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NCT Number: NCT06168604

Evaluating the Efficacy of the Pain Identification and Communication Toolkit

This study will evaluate the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention for caregivers of people with Alzheimer's disease and related dementias (ADRD). PICT provides training in observational pain assessment and coaching in effective pain communication techniques. It will recruit participants from programs of all-inclusive care for the elderly (PACE) and partnering health care clinics. The investigators hypothesize that PICT will help caregivers to recognize and communicate about pain in their care recipients.

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Key information

Conditions

Caregiver Burden Alzheimer Disease Behavior Behavioral Symptoms Brain Diseases Central Nervous System Diseases Chronic Pain Cognition Disorders Cognitive Dysfunction Cognitive Impairment Dementia Mental Disorders Nervous System Diseases Neurocognitive Disorders Neurodegenerative Diseases Neurologic Manifestations Pain Pain, Chronic Pathological Conditions, Signs and Symptoms Signs and Symptoms Stress, Psychological Tauopathies

Age range

21 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Weill Cornell Medicine

New York, 10065, United States

Location status: Recruiting

Location contact

Lisa Sacerio

CONTACT

[email protected]

646-962-6941

About this study

Up to 60% of older persons with Alzheimer's disease and related dementias (ADRD) suffer from bothersome pain and nearly half experience pain-related activity limitations. Despite best-practice guidelines calling for routine pain assessment of persons with ADRD, pain is severely under-detected and poorly managed in this population. A major barrier to the identification and treatment of pain in persons with ADRD is impaired communication. Informal (family) caregivers are well situated to detect pain and facilitate management in persons with ADRD, given their extensive involvement in care activities. However, caregivers receive virtually no guidance or training in these areas. The Pain Identification and Communication Toolkit (PICT) is a multicomponent intervention for ADRD caregivers that provides training in observational pain assessment and coaching in effective pain communication techniques. PICT consists of 4 weekly telephone sessions (30-60 minutes each) delivered by a trained interventionist. This project aims to (1) determine the efficacy of PICT compared with an Attention Control (AC) condition, (2) identify the patient and caregiver factors that may moderate the effects of PICT on study outcomes, and (3) evaluate the mechanisms (theoretically-derived variables) by which PICT affects study outcomes. Participants will be recruited from programs of all-inclusive care for the elderly (PACE) programs and partnering health care clinics. They will complete assessments at 0 (baseline), 1, 3, and 6 months.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

CAREGIVER PARTICIPANTS

Inclusion criteria

  • Age 21 or older
  • Any gender
  • English speaking
  • Cognitively intact (BOMC ≤10)
  • Provides care to a community-dwelling adult with dementia or cognitive impairment who also has a pain diagnosis
  • Care recipient is not enrolled in hospice
  • Visits the care recipient at least weekly
  • Accessible by telephone

Exclusion criteria

  • Paid caregiver
  • Age 20 or younger
  • Non-English speaking
  • Cognitively impaired
  • Does not provide care to a person with dementia or cognitive impairment who also has a pain diagnosis
  • Currently enrolled in hospice
  • The patient to whom the caregiver provides assistance is enrolled in hospice
  • Visits care recipient less than weekly
  • Not accessible by telephone.

PATIENT PARTICIPANTS

Inclusion criteria

  • Residing in community settings
  • Record of dementia or cognitive impairment
  • Diagnosis of pain
  • Responsive to environment
  • No terminal illness with life expectancy <6 months
  • Not in active cancer treatment

Exclusion criteria

  • Lives in a residential facility (such as a nursing home or assisted living)
  • Enrolled in hospice
  • No dementia or cognitive impairment
  • Unresponsive to environment
  • Has terminal illness with life expectancy <6 months
  • Are in active cancer treatment

Treatment and study plan

Pain Identification and Communication Toolkit

Behavioral

The Pain Identification and Communication Toolkit (PICT) is a multicomponent (6 module) intervention for family caregivers of persons with Alzheimer's disease and related dementias (ADRD). PICT consists of 4 weekly telephone sessions (30-60 minutes each) delivered by a trained interventionist

Health Promotion Program

Behavioral

The attention control (AC) condition is referred to as the Health Promotion Program (HPP). The HPP will consist of 4 weekly telephone sessions (30-60 minutes each) but focus on caregiver health promotion topics, such as nutrition, exercise, and sleep.

