iCare Stress Management e-Training for Dementia Family Caregivers

描述（由申请人提供）：阿尔茨海默病（AD）和相关痴呆症的后果不仅对痴呆症患者，而且对家庭护理人员（估计有890万人）都是毁灭性的，他们被认为是隐藏的患者，并且具有与痴呆症治疗的压力和困难相关的抑郁症状和综合征的高风险。需要有效、低成本和易于获得的干预措施来科普痴呆症护理，特别是压力管理。本研究之目的为：（1）以一种新的心理治疗介入方式，提升失智症家庭照顾者的生活品质，并减轻其生活压力（iCare eTraining）;以及（2）以低成本和方便的方法开发iCare压力管理eTraining（DVD和互联网），以部署到数以百万计的家庭谁需要它。新的iCare包括：（a）从我们的研究内容整合不同种族群体;（B）根据认知行为疗法（CBT）改编我们的心理治疗课程，用于视频和互联网模式;（c）创造性地使用DVD，在线视频和网络技术。其结果是一种创新的心理治疗干预措施，以更有效和强大的功能来治疗痴呆症照顾者压力：参与方法（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;收集和分发应对痴呆症的集体知识的方法;以及其他支持工具。相关临床优势包括：鼓励参与培训，使用户能够互动，并促进更好地吸收概念;这应该提高护理人员处理高要求的护理任务的技能（最终导致减轻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“系列课程（CWC），在几项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护理者健康的资源”（REACH;贝儿等人，2006; Schulz等人，2003年），这表明《化学武器公约》培训减轻了来自不同社区的照料者的压力。iCare的心理治疗方面指的是“旨在鼓励洞察个人成长和行为矫正问题的心理技术”（以电子培训为导向），而不是治疗师的治疗（由于成本原因，广泛部署不可行）。iCare的教学形式是将DVD/在线视频培训与使用补充材料相结合，以培养技能和促进实践。我们将与阿尔茨海默氏症协会、家庭护理者联盟和其他组织合作，开发和评估iCare（针对普通护理者人群），并由专家咨询委员会（进行科学审查）和家庭护理者（提供消费者意见）。我们将通过一项随机临床试验（II期）评估iCare在改善护理人员的幸福感和减轻其压力方面的有效性。公共卫生相关性：越来越多的痴呆症家庭照顾者（估计为890万;家庭照顾者联盟，2007年）处于与阿尔茨海默病（AD）和相关痴呆症患者的生活压力和困难相关的抑郁症状和综合征的高风险中（Pinquart和Sorensen，2007年; Schulz等人，2000; Hooker et.例如，2000; Ory等人，1999; Schulz &海滩，1999; Schulz et.等人，1995; Gallagher等人，1989年）。全国每年用于治疗阿尔茨海默氏症的医疗费用、生活费用和生产力损失估计为1480亿美元;家庭护理人员每年提供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），节省了美国纳税人相当多的钱（例如，即使在十多年前，在家中而不是在养老院设施中照顾阿尔茨海默病患者估计每年为美国纳税人节省333亿美元; Ernst & Hay，1994）。iCare项目的预期成果如下：（1）提供经经验验证的有效培训，以具有成本效益和易于获得的方式管理压力，更好地科普痴呆症;（2）促进越来越多出现几种阴性症状的痴呆症家庭照顾者的福祉;（3）减轻痴呆症患者家庭照顾者的压力和照顾负担;此外，我们还预计会产生以下潜在的间接结果（本研究未测量）：（a）延迟AD患者的住院治疗（由于家庭成员的负担和压力减少，他们将承担更长时间的照顾责任）;（B）减少护理者药物使用和相关副作用（因为定期应用iCare概念，预期照料者的抑郁问题会减少，情绪会好转）;和（c）通过如上所述的减少照顾者负担、延迟住院、减少药物使用，并促进照顾者的总体福祉。

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.