MassaChusetts General Hospital ROybal CeNter For BehavIoral Dyadic ResEarch in Alzheimer's Disease and Related Dementias (CONFIDE-ADRD)
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PROJECT SUMMARY (ADMINISTRATIVE CORE): The mission of the “MassaChusetts General Hospital ROybal CeNter For BehavIoral Dyadic ResEarch in Alzheimer’s Disease and Related Dementias” (CONFIDE-ADRD) is the development, optimization, testing and implementation of dyadic behavioral prevention interventions (DBPIs) across the spectrum of ADRD in both hospital and community settings, to improve health and prevent negative individual and dyadic health outcomes. The Administrative Core (AC) will contribute to this mission by guiding the overall direction of CONFIDE-ADRD and serving as a central communication and decision-making hub. The AC will support the CONFIDE-ADRD mission in 3 main ways: 1) organize and guide the center’s overall direction and ensure proper allocation of resources through overseeing the integration with the Behavioral Intervention Development Core, MGH (NIA funded AD/ADRD RCMAR, NIA funded R25 dementia palliative care, NIA funded T32 in behavioral interventions in aging, Mongan Institute, ADRC, Research Institute, Harvard Catalyst, etc) and national (IMPACT Collaboratory, Pepper Centers, Roybal Coordinating Center, other Roybals, RCMAR coordinating center) resources, as well as our Advisory Committee; 2) leverage the CONFIDE-ADRD resources and expertise at all levels of the NIH Stage model including other components of our conceptual model (Science of Behavior Change, NIA Health Disparities Framework, Center for Disease Control Prevention model and dyadic theory and interpersonal processes) to integrate and structure local and national resources and foster experiential learning of research skills necessary to develop, test and implement rigorous dementia DBPIs and swiftly translate them across the NIH stage model and into routine care, and foster interdisciplinary collaborations across investigators; and 3) evaluate and monitor the process and outcome indicators of funded pilot projects and CONFIDE-ADRD activities. Specific aims of the AC are: 1) Coordinate and oversee the administrative functions of CONFIDE-ADRD in order to establish and maintain centralized research resources and a stable research infrastructure to advance dementia DBPI research across the spectrum of ADRD, to improve health and prevent negative health outcomes across hospital and community settings; 2) Optimize the use of all CONFIDE-ADRD center resources and expertise in elements of our conceptual model, to facilitate, monitor, and accelerate pilot research and provide an enriched interdisciplinary environment; and 3) Evaluate funded pilot projects and CONFIDE-ADRD activities, make subsequent refinements, and report annually on the overall effectiveness and efficiency of our Center, its cores, and funded pilot projects. Our Center includes evidence-based method for teaching from Bandura’s Social Cognitive Theory as well as a novel method of evaluation that includes the NIH stage model and elements of our conceptual model. The MPI and investigators have rich experience in these methods. CONFIDE-ADRD has the potential to serve as a national model for rigorous training and resource integration in dementia DBPIs.
PROJECT SUMMARY (BEHAVIORAL INTERVENTION DEVELOPMENT CORE): The mission of the “MassaChusetts General Hospital ROybal CeNter For BehavIoral Dyadic ResEarch in Alzheimer’s Disease and Related Dementias” (CONFIDE-ADRD) is the development, optimization, testing and implementation of dyadic behavioral prevention interventions (DBPIs) across the spectrum of ADRD in both hospital and community settings, to improve health and prevent negative individual and dyadic health outcomes. The Behavioral Intervention Development Core (BIDC) will support the CONFIDE-ADRD mission through 3 specific aims: Aim 1: Accelerate translation of DBPIs across the NIH Stage Model for steadfast implementation; Aim 2: Facilitate a program of dementia DBPI mechanistic pilot studies using a novel accelerator model for team project management and continuous performance review with feedback and plan for skill improvement to support pilot funded investigators to conduct rigorous dementia DBPIs with efficient translation; and Aim 3: Catalyze translation and foster pilot program synergies across MGH/HMS, Roybal Centers and nationally. We will distribute a national call for applications. Investigators will submit a letter of intent. We will meet with selected investigators to review aims, explore available resources and expertise, establish a plan for aim completion and diversity in the sample, and determine a timeline for proposal development and pathway progression including subsequent funding for the next stage of work. Meetings will be over zoom. This early support will ensure that the applicants fully understand our