Table 2.
Priorities for Advanced Dementia Research Over the Next Decade
| Discipline | Broad Research Objectives | Specific Examples |
|---|---|---|
| Intervention | Design and conduct RCTs of interventions to promote high-quality, goal-directed care across health care settings Design and conduct RCTs of interventions to reduce disparities in end-of-life care |
RCT of an intervention to reduce hospital transfers for nursing home residents with advanced dementia whose goal of care is comfort RCT of a clinical pathway to reduce feeding tube insertions in hospitalized patients with advanced dementia RCT of culturally sensitive video decision aids that use visual images (vs. verbal explanations) to illustrate treatment options |
| Health policy/services | Identify policies that incentivize high-quality, cost-effective end-of-life care Test strategies to increase access to hospice care and palliative care programs Conduct comparative effectiveness research of treatment strategies |
Develop and evaluate nursing home quality indicators for end-of-life care Examine effect of introducing payment for hospice during receipt of skilled nursing facility care Determine the incremental cost-effectiveness ratio of not hospitalizing nursing home residents with advanced dementia for suspected pneumonia (e.g., incremental changes in quality-adjusted outcomes relative to costs) |
| Implementation | Conduct projects to implement proven interventions and policies | Demonstration project of evidence-based advanced dementia care intervention into nursing home practice |
| Measurement | Develop new advanced dementia-specific instruments for outcomes currently lacking valid measures Better establish psychometric properties of existing instruments |
Measure of stress among family members of nursing home residents with advanced dementia Develop utility-based measures of health-related quality of life in order to conduct comparative effective research Determine minimally clinically important difference for Symptom Management at the End-of-Life in Dementia Scale (30) |
RCT = randomized, controlled trial.