Sommerlad Andrew, Manela Monica, Cooper Claudia, Rapaport Penny, Livingston Gill
Division of Psychiatry, University College London, London, UK.
BMJ Open. 2014 Jun 4;4(6):e005273. doi: 10.1136/bmjopen-2014-005273.
To analyse the experience of individual family carers of people with dementia who received a manual-based coping strategy programme (STrAtegies for RelaTives, START), demonstrated in a randomised-controlled trial to reduce affective symptoms.
A qualitative study using self-completed questionnaires exploring the experience of the START intervention. Two researchers transcribed, coded and analysed completed questionnaires thematically.
Three mental health and one neurology dementia clinic in South East England.
Participants were primary family carers of a patient diagnosed with dementia who provided support at least weekly to their relative. We invited those in the treatment group remaining in the START study at 2 years postrandomisation (n=132) to participate. 75 people, comprising a maximum variation sample, responded.
(1) Important aspects of the therapy. (2) Continued use of the intervention after the end of the therapy. (3) Unhelpful aspects of the therapy and suggestions for improvement. (4) Appropriate time for intervention delivery.
Carers identified several different components as important: relaxation techniques, education about dementia, strategies to help manage the behaviour of the person with dementia, contact with the therapist and changing unhelpful thoughts. Two-thirds of the participants reported that they continue to use the intervention's techniques at 2-year follow up. Few participants suggested changes to the intervention content, but some wanted more sessions and others wanted the involvement of more family members. Most were happy with receiving the intervention shortly after diagnosis, although some relatives of people with moderate dementia thought it should have been delivered at an earlier stage.
Participants' varied responses about which aspects of START were helpful suggest that a multicomponent intervention is suited to the differing circumstances of dementia carers, providing a range of potentially helpful strategies. The continued use of the strategies 2 years after receiving the intervention could be a mechanism for the intervention remaining effective.
分析痴呆症患者的个体家庭照料者接受基于手册的应对策略项目（亲属策略，START）的体验，该项目在一项随机对照试验中已证明可减轻情感症状。
一项定性研究，使用自我填写的问卷来探究START干预的体验。两名研究人员对完成的问卷进行转录、编码并进行主题分析。
英格兰东南部的三家心理健康诊所和一家神经学痴呆症诊所。
参与者为被诊断患有痴呆症患者的主要家庭照料者，他们每周至少为其亲属提供一次支持。我们邀请了随机分组后2年仍留在START研究中的治疗组参与者（n = 132）参与。75人组成了一个最大变异样本并做出了回应。
（1）治疗的重要方面。（2）治疗结束后对干预措施的持续使用情况。（3）治疗的无益方面及改进建议。（4）干预实施的合适时间。
照料者确定了几个不同的重要组成部分：放松技巧、痴呆症教育、帮助管理痴呆症患者行为的策略、与治疗师的联系以及改变无益思维。三分之二的参与者报告称，在2年随访时他们仍在继续使用干预措施中的技巧。很少有参与者建议改变干预内容，但有些人希望增加疗程，另一些人希望更多家庭成员参与。大多数人对在诊断后不久接受干预感到满意，尽管一些中度痴呆症患者的亲属认为应该在更早阶段实施干预。
参与者对START哪些方面有帮助的不同反应表明，多成分干预适合痴呆症照料者的不同情况，提供了一系列可能有帮助的策略。在接受干预2年后继续使用这些策略可能是干预措施保持有效的一种机制。
