NegotiAge —An AI ‐Based Caregiver Negotiation Training: Results From the Multiphase Optimization Strategy ( MOST ) Trial

BACKGROUND: Family caregivers experience conflicts in caring for people with Alzheimer's dementia (PWD; e.g., siblings disagreeing, advocating with providers, PWD refusing assistance). Subsequently, family caregivers experience frustration, burden, and stress. Furthermore, these caregivers rarely receive formal conflict resolution training to ameliorate these concerns. We developed NegotiAge-an artificial intelligence (AI)-based negotiation training intervention that teaches caregivers how to resolve conflicts and provides the opportunity to practice negotiating with online avatars in real-world conflicts. We sought to optimize the potency and test the early effect of NegotiAge on family caregivers following the multiphase optimization strategy (MOST). PARTICIPANTS, DESIGN, SETTING: National randomized factorial trial of NegotiAge with family caregivers of PWD (> 65 years). Caregivers were randomized to one of eight conditions and variables/outcomes assessed at baseline and 1 month following NegotiAge. The mixed methods project used dependent sample t-tests (quantitative) and constant comparative analysis (qualitative). RESULTS: Across 23 states, 125 family caregivers (mean-age 54 years, 77% female) completed the study. Participants experienced significantly less caregiver burden (-3.24, p < 0.002) and negative affect (-2.1, p < 0.0001) between baseline and 1 month following. Those receiving two or more exercises experienced further significant burden reduction (-5.28, p < 0.04). Qualitative analyses supported these findings: "There was a time when my mother was crying. Because of the training I was able to calm her."; "When we have a conflict, I focus on the interest of both of us-helped tremendously." In the month following, 54% (n = 67) of participants experienced conflicts and 74% (n = 93) applied skills learned. Among utilizers, there was a significant decrease in forcing behaviors (-1.24, p < 0.0001). CONCLUSIONS: NegotiAge, an AI-based negotiation training intervention, significantly reduced burden and improved negative affect among family caregivers. Engaging in more negotiation exercises further reduced burden. NegotiAge has the potential to improve the lives of caregivers and PWD. Further testing is needed to determine the direct impact on older adults and long-term effects. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04837937.