title: Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model.
abstract: OBJECTIVE
  To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time.
  
  
  METHODS
  Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups.
  
  
  RESULTS
  SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients.
  
  
  CONCLUSIONS
  Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients.
authors.affiliation: University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom. Electronic address: jane.griffiths@manchester.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Griffiths
authors.affiliation: Barts & The London School of Medicine, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turnser Street, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wilson
authors.affiliation: University of Cambridge, Centre for Family Research, Free School Lane, Cambridge, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Ewing
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Southmoor Lane, Wythenshawe, Manchester, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Connolly
authors.affiliation: University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom.
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
mesh_terms: D000328:Adult; D003142:Communication; D017144:Focus Groups; D006699:Home Care Services; D064946:Hospice and Palliative Care Nursing / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D009723:Nurse-Patient Relations; D064691:Nurses, Community Health / Q000193:education; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011361:Professional Competence; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Communication skills; District Nurse; Palliative care