Understanding and optimising renal clinicians’ communication with older patients: a mixed methods intervention development study

In the UK, 3,500 adults with end-stage-kidney-disease (ESKD) over 65 start dialysis annually; this is the fastest growing group of recipients, and providing dialysis in this patient group costs >£300 million/year. Yet for older people, the survival benefits of dialysis are uncertain and its quality of life impact greatest. Conservative (non-dialytic) care is an alternative to dialysis for these patients, but there is huge unwarranted variation in rates of conservative care: from 5-95% across UK renal units. One reason for this is inconsistency in how clinicians communicate about treatment options and help patients decide about treatment, which strongly influence patients’ decision-making.

The OSCAR study (Optimising Staff-patient Communication in Advanced Renal disease) is a new NIHR-funded project to understand and optimise how renal clinicians communicate with older people about their treatment. We are employing a Research Support Assistant to support the study – see here: http://www.bristol.ac.uk/jobs/find/details.html?nPostingID=56354&nPostingTargetID=169754&option=28&sort=DESC&respnr=1&ID=Q50FK026203F3VBQBV7V77V83&LOV3=8491&Resultsperpage=10&lg=UK&mask=uobext

The successful applicant for the Research Support Assistant post is eligible to apply for this PhD studentship. The PhD research will be embedded in, but discrete from, the OSCAR study and conducted alongside the Research Support Assistant post. The student will develop the PhD study with support from the OSCAR supervisory team.

OSCAR Study Aims
1. To understand communication, information provision and decision-making support in renal units with varying treatment rates for older patients
2. To identify and describe interactional features of consultations between older people (80+ or 65+ with poor performance status/comorbidities) with advanced CKD (eGFR <20) and kidney clinicians
3. To develop an evidence-based, acceptable intervention, incorporating clinician training, to enhance how clinicians support patients’ decision-making
4. To contribute to the evidence-base on how patient-centred decision-making is interactionally implemented

Plan of investigation:
This study has four elements:
(i) Qualitative research at renal units (ethnographic observation and collation of information resources; staff interviews);
(ii) Video-recording consultations at renal units, analysing them using Conversation Analysis; collection of quantitative data from the patients, carers and staff recorded; qualitative patient and carer interviews about experiences of communication and decision-making;
(iii) Co-production of an intervention with keys stakeholders (patients, carers, clinicians, educators, commissioners);
(iv) Piloting the intervention; mixed-methods data collection exploring acceptability and implementation.

This research will contribute significantly to the currently limited evidence base on how clinicians communicate in consultations, and will develop an intervention to optimise how renal clinicians communicate with and support patients deciding whether or not to have dialysis.

We are looking to recruit an enthusiastic and talented PhD student to work with Dr Lucy Selman, Dr Rebecca Barnes and Dr Fergus Caskey at the University of Bristol. The studentship will provide training in qualitative and quantitative research methods and intervention development. You will be based within Population Health Sciences at the University of Bristol, a leading centre for excellence in population health science. The successful candidate will have access to an excellent training portfolio of short courses and transferable skills training. The role will include working away from Bristol at UK renal units during data collection period; applicants are referred to the job advertisement. Potential applicants are encouraged to email Dr Lucy Selman for more information or to arrange to discuss the post.

How to apply:
Please make an online application for the OSCAR Research Support Assistant post at: http://www.bristol.ac.uk/jobs/find/details.html?nPostingID=56354&nPostingTargetID=169754&option=28&sort=DESC&respnr=1&ID=Q50FK026203F3VBQBV7V77V83&LOV3=8491&Resultsperpage=10&lg=UK&mask=uobext.

The successful applicant will apply for the PhD studentship after selection.

Candidate requirements:
Academically, candidates for the PhD may qualify for admission if they have: a Master’s degree; an Honours degree, or a 4-year Bachelor’s degree, plus at least 1 year of registration for the Master’s degree; a 3-year Bachelor’s degree plus at least 2 years of registration for a Master’s degree. The PhD candidate will ideally have a background in applied health research or another relevant (social science or medical) discipline.

Contacts:
Interested and suitably qualified candidates should make informal contact with [Email Address Removed]. The project is available for start date from 1st January 2020.