Primary outcomes

  1. Change in caregiver-reported pain communication

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver-reported pain-related communication as measured by ten questions from the Perceived Involvement in Care Scale (PICS). The range of possible scores is 10-50, where higher scores indicate greater caregiver involvement in patient consultation.

  2. Change in pain management discussions with health care providers

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in pain management discussions as measured by the combined number of phone calls and appointments made to discuss pain management recorded in the patient's medical chart.

  3. Change in concordance between patient and caregiver pain ratings

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in concordance in patient and caregiver pain ratings as measured by the absolute difference between caregiver and patient pain ratings of the patient's pain on the Iowa Pain Thermometer (IPT). The IPT is scored on a scale of 0-10 where 0 means "no pain" and 10 means "the most intense pain imaginable."

  4. Change in caregiver's ability to recognize pain

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver's ability to recognize pain as measured by the absolute difference between the caregiver-reported PAINAD score and correct PAINAD score (i.e. absolute value of the deviance between the scores). The PAINAD is scored on a scale from 0-10 where 0 means "no pain" and 10 means "severe pain." Participants will be shown multiple videos on which to score the PAINAD.

  5. Change in caregiver's ability to recognize pain behaviors

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver's ability to recognize pain behaviors as measured by the absolute difference between the number of caregiver-reported behaviors within each of the 5 PAINAD behaviors (i.e., Breathing, Negative Vocalization, Facial Expression, Body Language, Consolability) and correct number of behaviors. Participants will be shown multiple videos on which to score the PAINAD.

Secondary outcomes

  1. Change in patient's behavioral disturbance

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in patient's behavioral disturbance as measured by 11 items on the Memory and Behavior Problem Checklist. Questions are asked on a likert scale of 0-never occurs to 4-occurs daily or more often for a total possible score of 44, with higher scores indicating more behavioral disturbance in the patient.

  2. Change in patient's pain treatments or regimens

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in number of each type of caregiver-reported patient treatment/regimens.

  3. Change in caregiver burden

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver burden will be assessed by the 7-item version of the Zarit Burden Index (ZBI). Response options for each item range from 0-"never" to 4-"nearly always". The highest possible score is 28 and the lowest possible score is 0; higher scores indicate more caregiver burden.

  4. Change in caregiver distress level

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver distress as measured by 11 items on the Memory and Behavior Problem Checklist. Questions are asked on a likert scale of 0-not at all to 4-extremely for a highest possible score of 44 and a lowest possible score of 0, with higher scores indicating more caregiver distress.

  5. Change in caregiver self-efficacy in pain recognition

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver self-efficacy in pain recognition as measured by 9 items adapted from The Health Education Impact Questionnaire on a scale of 1-"completely disagree" to 5-"completely agree" with a highest total score of 45 and a lowest total score of 9. Higher total scores indicate higher self-efficacy in pain recognition.

  6. Change in caregiver self-confidence in recognizing pain

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in self-confidence in recognizing pain as measured by four items adapted from McCabe et al., 2012. Questions are asked on a scale of 1-"not at all confident" to 4-"very confident," with a highest possible score of 16 and a lowest possible score of 4. Higher scores indicate more confidence in ones ability to recognize pain.

  7. Change in caregiver self-efficacy in pain-related communication

    Time frame: Baseline, 1 month, 3 month, 6 month

    Change in caregiver self-efficacy in pain-related communication as measured by a modified 10-item version of the Perceived Efficacy in Patient-Physician Interactions (PEPPI) Scale. Questions are asked on a scale of 1 - "not at all confident" to 5 - "very confident" with a highest total score of 50 and a lowest total score of 10. Higher scores indicate higher self-efficacy in pain-related communication between a caregiver and a healthcare provider.

Study contacts

Contact information is provided by the study sponsor or research team.

Lisa Sacerio

CONTACT

[email protected]

646-962-6941

Sponsors and collaborators

Lead sponsor

Weill Medical College of Cornell University

Other

Collaborators

  • National Institute on Aging (NIA)

Registry information

Official study title

The Pain Identification and Communication Toolkit: A Training Program to Support Family Caregivers of Persons With ADRD

Acronym: PICT

Important dates

Study start
2023
Primary completion
2027
Study completion
2027
First posted
Dec 13, 2023
Registry last updated
Feb 12, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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