes’ (DH,2000). A three day national Advanced Communication Skills Training (ACST) programme (known as Connected) was developed, funded centrally and rolled out nationally by the National Cancer Action Team and delivered by trained and accredited facilitators. In 2008, the national programme was adapted to ensure a single model of advanced communication skills training and commissioners were instructed to commission cancer and palliative care services from providers who could evidence that HCPs had undertaken the Connected ACST course. Debbie Wyatt became an accredited ACST facilitator for Merseyside and Cheshire Cancer Network in 2009.
In response to evaluations from participants and subsequent piloting, the 3 day course was revised and rolled out as a 2 day course from March 2012. The National Cancer Action Team ceased operations from 31st March 2013 and the local cancer networks were reorganised into Clinical Network Groups. As a result, central funding for ACST courses ceased from April 2013 and the local clinical network groups continued to support the delivery of courses until July 2015. The Marie Curie Palliative Care Institute Liverpool (MCPCIL), a partnership between the University of Liverpool (UoL), Marie Curie Cancer Care (MCCC) and the Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT) were successful in their bid to continue and take forward advanced communication skills training within the North West region from August 2015. Debbie has continued to facilitate advanced communication skills training based on the connected model in collaboration with MCCN, CMCNG and more recently with MCPIL.
In your view, what is it about this innovation that makes it different/important?
This model of advanced communication skills training works as evidence by the following extract taken from NCATs evaluation of the Connected course in 2011:
The original three day Connected programme was subjectively evaluated by participants to identify whether participants felt it impacted on their practice. Up to December 2011, 12,733 senior health professionals had attended the course. All have completed a post course evaluation; 95% of participants said the course met their expectations; 83% would recommend the course to others; In a small follow up survey 93% said they learned something on the course that they later used in clinical practice.
The new two day Connected programme was piloted in ten sites during Autumn 2011 with 97 HCP’s and independently evaluated by Birmingham City University; 96% said that the course met their expectations; 92% said they would definitely recommend the course to others.
Incorporating this model of advanced communication skills training into the module is a novel way of enhancing practice whilst maintaining academic rigour, of developing effective collaboration with outside agencies, of responding to national drivers and practice requirements and of meeting different learning styles. The programme supports interprofessional learning between a range of practitioners including specialist nurses, allied health professionals, researchers and managers who have responsibility for cancer care and/or cancer services in cancer and non-cancer specific settings. It’s skills based focus can make make a very real difference in practice, supported by an NCAT evaluation of almost 13,000 participants of the Connected programme which indicated that the majority of participants felt that the course had had a positive impact on their practice.
To what extent does your innovation make use of existing approaches, resources or technologies?
The innovation utilises existing resources through accredited Connected facilitators, actors trained in the Connected model, an existing validated programme with associated classroom and learning resources and recording equipment available through the Faculty of Health and Social Care.
To what degree has this innovation led to changes in education or clinical practice?
I have anecdotal evidence that students who completed the module felt that the ACST component had had a positive impact on their practice. However, evidence to support the Connected model was collated for several years. Extracts from the 2011 evaluation include:Prior to this course, I found the quiet, non cooperative patient difficult. It has helped role playing this in the course, as I was able to have confidence in my abilities as the actors were so good at playing that characteristic. I feel able to ‘challenge’ this type of behaviour model and was able to build rapport with a number of patients who I previously would have allowed to continue to use their non communication as a barrier. I now have good relationships with these patients and this fosters better communication and trust and ultimately better patient care. The findings of a range of research undertaken by the three national leads, Wilkinson, Maguire and Fallowfield, support the development of the Connected programme.
What evidence do you have of the impact of the innovation?
Informal and formal feedback indicates that the students both enjoyed and benefitted from the module. Though they found the 2 day ACST component very challenging, they stated that they had experienced deep learning from the process which they were able to apply in practice. The effectiveness of teaching, assessment, guidance and support was rated as excellent. Students commented that they enjoyed interacting with other professionals from other clinical areas, enjoyed the teaching style and felt very supported.
The 2014 Internal Programme review stated ‘The inclusion of the ACST course stands as an example of excellence and I am sure represents added value for the learners engaging with this module’.
References
Wilkinson S., Perry R., Blanchard K. (2008) Effectiveness of a three day communication skills course in changing nurses communication skills with cancer/ palliative care patients; a randomised controlled trial. Palliative Medicine 22 365-375
Maguire, P Booth K., Elliot C., Jones B. (1996). Helping health professionals involved in cancer care acquire key interviewing skills – the impact of workshops. European Journal of Cancer 32A (9):1486-1489.
Fallowfield, L. Jenkins V., Farewell V., Saul J., Duffy A., Eves R (2002). Efficacy of CRUK communication skills training model for oncologists: a randomised controlled trial. Lancet, 359:650-656
To what degree has the innovation been disseminated in your organisation or elsewhere?
Through Programme Committee and Department meetings.
Please provide details of any plans you have to disseminate the innovation in the future.
Within the Faculty.
Dissemination currently under review. For any queries regarding the module/innovation, please contact Debbie Wyatt.