Dr. Douglas is professor in the Department of Communications Sciences & Disorders at Central Michigan University. Dr. Douglas is a speech-language pathologist who specializes in improving the capability to communicate one’s feelings, preferences, and needs to support relationships. She has 20 years of experience supporting people living with dementia and their care partners in long-term care through clinical practice, research, quality improvement projects, and teaching. Her research aims to advance evidence-based, person-centered practices in communication and quality-of-life interventions for people living with dementia, aphasia, and other communication disorders. Dr. Douglas is seeking to develop skills in implementation science and pragmatic trial design to improve outcomes for people living and working in long-term care environments.
Over two-million Americans live in skilled nursing facilities (SNFs), and most are people living with dementia (PLWD). Certified nursing assistants (CNAs) are responsible for providing the majority of physical and emotional care for PLWD in SNF settings, yet research demonstrates they lack effective tools and adequate training around communication. Ineffective communication between CNAs and PLWD can result in rejection of care, behaviors such as yelling and lashing out verbally or physically, and inappropriate antipsychotic prescribing. Addressing ineffective communication with CNAs is essential to improving care. However, most interventions are not tailored to PLWD, do not incorporate CNA input or use pragmatic outcome measures. This Career Development Award will provide Dr. Douglas with training in stakeholder engagement, pragmatic outcome measurement, and pragmatic trial methodology to develop interventions for effective communication with PLWD for CNAs. This training will support the following Specific Aims: (1) To assess the feasibility of data collection methods for pragmatic clinical outcomes (rejection of care, behavioral symptoms) from the electronic medical record; (2) To document flexibility of delivery and adherence of a speech-language pathologist administered communication coaching intervention on pragmatic outcomes in 4 SNFs, and (3) To conduct a process evaluation of the communication coaching intervention using a stakeholder focus group comprised of CNA participants, speech-language pathology participants, PLWD, and facility leadership before and after implementation of the communication coaching intervention to assess implementation endpoints (acceptability, appropriateness, feasibility), and to identify facilitators and barriers to successful implementation. This award will support the development and testing of effective communication strategy interventions to support optimal outcomes for PLWD and to alleviate care partner burden for CNAs.