GamePlan4Care: Online Support for Family Caregivers

Study Overview
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Brief Summary
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As the population of older adults grows, almost doubling in size from 2012 to 2040, so too will the need for family caregiving. Caregiving can lead to negative psychosocial outcomes such as depression, anxiety, and burden; social isolation and family conflict: financial strain due to costs of care; and some caregivers also experience negative health consequences. This project will test the value of GamePlan4Care (GP4C) an evidence-based, internet-enabled system capable of providing immediate, tailored education and skills training to caregivers who can access live support from a DCS via phone or web-based video.

Detailed Description
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Daily care and supervision of a person living with dementia (PWD) has been defined as intense caregiving and is associated with significant daily burdens and an overall threat to the caregiver's quality of life. Despite evidence suggesting that negative consequence can be remediated with community-based supports, those services remain allusive to caregivers due to the systemic challenges of turning interventions into services. This study is based on a practical approach of applying technology to an existing evidence-based intervention, Resources for Enhancing Alzheimer's Caregiver Health II (REACH II), refined with real-world user feedback and rigorously tested with the goal of creating an online family caregiver support system that has the potential of both scalability and sustainability. This two-group randomized controlled trial will compare the relative impact of GP4C to an education-based online site called Resources4Care (R4C) on a wide range of family caregiver outcomes. Family caregivers will be randomized to one of the two conditions and will complete an assessment battery at baseline and at the 6-month follow-up.

Official Title
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GamePlan4Care: Web-based Delivery System for REACH II

Conditions
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Dementia

Intervention / Treatment
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* Behavioral: GamePlan4Care
* Behavioral: Resources4Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be age 18 years or older Providing at least 8 hours of weekly care and/or supervision (on average) for a friend or family member with a self-reported diagnosis of Alzheimer's disease or a related dementia. Family will be subjectively determined by the caregiver to enable a broader definition of a family member often found in minority communities (e.g., a person not related by blood but who serves in the role of an aunt or grandchild). The family member, named as the care recipient (CR) in this proposal, must be diagnosed with AD/ADRD (self-report from the caregiver accepted) and is experiencing signs of dementia as verified by the family caregiver on the AD8 informant interview. A score of 2 or greater is the inclusion criteria. Must demonstrate access to a home computer with internet access to research staff and report using the computer to access the internet at least three times per week, on average. English-speaking caregivers Must reside within the recruitment area (Target counties within Texas: Bastrop, Bell, Blanco, Burnet, Caldwell, Coryell, Fayette, Hamilton, Hays, Lampasas, Lee, Llano, Milam, Mills, San Saba, Travis, Williamson) Exclusion Criteria: Current participation in another caregiving evidence-based program Previous participation in usability testing for current system development

