| Sumario: | 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 Summary: Key Points ○Family caregivers experience conflicts when interacting with and advocating for their older adults with Alzheimer's dementia (PWD). NegotiAge is an AI‐based online negotiation training program that teaches family caregivers how to resolve conflicts and enables them to practice negotiating with avatars receiving real time feedback on how to improve their skills.○Using the multiphase optimization strategy (MOST) framework, we conducted a national randomized factorial trial with four different NegotiAge exercises with family caregivers of PWD (n = 125, 23 states) with data collection at baseline, immediately, and 1 month following completion of NegotiAge.○One month after completing NegotiAge, family caregivers experienced significantly less burden (p < 0.005), less negative affect (p < 0.05), and qualitative analysis revealed the family caregivers had life‐changing experiences with their PWD following training.Why Does This Paper Matter? ○Family caregivers are frequently unprepared to handle conflicts that occur when working with and advocating for their older adult loved ones. Participating in NegotiAge, an online AI‐based negotiation program, reduced caregiver burden and improved negative affect after 1 month following use. Scalable interventions for caregivers that reduce burden are efficient (around 45 min) and can be completed on the users' schedule are vital to aiding family caregivers and improving the care of PWD.
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