The evidence

Summary of research findings on SAGE & THYME, plus publications, textbooks and independent evaluation

Summary of research findings on how SAGE & THYME helps

The evidence for the impact of SAGE & THYME training can be demonstrated at each level of Kirkpatrick's model for evaluating training:

  1. Reaction of learners to the training (e.g. enjoyable, engaging and relevant)
  2. Learning gained (e.g. acquire the intended knowledge, skills, attitude, confidence)
  3. Behaviour change (e.g. use what they learned in their job)
  4. Results (e.g. outcomes resulting from the training)

We have summarised the evidence below - the full details can be found in the published papers.

Kirkpatrick pyramid level 1 - reaction
Level 1 - Reaction of learners to the SAGE & THYME workshop
  • Motivation: high post-workshop and sustained at 2 months
  • Usefulness: high post-workshop and sustained at 2 months
  • Self-confidence: significant increase
  • Perceived competence: significant increase
  • Plan to change practice: 95%
  • Recommend training: 100%

Reaction needs to be positive for learning to be transferred into practice.

Kirkpatrick pyramid level 2 - learning
Level 2 - Learning


Participants were asked to identify helpful behaviours in a film of an acted conversation:

  • No change in control group after other training
  • Significant increase in knowledge after SAGE & THYME training
Kirkpatrick pyramid level 3 - behaviour
Level 3 - Behaviour

Self-efficacy is the perceived mastery of skills and outcome expectancy is the anticipated positive outcome of behaviour - these help to transfer learning into behaviour changes and are significantly increased after SAGE & THYME training (immediately and after 2 months).

Talking to a simulated patient:

Participants were filmed talking to a simulated patient and an expert rated behaviour pre and post training (blinded to order):

  • Significant increase in helpful behaviour after SAGE & THYME training

Use of SAGE & THYME in conversations (2 weeks and 2 months) - staff report:

  • Structure helpful
  • Increased confidence
  • Gave control
  • Feel satisfied about supporting patients
  • Conversations more patient-focussed
  • Left patients feeling satisfied and empowered
  • Use with others (not just patients)
  • Motivated to use elements
Kirkpatrick pyramid level 4 results
Level 4 - Results

People tell stories about how using SAGE & THYME in conversations has helped others.

Papers, articles and textbooks

Journal articles

Brand S, Coyne E, Tomlin M, Rigby M (2014).  Training renal staff to feel confident to respond to distressed patients.  J Renal Nurs: 6 (6); 289-292.

Connolly M (2016).  Listening skills 1: how to improve your listening skills.  Nursing Times: 112 (45/46); 10-12.

Connolly M (2016).  Listening skills 2: developing listening skills through practice.  Nursing Times: 112 (45/46); 16-18. 

Griffiths J (2017).  Person-centred communication for emotional support in district nursing: SAGE and THYME model.  British Journal of Community Nursing; 22 (12): 593-597.

Martin ASH, Costello J, Griffiths J (2017).  Communication in palliative care: the applicability of the SAGE and THYME model in Singapore.  International Journal of Palliative Nursing; 23 (6): 288-295.

Petley R (2017).  How a model of communication can assist nurses to foster hope when communicating with patients living with a terminal prognosis.  Religions; 8 (10): 277

Ang SH (2019).  Promoting effective nurse-patient communication in palliative care using the SAGE & THYME model: can it be implemented cross-culturally?  The Open Nursing Journal; 13: 153-155.

Reports and textbooks

The SAGE & THYME model and its training has been picked up by a number of textbooks, independent reports, articles and strategy documents:

Getting It Right - End of life care in advanced kidney disease

Communication skills in end stage respiratory disease

Chartered Society of Physiotherapy Frontline Magazine

Department of Health: One chance to get it right

Macmillan report: How we can support and empower NHS staff to deliver a good experience of care to patients

The Royal Marsden Manual of Clinical Nursing Procedures (9th edition, March 2015) - chapter 4 on communication.

York Teaching Hospital Staff Matters newsletter (March 2016)

Respiratory Nursing at a Glance - Wendy Preston and Carol Kelly (2017).  Wiley Blackwell, Chichester

Oxford Textbook of Communication in Oncology and Palliative Care (2017), Oxford University Press, Oxford -  chapter 24 on SAGE & THYME model


The Hearing Aid podcast recorded in March 2019 on 'communication wih relatives' talks about how SAGE & THYME can be used in conversations - access it here. (You need to provide your email address and name to be able to play the podcast).

Library shelves
Independent evaluation of SAGE & THYME Foundation Level workshop

Imperial College Healthcare NHS Trust

Imperial College Healthcare NHS Trust investigated whether staff could recall what was taught in the SAGE & THYME foundation level workshop a few months after receiving this communication skills training.  

They found that 3-6 months post-workshop, over 60% of staff reported remembering "a lot" of what was taught during the workshop and over 30% reported that the training had impacted on their practice "a lot".

