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Clinician Article

Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review.



  • Nguyen H
  • Terry D
  • Phan H
  • Vickers J
  • McInerney F
J Clin Nurs. 2019 Apr;28(7-8):1050-1069. doi: 10.1111/jocn.14697. Epub 2018 Nov 20. (Review)
PMID: 30357952
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Disciplines
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 5/7
  • Neurology
    Relevance - 5/7
    Newsworthiness - 6/7
  • FM/GP/Mental Health
    Relevance - 5/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7
  • Psychiatry
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

AIMS AND OBJECTIVES: To review communication interventions that aim to improve regular care interactions between people with dementia and their carers in various settings; and to examine the impact of such interventions on both carer and care-receiver outcomes.

BACKGROUND: Effective communication is imperative to ensure quality of care for people living with dementia. Due to neurodegenerative changes, people with dementia encounter ongoing and progressive difficulties in both understanding and expressing themselves. This in turn creates challenges for carers, which highlights the need for equipping them with necessary communication skills to respond to the specific communication needs of people with dementia.

DESIGN: Systematic review and meta-analysis.

METHOD: Medline, Embase, CINAHL, ProQuest and PsycINFO databases were searched for eligible interventions with any date of the publication. Hand searching was also conducted through reviewing the reference lists of relevant articles. The screening and selection of studies were based on the inclusion/exclusion criteria for eligibility and the methodological quality assessment checklist. Random-effects meta-analyses were conducted on comparable quantitative data. The review is reported following the PRISMA reporting guidelines.

RESULTS: Seventeen studies were included in the final review, including 12 randomised controlled trials (RCTs), three nonrandomised controlled trials (NRCTs) and two controlled before-after interventions. The intervention designs, settings and outcome measures were varied. The findings suggest that the communication training had a positive impact on both carer and care-receiver outcomes, albeit to different degrees. The intervention effects were found to be strongest on carer communication skills and knowledge.

CONCLUSION: There is solid evidence for the positive impact of communication training on the skills and knowledge of carers. More research is needed regarding the effects of such educational interventions on carer physio-psychological outcomes and care-receiver neuropsychiatric symptoms. It is important to establish best practices in training design, develop validated outcome measures and adopt consistent reporting approaches.

RELEVANCE TO CLINICAL PRACTICE: The increasing global prevalence of people with dementia manifests across clinical and community contexts. The profound impact of dementia on communication and associated care raises the imperative for enhanced health worker and carer communication skills to meet the needs of this particular client group. The findings of this review indicate that educational interventions incorporating face-to-face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

The outcomes are of uncertain clinical significance.

FM/GP/Mental Health

As a general practitioner, it is relevant to learn that educational interventions incorporating face-to-face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training.

FM/GP/Mental Health

Though the authors concluded that there is solid evidence for the positive impact of communication training on the skills and knowledge of carers, considering the intervention designs, settings and outcome measures were varied, the evidence is questionable.

Geriatrics

That communication training improves communication skills is not surprising, but that communication training to caregivers improves neuropsychiatric symptoms in the dementia patients (Fig 6) is useful. The paper is difficult to read. Note that Figures 4 and 5 have the same caption but have different findings! Details re the training would help.

Neurology

This meta-analysis and systematic review highlights strong evidence for the positive effects of communication training interventions on the communication skills and knowledge of carers in their regular care interactions with people affected with dementia. The authors found positive outcomes, sustainable beyond the intervention period. Moreover, they found reduced negative psycho-physiological states on carers' end and, as a consequence, a diminished of neuropsychiatric symptoms of patients during the follow-up. Overall, this manuscript is well-written. The flow is easy to follow, even by general readers who may not be experts in the field.

Neurology

This is a very important review showing that communication training for carers is beneficial. The use of systematic ways in finding and appraising the evidences are the strength of this article, with very comprehensive searching methodology. The appraising methodology is very objective and clear. This review should be part of evidence-based policy for managing dementia.

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