Mechanistic Trial of the "Let's Talk Tech" Dyadic Intervention to Support Person-Centered Decision Making about Technology Use

Background and Purpose: The goal of this behavioral intervention research is to help dementia care dyads understand technology options to support care so they can negotiate person-centered decisions. Let’s Talk Tech (LTT) is the first intervention to enable families to identify and discuss technology preferences held by people living with dementia or mild cognitive impairment (PLWD/MCI) and to prepare their care partners to make decisions that everyone can feel good about. LTT is a one-time, self-administered web-app intervention that targets education and interpersonal communication processes to enable informed decision making and planning for technology use that relieves care partners of the burden of making decisions without awareness of the other person’s preferences. We report findings from the NIH Stage Model Stage1B mechanism-focused RCT of Let’s Talk Tech.

Methods: Ninety-five dyads (190 individuals) of PLWD or MCI (50%) and an adult care partner completed the study in English. Dyads were recruited through cohorts of four Alzheimer’s Disease Research Centers, health fairs, and caregiver influencers on social media. The sample was dispersed across 31 U.S. states and 72.5% identified as white, 12% as Black, 9.5% as Latinx, and 6% as mixed race, AIAN, or Native Hawaiian or Pacific Islander. For Aim 1, we tested if care partners in dyads randomized to LTT compared to Usual Care will report greater technology awareness and intention to honor the PLWD/MCI’s preferences, and both care partners and PLWD/MCI will report greater technology comprehension, communication satisfaction, mutual understanding, and dyadic alignment. We conducted a separate longitudinal regression for each PLWD/MCI and care partner hypothesized mechanism using generalized estimating equations to test whether LTT vs. Usual Care was associated with differences in pre-to-post change for these outcomes.

Results: Both PLWD/MCI (d = 0.60, p = .007) and care partners (d = 0.84, p < .001) who completed LTT reported greater post-test improvement in technology comprehension. There was greater improvement in care partners’ perceptions of PLWD/MCI’s technology comprehension under LTT (d = 1.05, p < .001). Care partners who completed LTT reported a greater improvement in technology awareness (d = 0.59, p < .001), communication satisfaction (d = 0.79, p < .001), and dyadic alignment (d = 0.83, p < .001). Collectively, these findings correspond with medium-to-large intervention effects (Cohen, 1988). While there was no effect on PLWD/MCI’s mutual understanding, care partners who completed LTT reported that their partner better understood their feelings about technology (d = 0.76, p = .001) and that they better understood their partner’s feelings about technology (d = 0.90, p < .001).

Conclusions and Implications: We tested the first intervention that educates people living with dementia and their care partners about technologies used in care and helps them talk about what matters to them so they can make informed decisions. This trial shows that factors such as technology comprehension and communication challenges are modifiable barriers to person-centered decision making. This scalable, self-administered intervention has the potential to support families to use technology to support care in ways that align with their values.