Adaptive Treatment for At-Risk Family Caregivers

针对高危家庭护理人员的适应性治疗

• 批准号: 7224936
• 负责人: STEVEN H ZARIT
• 金额: $ 18.94万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-20 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7224936
• 关键词: Address; Affect; Age; Anger; Anxiety; Area; Behavioral; Caregiver Burden; Caregivers; Caring; Clinical; Communities; Conflict (Psychology); Data; Dementia; Depth; Development; Diagnosis; Distal; Effectiveness; Family; Family Caregiver; Family member; Feeling; Foundations; Future; Goals; Guide prevention; Health; Intervention; Investigation; Knowledge; Manuals; Measures; Mental Health; Methodology; Modeling; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Perception; Personal Satisfaction; Persons; Phase; Pilot Projects; Pliability; Population; Prevention approach; Preventive; Problem behavior; Process; Professional counselor; Protocols documentation; Psyche structure; Purpose; Rate; Reporting; Research; Resources; Risk; Risk Factors; Role; Sampling; Series; Shipping; Ships; Son; Specificity; Stress; Symptoms; System; Testing; Touch sensation; Training; Treatment Protocols; base; caregiving; depressive symptoms; design; dosage; improved; instrument; mortality; satisfaction; size; skills; stressor; therapy design; therapy development; treatment effect; treatment planning

DESCRIPTION (provided by applicant): The proposed study will conduct preliminary steps for the development of an adaptive treatment protocol for family caregivers of people with dementia. An adaptive treatment matches caregivers' needs to an appropriate "tailor-made" intervention, using operational treatment assignment rules. The adaptive approach represents a new treatment methodology, which may improve outcomes for treating caregiver stress and other mental health problems that have multiple risk factors that are not highly correlated with one another. Findings from 25 years of research suggest that family caregiving can best be conceptualized as a multi-faceted system with stressors having low to moderate correlations with one another. In other words, the presence of one stressor (e.g., behavior problems) or the targeting of that stressor for treatment does not necessarily affect the caregivers' other stressors (e.g., family conflict) and/or mental health outcomes (e.g., depressive symptoms). Despite this knowledge, prior caregiver treatment models have taken a fixed, "one size fits all" approach, providing the same treatment to all participants at the same intensity and dosage regardless of caregivers' constellation of risk and protective factors and without consideration of other potential stressors that could affect outcomes. Contrasted to a fixed approach, the adaptive regimen treats participants only when they demonstrate the need for a particular treatment component. The proposed treatment development study will proceed in two phases. Phase 1 will focus on the development of treatment assignment rules. Thirty caregivers will complete a multidimensional assessment battery that contains measures of risk and protective factors related to treatment modules, and then will participant in an in-depth discussion with a trained clinician to clarify the findings of the assessment. Treatment assignment rules will be developed by examining consistencies and discrepancies between the findings of risk from standardized instruments and caregivers' reports of risk and need. Phase 2 will apply the treatment assignment rules developed in Phase 1 in a pilot study that implements and evaluates the adaptive treatment on a sample of 30 primary caregivers caring for a family member with a dementing illness. Outcomes will be assessed in terms of caregivers' acceptance and satisfaction with treatment, the specificity of effects of modules for targeted risk factors, and by comparing proximal and distal outcomes between Phase 1 and Phase 2 participants. These data will provide evidence of the acceptability and specificity of the adaptive approach as well as information about treatment effect size that could be used in planning a large-scale trial.

描述（由申请人提供）：拟议的研究将为制定痴呆症患者的家庭护理人员制定适应性治疗方案的初步步骤。适应性治疗与护理人员的需求相匹配，可以使用操作治疗分配规则进行适当的“量身定制”干预措施。自适应方法代表了一种新的治疗方法，可以改善治疗护理人员压力和其他具有多种危险因素的心理健康问题的结果，而心理健康问题彼此之间没有高度相关。从25年的研究中的发现表明，家庭照顾最好地概念化为一个多方面的系统，其压力源与彼此之间的相关性低至中等相关。换句话说，存在一种压力源（例如行为问题）或该压力源以治疗的靶向并不一定会影响看护人的其他压力源（例如家庭冲突）和/或心理健康结果（例如，抑郁症状）。尽管有这些知识，但先前的护理人员治疗模型已采取了固定的“一项尺寸适合所有方法”的方法，无论看护人的风险和保护因素如何，都以相同的强度和剂量为所有参与者提供相同的治疗方法，并且不考虑其他可能影响成果的潜在压力源。与固定方法形成鲜明对比的是，自适应方案只有在证明需要特定治疗成分的需要时才能对待参与者。拟议的治疗开发研究将分为两个阶段。第1阶段将重点关注治疗分配规则的制定。 30名护理人员将完成一个多维评估电池，其中包含与治疗模块有关的风险和保护因素的度量，然后将与训练有素的临床医生进行深入讨论，以阐明评估的发现。将通过检查标准化工具的风险结果与看护人的风险和需求报告之间的一致性和差异来制定治疗作业规则。第2阶段将应用第1阶段在一项试点研究中制定的治疗分配规则，该规则在30名主要护理人员的样本上实现和评估适应性治疗，以照顾患有痴呆疾病的家庭成员。结果将根据护理人员对治疗的接受和满意度，模块对目标危险因素的影响的特异性以及比较1阶段和第2阶段参与者之间的近端和远端结果来评估结果。这些数据将提供自适应方法的可接受性和特异性的证据，以及可用于计划大规模试验的治疗效果大小的信息。