conceptual framework including the NIH stage model, definition of dyadic research, and dyadic theoretical processes, so that they submit competitive, rigorous applications. Pilot awardees will interact with CONFIDE-ADRD weekly for the funded pilot year(s) so that they: 1) are connected to the broader resources and expertise in DBPIs; 2) receive directed support to overcome potential barriers; and 3) develop a network of other dementia pilot awardees through MADRC, RCMAR, NIA dementia palliative R25, and Roybal Centers. We will support Pilot Awardees to submit their subsequent NIH grant. Per the RFA, each pilot will last between 1-3 years and will be fully powered. We received 32 applications for our first call for applications and selected 2. The first pilot (social worker-led) will test the preliminary efficacy (NIH 1B) of Let’s Talk Tech, a dyadic intervention to support conversations about the use of technology in dementia dyads. The second pilot (psychologist-led) will first culturally adapt SHARE, an evidence-based program to support conversations around care values and preferences early after dementia diagnoses, for the needs of African American patient-partner dyads, and then pilot test (NIH 1B) its preliminary efficacy. Activities in this aim will strengthen synergies across MGH/HMS, locally and nationally thus facilitating greater collective impact of our core funds. Awardees will form a cohort of fellows who will in turn expend the Center’s expertise, reach and visibility.
PROJECT SUMMARY (OVERALL): The scientific theme of the “MassaChusetts General Hospital ROybal CeNter For BehavIoral Dyadic ResEarch in Alzheimer’s Disease and Related Dementias” (CONFIDE-ADRD) is the development, optimization, testing and implementation of dyadic behavioral prevention interventions (DBPIs) across the spectrum of ADRD in both hospital and community settings, to improve health and prevent negative individual and dyadic health outcomes. ADRDs (herein called dementias) are progressive, debilitating, and terminal illnesses associated with progressive negative health outcomes. Dementia drastically alters the lives of both the person diagnosed and their informal care-partner (spouses, children, other family, friends), and often disrupts established roles, identities, relationships, and future plans. Most dementia interventions focus on patients or care-partners alone, without accounting for their interrelation and interpersonal processes. The few existing dyadic behavioral interventions are limited because: 1) they often lack dyadic theoretical foundation and conceptual framework; 2) they are not mapped onto the NIH stage model; 3) they do not use principles of the Science of Behavior Change (SOBC) to inform dyadic mechanisms of change and appropriate measurement; 4) they are not developed across the spectrum of primary, secondary or tertiary prevention; 5) they do not incorporate the NIA Health Disparities Framework to provide a mechanistic understanding of health disparities and levels of analyses relevant to dyadic research; and 6) they do not account for dyadic interdependence and interpersonal relationships to maximize potency and avoid negative effects for one of the partners. CONFIDE-ADRD will address these limitations and catalyze the development of interdisciplinary research to create, test and implement innovative and rigorous DBPIs mapped onto our novel conceptual model that incorporates the NIH Stage Model, SOBC, the Center for Disease Control and Prevention model, the NIA Health Disparities Framework and dyadic theory. CONFIDE-ADRD will: 1) develop a diverse, next generation of scientists committed to dementia DBPIs; 2) use an experiential learning approach to dementia DBPI research that prioritizes mechanisms of behavior change; 3) will swiftly move DBPIs across the NIH Stage Model for effective and efficient implementation. Our three overarching aims will be met by the Center’s two cores. The Administrative Core will: 1) coordinate the Center’s activities, promote interactions and networking among pilot awardees, co-investigators and collaborating partners; 2) integrate with local and national centers, institutes and organizational partners; 3) use experiential learning activities (e.g., DBPI Salon, grant writing workshops, mock grant reviews) to provide hands on learning of relevant DBPI research aspects. The Behavioral Intervention Development Core will provide awardees with support and practical experience in working with a dedicated research team to conduct DBPI pilot research that is feasible, rigorous, and mechanistic, prioritizing the patient-care-partner relationship. The MPIs (Vranceanu & Okereke) are senior investigators with extensive expertise in the NIH stage model, dementia care, dyadic research, leadership and mentoring, and, with support from nationally acclaimed investigators and local and national resources, are well poised to lead this center.
