Resilient Together for Dementia: A live video resiliency dyadic intervention for persons with dementia and their care-partners early after diagnosis

Resilient Together for Dementia：针对痴呆症患者及其护理伙伴在诊断后早期进行的实时视频弹性二元干预

• 批准号: 10524823
• 负责人: Sarah Bannon
• 金额: $ 7.4万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10524823
• 关键词: Activities of Daily Living; Acute; Acute Brain Injuries; Address; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Behavioral; Benchmarking; Caregivers; Caring; Chronic; Clinical; Clinical Trials; Cognition; Cognitive; Communication; Dementia; Development; Diagnosis; Disease; Distress; Early Intervention; Elements; Eligibility Determination; Emotional; Ensure; Environment; Family; Family member; Feedback; Focus Groups; Foundations; Future; General Hospitals; Geriatrics; Goals; Health; Home; Hybrids; Impairment; Individual; Intervention; Intervention Studies; Interview; Judgment; Language; Link; Long-Term Care; Manuals; Massachusetts; Medical; Memory impairment; Mentors; Mentorship; Methodological Studies; Methodology; Methods; Mission; Modeling; Morbidity - disease rate; Neurologic; Neurologist; Palliative Care; Pamphlets; Participant; Pathologist; Patient Self-Report; Patients; Personal Communication; Personal Satisfaction; Persons; Physicians; Population; Populations at Risk; Primary Health Care; Procedures; Process; Provider; Psychologist; Psychology; Publications; Quality of Care; Quality of life; Randomized; Research; Research Assistant; Research Design; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Risk; Secure; Self Care; Self Efficacy; Social Workers; Social support; Speech; Spouses; Strategic Planning; Stress; Structure; Surveys; Symptoms; Testing; Training; Training Programs; Trauma; United States National Institutes of Health; Work; acceptability and feasibility; base; care providers; career; career development; clinical care; coping; dementia care; effectiveness trial; emotional distress; experience; feasibility testing; flexibility; improved; informal care; innovation; intervention refinement; loved ones; medical schools; medical specialties; meetings; member; mindfulness; mortality; novel; preference; preservation; prevent; programs; psychosocial; resilience; skills; skills training; social; stressor; success; symposium; symptom management; therapy development; treatment as usual

PROJECT SUMMARY In this K23 proposal, I outline a comprehensive 5-year training program that will support my transition towards an independent investigator focused on the development and rigorous testing of interventions for dyads (i.e., pairs) of persons living with dementia (PWDs) and their informal care-partners, with an emphasis on early intervention. In this application, I propose a significant and innovative proposal that is directly tied with my proposed training and career development goals. Background: Alzheimer's disease and related dementias (ADRD) produce a host of stressors for PWDs and their spousal care-partners (SPs), who both experience substantial emotional distress after diagnosis. Emotional distress is interdependent within dyads and – without treatment—becomes chronic and negatively impacts both partners' health, quality of life, and their ability to navigate the short and long-term challenges associated with ADRDs. Addressing emotional distress early, when PWDs can still meaningfully participate, is an unexplored opportunity to prevent chronic emotional distress and preserve quality of life for both partners. Specific aims and research design: I aim to develop the first version of the live video Resilient Together for Dementia (RT-D) intervention and methodology via 1) interviews and quantitative surveys (N=20) of PWD-SP dyads, with additional feedback from 2) focus groups with ADRD medical stakeholders (N=4) (Aim 1). Next, I will explore, via an open pilot (N=5 dyads) with exit interviews and pre-post self- report assessments, the initial feasibility, acceptability, and credibility of the live video RT-D and procedures, and to further refine RT-D as needed (Aim 2). Finally, I will establish, via a pilot feasibility RCT of the RT-D versus control (N= up to 50 dyads), the feasibility, acceptability and credibility of RT-D following predetermined benchmarks (Aim 3). Findings will inform a hybrid efficacy-effectiveness trial through the R01 mechanisms and future studies extending this work to include additional family members and other care-partners. Training and mentoring: My aims are supported by 3 training goals to develop expertise in: 1) qualitative and mixed methods assessment to inform intervention adaptation; 2) specialty training in geriatrics and ADRD clinical care; 3) clinical trial methodology to facilitate dyadic intervention development and refinement. I will obtain mentorship from an exemplary team led by my primary mentor Dr. Ana-Maria Vranceanu, a clinical health psychologist with expertise in mixed-methods research and live video dyadic intervention development, and my co-mentor Dr. Christine Ritchie, a geriatrician and palliative care physician with decades of work improving the treatment of ADRD. My training goals are supported by 1) a team of expert mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and 3) targeted coursework, scientific meetings, seminars and planned publications. Relevance to the NIA mission. This K23 is in line with NIAs priorities to develop interventions to the maintain health and wellbeing and reduce the burden of ADRDs. Impact: I am a clinical psychologist with expertise in couple and family interventions for neurological populations. The experience gained will serve as the foundation for an independent career in dyadic interventions for ADRDs, with a focus on early intervention.

