Negotiation Training to Optimize Caregiver Communication in Alzheimer's Disease

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The goals of this proposal are to adapt and test a negotiation and dispute resolutions (NDR) training program for caregivers of patients with Alzheimer’s disease (AD), who experience conflicts when they act as patient advocates in the health system [Stage 1A and 1B]. Teaching NDR to family caregivers has the potential to improve caregiver communication, wellbeing, mood, and the care of the adult with AD. Alzheimer’s disease (AD) affects more than 5 million older adults nationally, with the prevalence expected to increase as our population ages. An integral driver in the care of older adults with AD is the family caregiver. Our prior research has shown that family caregivers act as patient navigators for their loves ones with AD, often interacting with the health system for a multitude of conflicts (e.g. determining if a test/medication/hospitalization is necessary, responding to insurance denials, billing errors). A reoccurring theme is that family caregivers experience frustration, anxiety, and stress as they deal with these health system conflicts. Whether it is spending hours on the phone trying to get answers from a health care provider’s team or navigating complex insurance hoops, these conflicts contribute to the burden experienced by a family caregiver. Unfortunately, family caregivers are vastly underprepared to effectively negotiate through these conflicts. Northwestern University’s Kellogg School of Business is an innovator in the field of negotiations and dispute resolution training. Previously, we have tailored the negotiations training for health professionals with positive results. We hypothesize that teaching negotiation and dispute resolution tactics to family caregivers of patients with AD will help improve communication, caregiver stress, anxiety, and empowerment. To test this hypothesis, we aim to: Aim 1: Employ a caregiver (user)-centered design approach to modify and tailor a negotiations and dispute resolution (NDR) training intervention to support communication skills of family caregivers of adults with AD. Aim 2: Utilizing Multiphase Optimization Strategy (MOST), conduct a randomized pilot trial of the NDR intervention that targets better communication between caregivers and health teams, using a 2X3 full factorial design, to (2a) determine the feasibility of delivering the intervention, and (2b) derive estimates of the effect of 3 intervention components on changes in patient-centered outcomes at post-intervention and follow-up to inform a future RCT trial. Exploratory Aim 3: Explore if intervention components (lectures/exercises) interact to change communication between caregivers and health care teams at post-intervention and follow-up. The factorial design will enable testing if the effect of a component is moderated by another component, to ensure the optimized intervention retains components that directly or indirectly impact outcomes. We have partnered with community-based family caregivers who will provide feedback for tailoring the NDR and assist with recruiting family caregivers for the study. Our goal is to improve communication of family caregivers of adults with AD with healthcare providers and others through the negotiation and dispute resolution training.