Negotiation Training to Optimize Caregiver Commuication in Alzheimer's Disease
Funded Grant
Overview
Affiliation
View All
Overview
description
The goal of this proposal is to conduct a rigorous Stage 2 efficacy trial of the NegotiAge negotiation training program for family caregivers of older patients with Alzheimer's disease (PND). Family caregivers frequently experience conflicts with their older adult, other family caregivers, and the health care system as they advocate for their PND (e.g., determining if medication is necessary, responding to billing errors, home health extensions). Consequently, family caregivers experience u n necessary frustration, anxiety, and stress as they deal with conflicts and l ack formal training to resolve these conflicts. To remedy this issue and through prior NIA funding, we developed NegotiAge, an online negotiation training program for family caregivers. NegotiAge provides family caregivers with instructional negotiation resources and the opportunity to practice negotiation skills through simulated real-world conflicts involving caregiver-PND, caregiver-healthcare provider, and caregiver-caregiver interactions. Automated conversational technology, utilizing artificial intelligence, was incorporated during intervention development to improve standardized delivery of practice exercises and did not substantially alter the original negotiation training curriculum. In pilot MOST optimization testing with 125 family caregivers, promising findings showed that caregivers experienced less burden (p< 0.002), were less likely to avoid conflicts and demonstrated improved problem-solving skills (p< 0.05) following NegotiAge. Consistent with the NIH Stage Model, the next critical step is rigorous Stage 2 efficacy testing to establish intervention effects before proceeding to large-scale effectiveness studies. Aim 1: Finalize NegotiAge intervention standardization and establish intervention fidelity, usability, and participant engagement. To complete Aim 1 and leveraging the data collected from our MOST optimization trial, we will complete final intervention standardization activities, including fidelity-monitoring, delivery protocols, participant instructions, and quality assurance methods necessary for rigorous efficacy testing. Aim 2: Determine the efficacy of NegotiAge, among family caregivers of PND on family caregiver outcomes (e.g., burden [primary], conflict resolution behaviors, stress, anxiety, and fatigue [secondary]). We will conduct a Stage 2 randomized controlled efficacy trial of NegotiAge with family caregivers (n= 200). Nationwide recruitment will occur in 3 ways through clinical-academic partnerships, community partners, and snowball recruitment of caregivers. Participants will be randomized to one of two arms: 1.) NegotiAge intervention or 2.) an attention control website. Assessments will occur before randomization (baseline), and then at 1- and 3-months. Besides the primary outcome of burden (Zarit), we will collect secondary variables/outcomes including validated PROMIS measures (anxiety, fatigue, physical function, self-efficacy), and NIH Toolbox measures (stress, social cohesion, socialization). Data will be analyzed using Independent-sample two-sided t-tests between the NegotiAge and control arms and generalized linear mixed model (GLMM) for repeated measures modelling. Upon completion of this efficacy trial, we will be positioned to engage in a hybrid effectiveness-implementation trial of NegotiAge.
