A randomised controlled trial of Empowered Conversations: training family carers to enhance their relationships and communication with people living with dementia

Background: Almost one in two informal carers of people with dementia experience depression or anxiety. Challenges to communication cause frustration, low mood and stress for both people living with dementia and their carers. Improved communication can reduce relational strain and stress for carers. Extensive scoping exercises identified a need for an interactive training that supports carers and provides them with tools to cope with the relational and emotional challenges they experience, as well as with more specific communication skills, to improve connection and reduce stress. In response to this, we have developed and evaluated a training course for informal carers of people living with dementia: Empowered Conversations (EC) . EC is a 6-sessions group-based psychosocial intervention; sessions last 2-hours. We will offer informal carers the opportunity to access EC either in person or online. Prior to our recent RfPB feasibility randomised controlled trial (RCT), there was some quantitative evidence of promise of EC, primarily from a pre-post follow-up study of the in-person version (N = 159), in which the Standardised Effect Size (SES) on the Perceived Stress Scale (PSS) from pre-treatment to 4-month follow-up was 0.48. Further evidence of promise of a small to moderate effect was obtained from the feasibility RCT, with an estimated reduction of SES=0.13, 95%CI -0.32 to 0.57 on PSS. Qualitative research has used to inform EC intervention development. Twenty-eight carers were interviewed regarding their experiences of in-person EC; 27 described feeling able to better connect with the person they support after attending EC. Within the recent feasibility RCT, 15 semi-structured qualitative interviews were conducted with carers who had attended online EC. The 15 carers expressed general satisfaction with the online format and identified advantages to this format (such as not needing to travel and being more able to manage caring responsibilities at home); however, most participants felt that an in-person course would provide a better environment for connecting with other carers. Qualitative work with minoritised groups has informed intervention design. Aims and Objectives: The aim is to examine the effectiveness and cost-effectiveness of EC. Key objectives include providing the first examination of whether effectiveness differs between the in-person version and the online version of EC; exploring whether effectiveness varies according to key carer status factors. Methods: A multi-centre, parallel-group RCT comparing EC+TAU (intervention condition) with TAU alone (control condition). TAU will be measured and remain as usual in both groups. Assessments will be carried out at baseline, 16 weeks post randomisation (post intervention) and 26 weeks post randomisation (follow up). In line with our feasibility RCT, allocation will be a 2:1 in favour of the EC+TAU arm. Sample size: 336 randomised. Impact: If the trial provides evidence of the effectiveness and cost-effectiveness of EC, key impacts will be: (1) providing a robust evidence base for a group-intervention supporting carers with their stress, communication and relationship; (2) greater access to psychosocial interventions for under-served and minoritised carers of people living with dementia; (3) standing as an example of best practice in involving carers evaluating psychosocial interventions.