Adaptation and feasibility of START online, a multicomponent intervention for Australian carers of people with dementia: a pilot randomised controlled trial

Background There are more than 400 000 Australians living with dementia and an estimated 200 000 carers who provide unpaid or informal care for a person with dementia. Around a third of those live in regional and rural Australia. The objective of this study was to test the feasibility and acceptability of the adapted telehealth STrAtegies for RelaTives (START) program within the Australian healthcare context.Methods A two-armed, randomised controlled pilot trial was conducted. Twenty-eight family carers were assigned to the START 8-week manualised coping program or cognitive behaviour therapy (CBT) delivered in a university psychology clinic. Carers completed pre- and post-intervention questionnaires to determine the acceptability of the program. Standardised measures of mood and perceived carer burden were also administered to explore evidence for limited efficacy using Reliable Change Indices.Results Eighteen carers were allocated to the START program and 10 to the CBT program. At completion, 10 of 13 commencers in START completed, whereas four of eight eligible CBT carers completed. START carers reported higher overall satisfaction and acceptance of the intervention compared to carers who underwent CBT. Furthermore, the telehealth modality was shown to be a practical and acceptable method of intervention delivery, and satisfaction was rated highly (8.5/10). Referral to and demand for the program proved the largest challenge. Improvement in mood was indicated for some carers who completed START.Conclusions These findings indicate preliminary evidence for aspects of feasibility of the START intervention for supporting carers in their caring roles via telehealth delivery. Further investigation is needed to determine intervention efficacy for the treatment of mental health symptomology via telehealth. Any future trial examining dementia carers should first establish strong referral pathways and linkages with primary healthcare and diagnostic services.Clinical Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12617000413325). There are more than 400 000 Australians living with dementia and an estimated 200 000 family or friends providing care to them. While the carer's experience can be a positive one, it can also be very stressful. This study shows that an online carer support program was received well and can be helpful in improving mood. Support should be offered to all carers of people living with dementia.