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）：拟议的研究将进行初步步骤，为痴呆症患者的家庭照顾者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，将照顾者的需要与适当的“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，它可以改善治疗照顾者压力和其他心理健康问题的结果，这些问题具有多种风险因素，彼此之间并不高度相关。从25年的研究结果表明，家庭团聚可以最好的概念化作为一个多方面的系统与压力源有低到中等的相互关系。换句话说，一个应激源的存在（例如，行为问题）或针对该应激源进行治疗不一定影响护理者的其他应激源（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，先前的护理人员治疗模式采取了固定的、“一刀切”的方法，以相同的强度和剂量向所有参与者提供相同的治疗，而不管护理人员的风险和保护因素的组合，也不考虑可能影响结果的其他潜在压力源。适应性方案采用固定的方法，只有当参与者证明需要特定的治疗成分时才治疗他们。拟议的治疗发展研究将分两个阶段进行。第1阶段将侧重于制定治疗分配规则。30名护理人员将完成一个多维评估组合，其中包含与治疗模块相关的风险和保护因素的措施，然后将参与与训练有素的临床医生的深入讨论，以澄清评估结果。将通过检查标准化工具的风险结果与护理人员的风险和需求报告之间的差异和差异来制定治疗分配规则。第2阶段将在一项试点研究中应用第1阶段制定的治疗分配规则，该研究对30名照顾痴呆症家庭成员的主要照顾者进行适应性治疗并进行评估。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应的特异性以及通过比较I期和II期受试者的近端和远端结局来评估结局。这些数据将提供适应性方法的可接受性和特异性的证据，以及可用于计划大规模试验的治疗效应量信息。