Imperial College Healthcare evaluation


Leeds Teaching Hospitals NHS Trust

In 2014, Leeds Teaching Hospitals NHS Trust presented the findings of their evaluation on teaching the SAGE & THYME model to renal staff at the Trust's annual Nursing and Midwifery conference.

In 2015, Emma Waters conducted some research, commissioned by Dr Gary Latchford in the Department of Clinical and Health Psychology to evaluate the SAGE & THYME Foundation Level workshop and determine whether participants use the training in their day-to-day practice using semi-structured interviews.  

All of the participants in the study said that the workshop had influenced their practice in some way.  

Leeds Teaching evaluation poster Jun 2014


Evaluation of SAGE & THYME Communication Skills Training - E Waters


NHS Tayside

NHS Tayside has produced a report evaluating data collected from the questionnaire in the delegate pack completed at the end of the workshop, and also 6 months after the workshop (to determine the impact of the training at Kirkpatrick level 2).  

  • In their follow-up data (response rate of 28%), they found that 95% reported SAGE & THYME to be of some help, although 27.3% had never used the model in practice – some reasons are given (e.g. not had the opportunity).  
  • Those that had used the SAGE & THYME model (either partially or fully) in general found it easy to use.  
  • Interestingly, those people who felt that they already had a lot of the skills taught, still found the workshop helpful/confirmation that they were doing the right thing.  
  • Examples of how SAGE & THYME has been used in practice are given.  
  • The factors that hinder the model’s use are what we would expect (e.g. lack of time/opportunity).

Nottingham University Hospitals NHS Trust

Nottingham University Hospitals NHS Trust presented the findings of their evaluation with renal staff on 2 May 2014 at UK Kidney Week (jointly hosted by the British Renal Society and the Renal Association) in Glasgow

Nottingham University Hospitals renal staff evaluation


South Central Strategic Health Authority

South Central Strategic Health Authority (in collaboration with the University of Southampton, Royal Berkshire NHS Foundation Trust and Oakhaven Hospice) evaluated the SAGE & THYME Foundation Level workshop training for over 2,500 health and social care staff.  

The findings were presented at the International Pstcho-Oncology Society (IPOS) conference in Brisbane, Australia in November 2012.

The University of Northampton

The University of Northampton Institute of Health and Wellbeing has evaluated the SAGE & THYME foundation level workshop, as one component in a series of multi-professional and multi-agency training courses run, to ensure the delivery of high quality services to frail and older people in Northampton.  

  • The Northamptonshire Local Education and Training Council (LETC) received funding from Health Education England to run and evaluate a suite of training courses (including SAGE & THYME) centred around: prevention and enabling self-care; geriatric assessment and personalised care planning; management of long term conditions; and end of life care.  
  • The SAGE & THYME foundation level workshop was delivered by the Northamptonshire Healthcare NHS Foundation Trust.  
  • The University’s report highlighted that the SAGE & THYME (S&T) workshop “engenders a sense that this was a well presented, easy to follow communication course which could be applied to practice easily”.  A summary of the main findings from the report that relate to SAGE & THYME can be downloaded below.

The University of Northampton evaluation summary


The University of Manchester

The University of Manchester conducted an evaluation on using the SAGE & THYME Foundation Level workshops to improve the psychological support provided by district nurses to patients in palliative home care.

The University of Manchester research with district nurses

Evaluation of SAGE & THYME Online
Online delegate feedback summary image

SAGE & THYME Online has been evaluated by us asking delegates from 18 workshops for feedback on the training:

  • 84% of the 225 delegates completed the evaluation form
  • 99% felt more confident about listening and responding to concerns
  • 95% felt more willing to talk to emotionally troubled people
  • 99% felt that the training would influence their practice.
Find out more

SAGE & THYME Online evaluation

Care Quality Commission (CQC) reports
CQC report for the Royal Marsden
Care Quality Commission (CQC) Reports

The SAGE & THYME training has been highlighted as good practice in the following CQC reports:


SAGE & THYME for Advance Care Planning (ACP) workshop


An evaluation of the workshops with over 400 participants has been carried out.  

  • This showed that the workshop significantly increased from pre to post workshop, staff confidence in starting a conversation about advance care planning or end of life care and also in responding to concerns raised during such a conversation.  
  • Participants also showed a significant increase in perceived confidence in conducting an advance care planning/end of life care conversation.  
  • In addition, 74% of participants said they would definitely change their practice as a result of the workshop and 88% would definitely recommend the workshop to others.

SAGE and THYME ACP workshop evaluation report


Reports and textbooks

Palliative and End of Life Care Strategy for Northern Ireland

Advance Care Planning in End of Life Care (first edition) - Keri Thomas, Ben Lobo.  Oxford University Press, Oxford, 2011.

Advance Care Planning in End of Life Care (second edition) - Keri Thomas, Ben Lobo and Karen Detering.  Oxford University Press, Oxford, 2017.