Considerations for the Design of a Systematic Review of Care Interventions for Individuals with Dementia and Their Caregivers Letter Report (2018) / Chapter Skim
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The National Academies committee held a meeting on November 12 and 13, 2018, to discuss and provide input on the preliminary key questions (KQs) and a draft study scope prepared by the Minnesota Evidence-based Practice Center (EPC)
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They may be delivered by health care, social services, and other community organizations or caregivers with the intention of having a direct impact on either a person with dementia or their caregiver, or both. Organizational Framework for the Interventions To organize the available literature and understand the evidence and gaps in knowledge regarding care interventions, the committee recommends that the EPC adopt and adapt a framework that builds on a prior National Academies consensus report, Families Caring for an Aging America.
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163. Categorization of Interventions The committee recommends eliminating the division of interventions into the categories, "care interventions" and "care delivery interventions." This is an artificial distinction that would not add significant value in interpreting the systematic review results, but would create significant complications in attempting to categorize interventions according to this distinction.
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Training describes activities such as basic dementia knowledge and understanding, as well as competency-based training in supporting and delivering services to PWD (e.g., comfort care, music therapy, behavioral change strategies to increase pleasant events for PWD and to identify and reduce environmental triggers that might cause behavioral issues, recognizing other reasons behind behavioral issues like pain and how to manage it, and cultural competence in understanding PWD and informal caregivers from different cultures and backgrounds)
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The EPC may find it helpful to look for existing efforts to catalogue interventions in the grey literature; examining prior publications by the following organizations would be a good place to start: the Administration for Community Living, Centers for Medicare & Medicaid Services, Office of the Assistant Secretary for Planning and Evaluation, Patient-Centered Outcomes Research Institute, Salzburg Global Health Seminar Dementia Initiative, and Substance Abuse and Mental Health Services Administration. 3 For examples of previous reviews that used an ecological framework to identify how studies address cultural adaptations and modifications, see (1)
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The committee recognizes that there are different approaches with regard to assessing "efficacy, effectiveness, and comparative effectiveness" separately in a systematic review, versus considering them in a single category of "benefits." For this review, the committee recommends looking at a single category of "benefits," which refers to outcomes that are generally regarded as good, helpful, or otherwise salutary for well-being and health (as described in the section above on a broad view of "care interventions")
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The committee recommends some changes to the PICOTS table that follow from the more general comments above: • The committee recommends revising the preliminary PICOTS table according to the organizational framework noted above, and potentially adding some systems-level outcomes to fill any gaps. Time spent on the intervention (e.g., participation or facilitation)
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Given the ultimate project goal of understanding what is ready for broad implementation, what study design/comparators are most important to include? The committee recommends that the EPC take a broad perspective in including study designs for inclusion in the review, restricting to study designs that are informative for drawing causal conclusions (i.e., those that include comparator groups or interrupted time-series analyses)
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However, evidence on successful dissemination and implementation should be held to similar standards of rigor in terms of the quality of the evidence. We support the staged approach to the literature search that would prioritize searching the implementation literature for evidence about dissemination and implementation of interventions that have at least low-strength of evidence.
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