ISSUES AND INNOVATIONS IN NURSING PRACTICE: Deconstruction of a complex tailored intervention to assess and treat discomfort of people with advanced dementia

This paper describes the use of components of the Serial Trial Intervention (STI), which is designed to address problems of physical and affective discomfort in people with late-stage dementia. Nursing intervention studies frequently test the efficacy of tailored interventions that contain multidimensional assessment and diverse treatment components. Describing differences in the intervention as planned in the research design and as delivered under study conditions increases understanding of what really contributed to outcomes achievement, Type III error and improves the validity of conclusions regarding intervention effectiveness. Data from 57 participants in the treatment arm of a randomized experiment testing the intervention are used to describe the assessments and treatments actually delivered, to evaluate the effectiveness of specific components, and to compare differences between those receiving and not receiving the intervention. While targeted treatment in response to positive physical assessment was effective for 86% of those receiving treatment, 70% of participants with a positive assessment finding did not receive treatment during this step of the STI. Trials of non-pharmacological treatments were effective for 62% and trials of analgesics were effective for 75% of participants. Those treated at the not-for-profit facilities received a higher dose of the intervention and had statistically significant less discomfort after treatment than those at for-profit facilities (effect size of 0*963). Components of the STI were effective for many participants and this supports the use of a multidimensional approach to resolve the unmet needs of people with dementia who no longer communicate their needs through spoken language. Treating the intervention as both a categorical and continuous variable in experimental studies allows the effect of group assignment as well as dosage delivered to be examined.