Sefcik Justine S, Boltz Marie, Dellapina Maria, Gitlin Laura N
College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
Innov Aging. 2022 Feb 5;6(2):igac005. doi: 10.1093/geroni/igac005. eCollection 2022.
Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers' knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested in RCTs and directed at formal caregivers.
Smith et al.'s methodology guided this systematic review of systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) for quality appraisals. Reviews were included if they contained interventions with an RCT design that focused on changing staff behavior and/or practice toward persons living with dementia, in any setting and for any health care discipline.
We identified six systematic reviews, one rated as high-quality on the AMSTAR 2. Most interventions were directed at nursing staff, in long-term care facilities, focused on agitation, and were atheoretical. There is insufficient evidence to guide implementation of currently tested interventions; however, training in communication skills, person-centered care, and dementia-care mapping with supervision show promise for improving agitation.
There's a critical need for additional research with well-designed RCTs, and clear reporting of protocols and findings to inform the field on how best to train and support the workforce. Although there is no conclusive evidence on what interventions are most effective, it could be argued that providing training using interventions with modest evidence of impact is better than no training at all until the evidence base is strengthened.
已有多项系统评价探讨了教育干预措施在旨在提高正式照护者知识与技能和/或改善痴呆症患者结局的随机对照试验（RCT）中的疗效。本文旨在总结现有系统评价，以评估在RCT中针对正式照护者进行测试的教育干预措施的有效性。
史密斯等人的方法指导了本次对系统评价的系统评价。我们使用系统评价和Meta分析的首选报告项目指南以及系统评价质量评估工具2（AMSTAR 2）进行质量评估。如果评价包含以RCT设计的干预措施，这些措施聚焦于在任何环境和针对任何医疗保健学科中改变工作人员对痴呆症患者的行为和/或实践，则纳入该评价。
我们识别出六项系统评价，其中一项在AMSTAR 2上被评为高质量。大多数干预措施针对长期护理机构中的护理人员，聚焦于激越行为，且缺乏理论依据。目前尚无足够证据指导当前测试干预措施的实施；然而，沟通技能培训、以患者为中心的护理以及在监督下进行痴呆症护理映射显示出改善激越行为的前景。
迫切需要开展更多设计良好且随机对照试验，并清晰报告方案和结果，以便为该领域提供信息，说明如何以最佳方式培训和支持工作人员。尽管尚无确凿证据表明哪些干预措施最为有效，但可以认为，在证据基础得到加强之前，使用有适度影响证据的干预措施进行培训总比完全不培训要好。
