National Institute on Aging, 1R01AG077113-01
5/15/22 - 4/30/27
Paul J. Barr, PhD (Geisel School of Medicine at Dartmouth); Joshua Chodosh, MD (New York University (NYU) Grossman School of Medicine
Other Project Staff
James O’Malley, PhD (The Dartmouth Institute), Martha Bruce, PhD (Department of Psychiatry, Geisel), Elizabeth Carpenter-Song, PhD (Department of Anthropology, Dartmouth College), Nick Jacobson, PhD (Center for Technology and Behavioral Health), Gina Fernandez, MD (Geriatrics, Dartmouth Hitchcock Medical Center), Yi Shan Lee, MD (Geriatric Medicine, NYU Langone Health), Susan Tarczewski (CTBH), Lisa Mistler (CTBH), Lisa Oh (CTBH), Craig Ganoe (CTBH), Ellen Flaherty (DH), Diana Hernandez (NYU), Mauricio Arcila-Mesa (NYU), Crytalinda Rapozo (NYU), and Wambui (Moraa) Onsando (TDI).
One in nine people aged 65 or older in the US lives with Alzheimer’s disease (AD) or Alzheimer’s disease-related dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits for dementia information, management, and community referrals. Quality interpersonal communication is associated with improved health-related outcomes. Models of triadic interactions purport that information exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to effective interpersonal communication. However, the degree to which effective interpersonal communication is achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application is unexplored in dementia.
The objective of this proposal is to design an intervention that enhances interpersonal communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their visit recording platform, HealthPAL, which leverages natural language processing to structure visit information. The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of 200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD.
Applicants hypothesize: 1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2) HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for behavior change will be identified using quantitative assessment of interpersonal communication during triadic visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on interpersonal communication in triadic AD/ADRD visits.
This work is a necessary first step to improving PLWD triadic care by identifying behaviors that impact interpersonal communication and their associations with health-related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.
Public Health Relevance
Effective interpersonal communication is associated with improved health related outcomes, yet it is unclear to what extent this occurs in triadic clinic visits in dementia, and few tools exist to support it. The objective of this project is to characterize the extent to which interpersonal communication occurs during triadic visits in dementia, examine how this is related to health outcomes and use this understanding to adapt an innovative clinic visit audio recording intervention, HealthPAL for use in this setting. The results are expected to have a major positive impact by providing a rich understanding of communication during triadic visits in dementia, and proof-of-principle of the usability, feasibility, and acceptability of visit audio recording to enhance interpersonal communication.