Communication practices to achieve early mobilisation of people living with dementia following surgery for hip fracture: a conversation analytical study (‘VideOing to Improve Communication through Education - Hip Fracture’; VOICE-HF).

Research question: What healthcare professional (HCP) communication practices are effective in achieving early and continued mobilisation among people living with dementia (PLWD) following hip fracture surgery? Background: 75,000 people are admitted to hospital with a hip fracture each year, half of whom have dementia. Outcomes are worse for PLWD. Fewer than half regain their pre-fracture mobility and a third die within a year. Best practice is for rapid fracture surgery, and early mobilisation – getting out of bed, standing or walking, by the day after surgery. This is associated with better outcomes, fewer complications and shorter hospital stay. PLWD are less likely to mobilise early. Dementia affects communication, judgement and reasoning. PLWD may be less able to communicate pain, anxiety, understand and follow HCP instructions, and see the benefits of mobilising early. Practitioners vary in how they communicate. Identifying HCP communication practices that are effective in achieving early mobilisation ( what works ) will allow the description and dissemination of best practice. Methods: Conversation analysis (CA), is a socio-linguistic research method, which looks at the fine detail of the language we use and responses to it. We will use CA to identify specific and teachable communication practices that HCPs use. We will recruit HCPs in advance, and PLWD, if possible, before their surgery. We will video record up to 50 interactions on 3 trauma orthopaedic wards when HCPs are supporting PLWD to mobilise. CA will be used to reveal systematic patterns in interactions, and successful practices. We have experience in conducting video research with PLWD on acute wards. We will use an established protocol for recruitment, consent and data collection, developed with user input and acceptable to ethics committees. Patient and public involvement (PPI): We have had extensive PPI engagement from the initial conception of the research. PPI representatives support the importance of this research and will be actively involved at every stage of the research process. Equality, diversity and inclusion: We have completed an Equality Impact Assessment. NHS HCP participants are ethnically diverse. This research attends to how communication challenges, both language- and dementia-related, are managed. Hip fracture is relatively uncommon among older people from ethnic minority groups. We therefore endeavour to over-sample individuals from these groups. Our previous VOICE studies have successfully recruited representative participants. Dissemination and impact: Findings will inform practical communication guidelines for HCPs, which will be immediately useable by staff on wards. We will deliver new socio-linguistic knowledge, which will be presented at conferences and published in journals. We will include findings on a website currently under development that includes digital learning resources to support educators to deliver communication skills training. This has the potential for widespread and low-cost uptake. We will apply for further funding to develop and evaluate a communication skills training course. Timelines: months -1 to 2 ethics and site approvals; months 3-10 recruitment and data collection; months 5-15 data analysis; months 11-15 identifying and describing trainables ; months 16-18 guidelines, grant application, paper submission, reporting.