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: 7090999
• 负责人: STEVEN H ZARIT
• 金额: $ 20.45万
• 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/7090999
• 关键词: angers; anxiety; behavior disorders; behavior therapy; behavioral /social science research tag; caregivers; clinical research; clinical trials; coping; dementia; depression; disease /disorder proneness /risk; family structure /dynamics; human subject; human therapy evaluation; outcomes research; patient care planning; patient oriented research; personal log /diary; psychological adaptation; satisfaction; stress management; stressor

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）：拟议的研究将采取初步步骤，为痴呆症患者的家庭护理人员制定适应性治疗方案。适应性治疗使用可操作的治疗分配规则，将护理人员的需求与适当的“量身定制”干预相匹配。适应性方法代表了一种新的治疗方法，可以改善护理人员压力和其他心理健康问题的治疗结果，这些问题具有多个彼此不高度相关的风险因素。 25 年的研究结果表明，家庭照顾最好可以被概念化为一个多方面的系统，其中的压力源彼此之间具有低至中度的相关性。换句话说，一种压力源（例如行为问题）的存在或该压力源的治疗目标并不一定会影响护理人员的其他压力源（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，以前的护理人员治疗模型仍然采取了固定的“一刀切”方法，以相同的强度和剂量向所有参与者提供相同的治疗，无论护理人员的风险和保护因素如何，并且不考虑其他潜在因素可能影响结果的压力源。与固定方法相比，适应性疗法仅在参与者表现出需要特定治疗成分时才对其进行治疗。拟议的治疗开发研究将分两个阶段进行。第一阶段将重点关注治疗分配规则的制定。三十名护理人员将完成一套多维评估，其中包含与治疗模块相关的风险和保护因素的衡量标准，然后将与经过培训的临床医生进行深入讨论，以澄清评估结果。将通过检查标准化工具的风险发现与护理人员的风险和需求报告之间的一致性和差异来制定治疗分配规则。第二阶段将在一项试点研究中应用第一阶段制定的治疗分配规则，该研究对照顾患有痴呆症的家庭成员的 30 名主要护理人员样本实施和评估适应性治疗。结果将根据护理人员对治疗的接受度和满意度、针对目标风险因素的模块效果的特异性以及通过比较第一阶段和第二阶段参与者之间的近端和远端结果来评估。这些数据将提供适应性方法的可接受性和特异性的证据，以及可用于规划大规模试验的治疗效果大小的信息。