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一项评估针对痴呆症患者非正式照料者的个性化认知行为沟通干预措施有效性的试点研究:“畅所欲言”项目。

A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: The Talking Sense programme.

作者信息

Barnes Colin J, Markham Chris

机构信息

Solent NHS Trust, St James Hospital, Portsmouth, UK.

School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.

出版信息

Int J Lang Commun Disord. 2018 May;53(3):615-627. doi: 10.1111/1460-6984.12375. Epub 2018 Feb 20.

Abstract

BACKGROUND

People with dementia and family carers often experience difficulties communicating together. These difficulties are considered to contribute significantly to the depression, anxiety and negative feelings such as guilt often reported by dementia family carers.

AIMS

To develop and contribute to the theory and evidence base for single-component, psychosocial interventions that address these difficulties by evaluating the effectiveness of the Talking Sense programme which was designed to reflect existing best evidence.

METHODS & PROCEDURES: Talking Sense was delivered as an individualized, one to one, cognitive behavioural approach for developing knowledge, skills, thinking and behaviour of dementia family carers in managing communication difficulties. In this study, a randomized controlled trial compared 27 carers who completed three one-to-one individualized sessions using Talking Sense with 25 carers who received a single, knowledge-only, control discussion.

OUTCOMES & RESULTS: There were no significant differences for the primary outcome measure of carer anxiety and depression as well as carer quality of life and general self-efficacy. Statistically significant results suggested carers receiving the Talking Sense intervention had fewer communication difficulties happening (p = 0.046) and felt more valued by their relatives (p = 0.046). A score close to significance (p = 0.052) suggested they perceived their relatives to be more communicatively competent.

CONCLUSIONS & IMPLICATIONS: The intervention and research design were shown to be effective with low attrition and high adherence to treatment. A non-significant finding for the primary outcome measure does not support the potential for this intervention to effect carer anxiety and depression. The potential for perceived change in the person with dementia, with statistically fewer communication difficulties happening and the carer feeling more valued by their relative, was the most significant finding from this programme of research. Recommendations for further research are made.

摘要

背景

患有痴呆症的患者及其家庭护理人员常常在沟通方面遇到困难。这些困难被认为是导致痴呆症家庭护理人员经常出现抑郁、焦虑以及内疚等负面情绪的重要因素。

目的

通过评估旨在反映现有最佳证据的“畅所欲言计划”的有效性,为解决这些困难的单组分心理社会干预措施的理论和证据基础的发展做出贡献。

方法与过程

“畅所欲言计划”采用个体化的一对一认知行为方法,旨在培养痴呆症家庭护理人员在应对沟通困难方面的知识、技能、思维和行为。在本研究中,一项随机对照试验将27名完成了三次使用“畅所欲言计划”的一对一个体化课程的护理人员与25名接受了一次仅提供知识的对照讨论的护理人员进行了比较。

结果与结论

在护理人员焦虑和抑郁的主要结局指标以及护理人员生活质量和总体自我效能方面,没有显著差异。具有统计学意义的结果表明,接受“畅所欲言计划”干预的护理人员出现的沟通困难较少(p = 0.046),并且感觉得到亲属更多的重视(p = 0.046)。一个接近显著水平的分数(p = 0.052)表明,他们认为亲属在沟通方面更有能力。

结论与启示

干预措施和研究设计显示出有效性,损耗率低且治疗依从性高。主要结局指标的非显著结果不支持该干预措施对护理人员焦虑和抑郁产生影响的可能性。痴呆症患者在沟通困难方面出现统计学上较少的变化以及护理人员感觉得到亲属更多重视的可能性,是该研究项目最重要的发现。提出了进一步研究的建议。

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