iCare Stress Management e-Training for Dementia Family Caregivers

描述(申请人提供)：阿尔茨海默病(AD)和相关痴呆症的后果不仅对痴呆症患者是毁灭性的，而且对家庭照顾者(估计为890万)也是毁灭性的，他们被认为是隐藏的患者，与痴呆症护理的压力和困难有关的抑郁症状和综合征的风险很高。需要有效、低成本和可获得的干预措施来应对痴呆症护理，特别是压力管理。我们快车道第一阶段/第二阶段项目的目标是：(1)通过一种新的心理治疗干预措施(iCare电子培训)，提高痴呆症家庭照顾者的生活质量，减少护理压力；以及(2)开发iCare压力管理电子培训，提供低成本和可获得的方法(DVD和互联网)，供数百万有需要的家庭使用。新的iCare包含：(A)整合我们与不同种族群体进行的护理研究的内容；(B)基于认知行为疗法(CBT)的心理治疗课程的改编，以适应视频和互联网形式；以及(C)DVD、在线视频和网络技术的创造性使用。其结果是一种创新的心理治疗干预措施，以更有效和更强大的功能来治疗痴呆症照顾者压力：参与式方法(DVD和在线视频)；鼓励与专业人员和其他照顾者进行支持性互动的工具；加强沟通；收集和分发有关应对照顾者的集体知识的方法；以及其他支持性工具。相关的临床优势是：鼓励培训参与，促进用户互动，促进更好地吸收概念；这应该会增强照顾者处理繁重的护理任务的技能(最终导致缓解压力和提高生活质量)。ICare课程的基础是由Gallagher-Thompson博士、Thompson博士及其同事在许多循证程序中开发的，导致了成功的“应对护理”课程系列(CWC)，并在几个随机临床试验中进行了评估，例如NIH资助的多地点国家研究项目“增强阿尔茨海默氏症照顾者健康的资源”(REACH；Belle等人，2006年；Schulz等人，2003年)的一个组成部分，该项目证明CWC培训减轻了来自不同社区的照顾者的压力。ICare的心理治疗方面指的是“旨在鼓励人们洞察个人成长和行为改正问题的心理技术”(由eTraining指导)，而不是由治疗师进行治疗(由于成本原因，不适合广泛部署)。ICare的教学形式是DVD/在线视频培训和补充材料的使用相结合，以培养技能和刺激实践。我们将与阿尔茨海默氏症协会、家庭照顾者联盟和其他组织合作，开发和评估iCare(针对普通照顾者群体)，并与专家咨询委员会(用于科学审查)和家庭照顾者(用于消费者的意见)。我们将通过随机临床试验(第二阶段)评估iCare在改善照顾者福祉和减轻照顾者压力方面的有效性。公共卫生相关性：越来越多的痴呆症家庭照料者(估计有890万人；家庭照顾者联盟，2007年)面临与阿尔茨海默病(AD)和相关痴呆症患者的压力和照顾困难有关的抑郁症状和综合征的高风险(PinQuart和Sorensen，2007年；Schulz等人，2000年；Hooker等人)。等人，2000年；Ory等人，1999；Schulz&比奇，1999；Schulz等人。Al，1995；Gallagher等人，1989)。据估计，全国每年护理阿尔茨海默氏症的成本为1480亿美元，包括医疗成本、生活成本和生产力损失；家庭照顾者每年提供85亿小时的护理，价值近830亿美元(阿尔茨海默氏症协会，2007年)，为美国纳税人节省了大量资金(例如，甚至在十多年前，在家中而不是在疗养院护理阿尔茨海默氏症患者估计每年为美国纳税人节省333亿美元；安永会计师事务所，1994)。ICare项目的预期结果如下：(1)提供经验性验证的有效培训，以经济高效和可获得的方式管理压力，更好地应对痴呆症护理；(2)促进越来越多经历几种负面症状的痴呆症家庭照顾者的福祉；以及(3)减轻痴呆症患者家庭照顾者的压力和负担；此外，我们预计以下潜在的间接结果(本研究未衡量)：(A)推迟AD患者的住院治疗(因为预计由于负担减少和压力减轻，家庭成员将承担更长时间的护理职责)；(B)减少照顾者用药及其相关副作用(因为定期应用iCare概念预计会减少抑郁问题，改善照顾者的情绪)；以及(C)如上所述，通过减少照顾者负担、推迟制度化、减少用药和促进照顾者的总体福祉，降低与AD相关的经济成本。

DESCRIPTION (provided by applicant): The consequences of Alzheimer's Disease (AD) and related dementia are devastating not only for dementia patients, but also for family caregivers (estimated at 8.9 million), who are considered the hidden patients, and are at high risk for depressive symptoms and syndromes related to the stress and difficulties of dementia caregiving. Efficient, low-cost and accessible interventions are needed to cope with dementia caregiving, particularly stress management. The goals of our Fast Track Phase I/Phase II project are: (1) to enhance the quality of life and reduce the caregiving stress of dementia family caregivers with a new psychotherapy intervention (iCare eTraining); and (2) to develop the iCare stress management eTraining in low-cost and accessible methods (DVD and Internet) for deployment to millions of families who need it. The novel iCare incorporates: (a) integration of content from our caregiving studies with different ethnic groups; (b) adaptation of our psychotherapy curriculum, based on Cognitive Behavioral Therapy (CBT), for video and Internet modalities; and (c) creative use of DVD, online video, and web technology. The result is an innovative psychotherapy intervention to treat dementia caregiver stress with more effective and powerful features: engaging methods (DVD and online video); tools to encourage supportive interactions with professionals and other caregivers; enhanced communication; methods to gather and distribute collective knowledge on coping with caregiving; and other supportive tools. Related clinical advantages are: encourage training participation, enable user interaction, and promote better assimilation of concepts; which should enhance caregivers' skills to deal with demanding tasks of caregiving (ultimately leading to alleviate stress and improve quality of life). The basis for the iCare curriculum was developed in many evidence-based procedures by Dr. Gallagher-Thompson, Dr. Thompson, and associates, resulting in a successful "Coping with Caregiving " class series (CWC), evaluated in several randomized clinical trials, e.g. a component of NIH-funded multi-site national research project "Resources for Enhancing Alzheimer's Caregiver Health" (REACH; Belle et al., 2006; Schulz et al., 2003), which demonstrated that CWC trainings reduced stress for caregivers from diverse communities. The psychotherapy aspect of iCare refers to "psychological techniques designed to encourage insight into problems for personal growth and behavior modification" (oriented by eTraining), rather than treatment by therapist (not feasible for broad deployment due to costs). The pedagogical format of iCare is a combination of DVD/online video training and use of supplemental materials that build skills and stimulate practice. In collaboration with the Alzheimer's Association, Family Caregiver Alliance, and other organizations, we will develop and evaluate iCare (targeting general caregiver population), with an expert Advisory Board (for scientific review) and family caregivers (for consumer input). We will assess the iCare effectiveness in improving the well-being and decreasing the stress of caregivers with a randomized clinical trial (Phase II). PUBLIC HEALTH RELEVANCE: A growing number of dementia family caregivers (estimated at 8.9 million; Family Caregiver Alliance, 2007) are at high risk for depressive symptoms and syndromes related to the stress and difficulties of caregiving for individuals with Alzheimer' Disease (AD) and related dementia (Pinquart and Sorensen, 2007; Schulz et al., 2000; Hooker et. al., 2000; Ory et al., 1999; Schulz & Beach, 1999; Schulz et. al, 1995; Gallagher et al., 1989). The annual national costs of caring for Alzheimer's are estimated at $148 billion in medical costs, living costs, and lost productivity; and family caregivers provide 8.5 billion hours of care annually, valued at almost $83 billion dollars (Alzheimer's Association, 2007), saving American taxpayers considerable money (e.g. even more than a decade ago, caring for Alzheimer's patients at home rather than in nursing home facilities was estimated to save American taxpayers $33.3 billion per year; Ernst & Hay, 1994). The expected outcomes of the iCare project are the following: (1) provide empirically validated effective training to manage the stress and cope better with dementia caregiving in a cost-effective and accessible manner; (2) promote the well-being of a growing number of dementia family caregivers who experience several negative symptoms; and (3) decrease the stress and burden of care for family caregivers of patients with dementia; in addition, we expect the following potential indirect outcomes (not measured by this study): (a) delay institutionalization of AD patients (as family members are expected to bear the duties of caring for a longer period of time as a result of decreased burden and reduced stress); (b) decrease caregiver medication use and associated side effects (as less depression problems and better mood of caregivers are expected by the regular application of the iCare concepts); and (c) lower the economic cost associated with AD, by decreasing, as noted above, caregiver burden, delaying institutionalization, reducing medication use, and promoting the general well-being of caregivers.