Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia

Abstract

Background and Objectives Despite its prevalence and impact, pain is under-detected and under-managed in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n=19) or a control condition (n=15). Caregivers in the PICT group participated in 4 weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12-weeks. Caregivers in the intervention group also completed semi-structured interviews at 12-weeks. Quantitative data were analyzed using descriptive statistics and t-tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12-weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT’s components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully-powered efficacy trial, an important step toward future integration into real-world care delivery.

Introduction to Special Issue: Translational Research on Pain and Pain Management in Later Life

“… Riffin et al (2023) evaluated a family caregiver-directed intervention designed to enhance caregivers’ ability to assess pain among care recipients (community-dwelling older adults with moderate-to-severe dementia) and to communicate those findings to the care recipient’s physician as a way of enhancing pain care. Intervention participants received the training weekly over a 4-week period by a trained interventionist.…”

“…K. Pillemer served as a coauthor in Riffin et al (2023) , and M. C. Reid served as a coauthor in Riffin et al (2023) and Ong et al (2023) included in this special issue; they were not involved in the review or decision for the articles.…”

Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons

“…We draw on examples from our work involving a multi-site clinical trial to discuss practical considerations for initiating and sustaining research-PACE partnerships that would apply to other evidence-based interventions. In brief, our multi-site trial aims to evaluate a caregiver-targeted training program to improve pain assessment among persons with dementia ( 19 ), which is a crucial element in the treatment of pain. The intervention is delivered over four weekly telephone sessions (30–60 min each) by a trained interventionist and provides caregiver training in observational pain assessment, coaching in effective pain communication, and structured opportunities for skill-building.…”