Implementing the Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention : Mixed-method process evaluation alongside a pragmatic randomised trial

Chester, Helen and Beresford, Rebecca and Clarkson, Paul and Entwistle, Charlotte and Gillan, Vincent and Hughes, Jane and Orrell, Martin and Pitts, Rosa and Russell, Ian and Symonds, Eileen and Challis, David (2022) Implementing the Dementia Early Stage Cognitive Aids New Trial (DESCANT) intervention : Mixed-method process evaluation alongside a pragmatic randomised trial. Aging and Mental Health, 26 (4). pp. 667-678. ISSN 1360-7863

Text (DESCANT Process Evaluation Accepted Manuscript)
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Abstract

Objectives The DESCANT (Dementia Early Stage Cognitive Aids New Trial) intervention provided a personalised care package designed to improve the cognitive abilities, function and well-being of people with early-stage dementia and their carers, by providing a range of memory aids, together with appropriate training and support. This sub-study aimed to assess implementation and identify contextual factors potentially associated with participant outcomes. Method A mixed-methods approach was adopted alongside the pragmatic randomised trial. Data were obtained from intervention records and interviews with five dementia support practitioners across seven National Health Service Trusts in England and Wales. A reporting framework was constructed from available literature and data assessed by descriptive statistics and thematic analysis. Results Participation and engagement was high with 126 out of 128 participants completing the intervention with packages tailored to individual participants. Misplacing items and poor orientation to date and time were common areas of need. Memory aids frequently supplied included orientation clocks (91%), whiteboards (60%), calendars (43%) and notebooks (32%), plus bespoke items. Intervention duration and timing were broadly consistent with expectations. Variation reflected participants’ needs, circumstances and preferences. Qualitative findings suggested a potentially positive impact on the well-being of people with dementia and their carers. Issues associated with successful roll-out of the intervention are explored in the discussion. Conclusion Successful implementation increased confidence in future findings of the randomised trial. Depending on these, DESCANT may prove a scalable intervention with potential to improve the function and quality of life of people with dementia and their carers.