School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA.
Alzheimer's Disease Research Center, University of Kansas, Fairway, Kansas, USA.
Gerontologist. 2023 Sep 2;63(8):1395-1404. doi: 10.1093/geront/gnac193.
Communication is fundamental for dementia care. The trouble source repair (TSR) framework can identify strategies that facilitate or impede communication in dyadic interactions.
A secondary analysis of videos (N = 221) from a clinical trial of a family caregiver telehealth intervention was analyzed using sequential behavioral coding of communication behaviors and breakdowns for 53 caregiver and person with dementia dyads. Coded data from 3,642 30-s observations were analyzed using penalized regression for feature selection followed by Bayesian mixed-effects modeling to identify communication strategies associated with communication breakdown and repair.
Breakdown (coded as 0) was associated with caregivers changing topic (median = -11.45, 95% credibility interval [CrI; -24.34, -4.37]), ignoring (median = -11.49, 95% CrI [-24.49, -4.72]), giving commands (median = -10.74, 95% CrI [-24.22, -3.38]), and taking over the task (median = -4.06, 95% CrI [-7.28, -1.77]). Successful repair of breakdown was associated with verbalizing understanding (median = 0.46, 95% CrI [0.09, 0.86]), tag questions, (median = 2.4, 95% CrI [0.33, 5.35]), and silence (median = 0.78, 95% CrI [0.42, 1.15]) and negatively associated with ignoring and changing topic (median = -3.63, 95% CrI [-4.81, -2.57] and -2.51 [-3.78, -1.33], respectively).
The TSR was effective in identifying specific communication strategies to avoid (changing topic, ignoring, commands, and taking over the task) and to use to repair breakdown (verbalize understanding, tag questions, and silence). Future research is needed to test these strategies and explore the potential effects of dementia stage, diagnosis, and dyad characteristics in additional samples. Behavioral coding provides evidence of communication best practices as a basis for family caregiver communication training.
沟通是痴呆症护理的基础。问题源修复（TSR）框架可以识别促进或阻碍二元互动中沟通的策略。
对一项家庭护理人员远程医疗干预临床试验的视频（N=221）进行二次分析，对 53 对护理人员和痴呆症患者的沟通行为和障碍进行连续行为编码。对来自 3642 个 30 秒观察的编码数据进行惩罚回归特征选择，然后进行贝叶斯混合效应建模，以确定与沟通中断和修复相关的沟通策略。
中断（编码为 0）与护理人员改变话题（中位数=-11.45，95%可信度区间[CrI；-24.34，-4.37]）、忽视（中位数=-11.49，95% CrI [-24.49，-4.72]）、发号施令（中位数=-10.74，95% CrI [-24.22，-3.38]）和接管任务（中位数=-4.06，95% CrI [-7.28，-1.77]）有关。成功修复中断与表达理解（中位数=0.46，95% CrI [0.09，0.86]）、疑问标签（中位数=2.4，95% CrI [0.33，5.35]）和沉默（中位数=0.78，95% CrI [0.42，1.15]）有关，与忽视和改变话题呈负相关（中位数=-3.63，95% CrI [-4.81，-2.57]和-2.51 [-3.78，-1.33]）。
TSR 有效地确定了避免（改变话题、忽视、命令和接管任务）和修复中断（表达理解、疑问标签和沉默）的特定沟通策略。需要进一步的研究来测试这些策略，并在其他样本中探索痴呆症阶段、诊断和对子特征的潜在影响。行为编码为家庭护理人员沟通培训提供了沟通最佳实践的证据。
