Review: Befriending for Carers of People with Dementia

There is a paper from the National Institute for Health Research Health Technology Assessment Programme titled ‘Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial’ by G Charlesworth and colleagues and which is freely available here. This is a 92-page document which begins with an overview of the NIHR Health Technology Assessment Programme where projects can cost between £40,000 to over £1 million. The researchers wanted to find out if providing trained befrienders to carers of people with dementia was cost-effective and associated with significant improvements on health and well-being measures.

There was a 2-year period follow-up and the main point for outcome measures was at 15 months.

The remit of the befriending volunteers was to provide companionship and conversation. Their role was to be a listening ear; that is, to provide emotional support to the carer

There was at least 6-months of contact with the befriender. Carers were family carers aged 18 and over. The researchers initially approached primary care in two areas in an effort to recruit but then needed additional recruitment strategies due to low numbers of participants. The randomisation procedure which ensured that variables of interest were examined were quite involved and detailed in the methodology section. However blinding in this study referred to the researchers rather than the participants due to the nature of the intervention. There were a number of outcome measures which included the HADS, PANAS (Positive and Negative Affect Schedule), The Carers Assessment of Difficulties Index (CADI), a two-item measure of emotional loneliness, the Mutual Communal Behaviours Scale (MCBS), the Practitioner Assessment of Network Type (PANT) scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the Brief Coping Orientation for Problem Experience (COPE), the List of Threatening Experiences, health related quality of life (EQ-5D) and resource use through the use of semi-structured interviews (they detail a number of ‘pre-existing interview schedules’). In terms of economic evaluation

The EQ-5D health profiles were converted to utilities using UK general population valuations and thence to QALYs over the period measured

There is a detailed summary of participant flow on page 20 in figure 1. In the results section the researchers state that they found no significant difference between the intervention and control group on the primary outcome measures including the economic analysis. They state that

‘In terms of the main outcomes for the ITT analyses, therefore, this is a strongly negative study’

before adding that they are not assessing the results of receiving a befriender but instead are examining

‘access to a befriender facilitator’

Roughly 50% of carers took up the befriending service and the researchers note that individual carers may have very specific service requirements or may need befriending services at times of crisis. The relatively low rate of take-up means that the study may not have been sufficiently powered to detect significant differences and indeed in their conclusions the researchers state that

‘However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls’

The researchers recommend another study and given the engagement of healthcare services with the voluntary sector this type of research is one with potentially marked practical benefits.

 

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