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GamePlan4Care (GP4C)<br>Participants in this arm will have access to full functionality and content of the online system GamePlan4Care (GP4C) including educational resources, skills training, and support tailored to their unique caregiving needs. Additional individualized feedback will be automatically generated based on responses to online questions and will include links to relevant site educational/skill-building content. Participants will be assigned a Dementia Care Specialist who will facilitate caregiver interactions with the online material and provide skills training via telephone or web-video conference. Study participants assigned to GP4C will receive 9 automated emails and 4 phone calls over a 6-month period. | Behavioral: GamePlan4Care<br>* GamePlan4Care; Experimental<br>|
| Active Comparator: Resources4Care (R4C)<br>Participants in this arm will receive access to Resources4Care (R4C), a feature-limited version GamePlan4Care system. R4C will serve as an online hub for articles and videos about Alzheimer's disease and dementia. Educational topics will included information on: 1) Alzheimer's Disease & Dementia, 2) Caregiving, 3) Caregiver Stress and 4) Home Safety. R4C will present a page on each topic with active links to two additional online sources on the same topic. Study participants assigned to R4C will receive two emails from their DCS encouraging the caregiver to review specific education materials. Each email will be followed by brief check-in calls (15-min each) at three months and five months after randomization. | Behavioral: Resources4Care<br>* R4C; Active Comparator<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Caregiving Burden at 6 months | A 12-item version of the Zarit Caregiver Burden Interview. The Zarit Caregiver Burden Interview (ZBI) is an assessment tool for evaluating caregiver burden. The ZBI consists of 12 items representing a statement related to some aspect of perceived burden. Respondents (i.e., caregivers) rate each item ranging 0 (=never) to 4 (=nearly always). Total ZBI score is the summation of 12 items ranging from 0 to 48. Higher scores indicate greater burden. | Baseline and six months | 
| Change from Baseline Depression at 6 months | Levels of depressed symptoms: A 10-item version of the Center for Epidemiological Studies Depression (CESD) Scale is an assessment tool for evaluating depression. Each item represents a statement for which respondents indicate how often in the past week they have felt that way from 0 (= rarely or none of the time) to 3 (= most or almost all of the time). Total score is the summation of 10 items ranging from 0 to 30. Higher scores indicate higher levels of depressed symptoms. | Baseline and six months | 
| Change from Baseline Self-rated health at 6 months | Assessment of perception of general health status A single item of self-rated health assess caregiver's perception on his/her own health from 0 (=excellent) to 4 (=poor). | Baseline and six months | 
| Change from Baseline Social Support at 6 months | Assessment of availability of support and satisfaction with support from others: Two constructs from Social Provision Scale (reliable alliance and guidance) are used to evaluate social support. Two constructs assess availability of support and satisfaction with support from others. Four items for each construct (total of 8 items) describe a statement for which respondents agree to what extent their relationships are with other people from 1 (= strongly disagree) to 4 (=strongly agree). A total score is the summation of 8 items ranging from 8 to 32. Higher scores indicate higher levels of social support. | Baseline and six months | 
| Change from Baseline Interaction with Health Care Providers at 6 months | Assessment of the frequency and experiences of medical care management and coordination for care-recipients: 9 items from the National Study of Caregiving (NSOC) ask about experiences and frequency of caregiver's interactions with care-recipients' health care providers. Each item represents a statement for which respondents indicate how often in the last 6 months they interact with health care providers/workers. | Baseline and six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Caregiver stress at 6 months | Assessment of levels of stress: The Perceived Stress Scale (PSS) is an assessment tool for evaluating stress level. The PSS consists of 10 stress items. Each item represents how often in the last month respondents felt that way from 0 (=never) to 4 (=very often). A total score is the summation of 10 items ranging from 0 to 40. Higher scores indicate higher levels of stress. | Baseline and six months | 
| Change from baseline reported positive aspects of caregiving at 6 months | Assessment of favorable aspects of caregiving experiences: An 11-item of Positive Aspect of caregiving (PAC) is an assessment tool for evaluating favorable aspects of caregiving experiences. Each item represents a statement of mental or affective state related to caregiving experiences. Respondents rate to what extent the each statement corresponds to their mental or affective state ranging from 0 (=disagree a lot) to 4 (=agree a lot). A total score is the summation of 11 items ranging from 0 to 44. Higher scores indicate higher levels of positive experiences of caregiving. | Baseline and six months | 
| Change from baseline neuropsychiatric symptoms in Care-recipient/corresponding caregiver distress at 6 months | Presence and severity of neuropsychiatric symptoms and levels of relevant caregiving distress : Neuropsychiatric Inventory Questionnaire-Q (NPI-Q), a 12-item self-administered questionnaire (NPI-Q), completed by the caregivers about care-recipients for whom they care, is a tool to assess the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as the caregiver's corresponding distress. Each item asks the presence (1=yes, 0=no), severity (1=mild, 2=moderate, 3=severe), and caregiving distress (0=not at all; 5=extreme or very severe). | At Baseline | 
| Program evaluation of GP4C/R4C | Assessment of Attitude toward GP4C/R4C system: A 30-items of USE questionnaire will evaluate participant's attitude toward GP4C system. The USE questionnaire includes four areas: assess usefulness (8 items), ease of use (11 items), ease of learning (4 items), and satisfaction (7 items). Respondents rate agreement with the statements, ranging from strongly disagree (=1) to strongly agree (=7). Total scores are the summation of items on each area. Higher scores in each are indicate more useful, easier to use, easier to learn, and more satisfied on their experience. | At six months only | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Caregiving, Skills-training