New programme to improve NHS stroke care for communication-impaired patients

A multidisciplinary team of experts are embarking on an £1m National Institute for Health and Care Research (NIHR) funded programme to change the way patients with aphasia, dysarthria, and other post-stroke communication impairments, are included in care and rehabilitation.

Led by academics at the University of Sheffield (Sheffield) and City, University of London (City), the ‘COMmunicating in STroke cAre and Rehabilitation’ (COM-STAR) research programme aims to understand the key communication training needs of stroke care staff working with NHS patients. Funded by the NIHR Health and Social Care Delivery Research (HSDR) Programme Grant, the three-year programme will then develop and test training to improve the communication abilities of these staff with patients, with the aim of increasing patient and staff satisfaction levels in services. This will ultimately better support inclusion, and access to services, for the two-thirds of stroke patients in the UK who have communication impairments.

Rebecca Palmer, Professor of Stroke Communication & Rehabilitation at Sheffield, and Madeline Cruice, Professor of Aphasia Rehabilitation and Recovery at City, jointly lead the programme. They are working in collaboration with colleagues at Glasgow Caledonian University; St George’s, University of London; University of Central Lancashire; University College London (UCL); University of Nottingham; University of Southern Denmark; and University of Technology Sydney (UTS).

The research consists of three stages:

• Stage 1 - Beginning in June 2024, the first stage will include a survey of UK stroke staff about their current communication training; barriers to getting trained or using the communication skills learned; and other factors that help. The first year also involves interviews with stroke survivors with communication impairments, family members, and staff to understand their experiences of communicating in hospital and community services, and reviewing the existing research literature to understand what has been done already in staff training.
• Stage 2 - All the findings from the first year of COM-STAR are integrated and will inform the context for the second year which uses the Experience-Based Co-Design (EBCD) process to develop a new communication skills training programme for staff and resources to support communication. This collaborative process involves a series of workshops with stakeholders including NHS stroke staff, service managers, policymakers, and stroke survivors with communication impairments and their families. Uniquely, COM-STAR will run this process in parallel across two sites in Sheffield and London, providing opportunities for a range of stakeholders to be involved.
  
  Some workshops will be attended by e-learning for health partners, NHS England-Technology Enhanced Learning, to help iteratively design and build what the team anticipate is likely to be a standardised digital communication training package for stroke staff.
• Stage 3 - The third stage of the research will be a full evaluation of the work conducted at four NHS trusts - two in the North of England and two in the South - including the implementation, feasibility, acceptability, outcomes and impact of the training package with stroke staff, patients, and family members.

Professor Palmer said:

“Communication is a basic human right which is compromised for many people following a stroke.  I have provided a lot of communication training to stroke staff over the years as a speech and language therapist, but I am very aware that not everyone that needs or wants to attend live training sessions is able to do so, and we don’t know what is needed to make training as useful as possible. I am extremely grateful to the NIHR for giving us this opportunity to address these issues through the evidence and experience based development and testing of new training, freely accessible to all.”

Professor Cruice said:

“On admission, 64% of stroke patients have issues with communication, and healthcare staff are often not equipped with the skills to deal with this. As a result, something needs to change, and we want to use this project to raise awareness of communication in general, and specifically, help stroke professionals improve the way they communicate with patients. Overall, it is about equitable care, and if we can get it right for people with aphasia and people with dysarthria, we can get it right for everyone.”

Dame Caroline Watkins, Professor of Stroke & Older People’s Care and Director of Applied Health Research hub (AHRh) at the University of Central Lancashire, who leads on the Stroke-Specific Education Framework (SSEF) support to the programme, said:

“It is vital that staff have the right knowledge and skills to deliver the right care, to the right people, at the right time, and COM-STAR will be fundamental to ensure that.  The high quality communication skills training developed will be a vital resource for the stroke care workforce in keeping with the Stroke-Specific Education Framework (stroke-education.org.uk) and the national stroke workforce strategy.”

Steve Jamieson, Chief Executive Officer, Royal College of Speech and Language Therapists (RCSLT), said:

“We’re absolutely delighted to see the National Institute of Health Research (NIHR) specifically commissioning and funding this exciting, new research, which seeks to understand the training needs of stroke rehabilitation staff with a view to improving the care of patients with aphasia and other post-stroke communication needs in the future. We look forward to collaborating and supporting the team to carry out this important work.”

COM-STAR will launch with a lunchtime webinar on Tuesday 25 June 2024 to share the proposed research programme and outline the opportunities for stroke staff and the public to be involved between now and February 2027. Please sign up here https://forms.gle/Uef3WD867YzJAPrf7 to receive the webinar link and more information about the project.