项目总结 在这份K23提案中，我概述了一个全面的5年培训计划，该计划将支持我向 独立调查员侧重于制定和严格测试针对二人(即对人)的干预措施。 痴呆症患者及其非正式护理伙伴，重点是早期干预。在此应用程序中， 我提出了一项有意义的创新建议，该建议与我计划的培训和职业发展直接相关 目标。背景：阿尔茨海默病和相关痴呆症(ADRD)会产生大量的应激源，导致残疾人及其 配偶护理-伴侣(SP)，两人在确诊后都经历了严重的情绪痛苦。精神上的痛苦是 在不治疗的情况下，双方相互依赖，成为慢性的，对双方的健康产生负面影响， 生活质量，以及他们驾驭与ADRDS相关的短期和长期挑战的能力。寻址 早期情绪困扰，当残疾人仍然可以有意义地参与时，是一个尚未探索的机会，可以预防慢性 情感上的痛苦和保持双方的生活质量。具体目标和研究设计：我的目标是开发 第一个版本的现场视频弹性一起治疗痴呆(RT-D)干预和方法，通过1)采访和 对PWD-SP二联体的定量调查(N=20)，2)ADRD Medical的焦点小组的额外反馈 利益攸关方(N=4)(目标1)。接下来，我将通过一个开放的试点(N=5个二元)，通过离职访谈和事后自我评估来探索 报告评估、现场视频RT-D和程序的初步可行性、可接受性和可信度，以及 根据需要进一步提炼RT-D(目标2)。最后，我将通过试点可行性RCT建立RT-D与对照(N= 根据预先确定的基准，RT-D的可行性、可接受性和可信度(目标3)。 这些发现将通过R01机制和未来的扩展研究为混合疗效-有效性试验提供信息 努力将更多的家庭成员和其他护理伙伴包括在内。培训和指导：我的目标得到了 3培训目标，以发展以下方面的专门知识：1)定性和混合方法评估，为干预适应提供信息；2) 老年医学和ADRD临床护理方面的专业培训；3)促进二元干预的临床试验方法学 发展精细化。我将得到由我的主要导师安娜-玛丽亚博士领导的模范团队的指导 Vranceanu是一位临床健康心理学家，在混合方法研究和现场视频二元干预方面拥有专长 和我的共同导师克里斯汀·里奇博士，一位有着数十年工作经验的老年病学家和姑息治疗内科医生 改进对ADRD的治疗。我的培训目标得到了1)专家导师团队的支持，2)丰富的机构支持 麻省总医院和哈佛医学院的环境，以及3)有针对性的课程作业，科学 会议、研讨会和计划出版的出版物。与国家安全局的任务有关。这款K23符合NIA的优先事项 制定干预措施，以维护健康和福祉，减轻ADRDS的负担。影响：我是一名临床医生 在神经病学人群的夫妻和家庭干预方面具有专业知识的心理学家。所获得的经验将 作为ADRDS双向干预的独立职业生涯的基础，重点是早期干预。