Caregivers’ Heart Failure Knowledge Is Necessary but Not Sufficient to Ensure Engagement With Patients in Self-care Maintenance

Abstract

The chronic illness literature suggests that patient–informal caregiver dyads who are relationally oriented (share decisions and activities) are more efficient and effective than those who are not. But this is currently unknown in heart failure (HF). Our aim was to examine differences between individually and relationally oriented HF dyads relative to patient symptom management scores. This was a cross-sectional study of 55 dyads (spousal/adult child/relative) analyzed using Actor-Partner Interdependence Model techniques. Dyad orientation was measured by the Dyadic Symptom Management Type scale, and symptom management by Self-care of HF Index. On average, patients were older, white males with younger, female caregivers. Whether the dyads were individually oriented or relationally oriented did not make a difference. However, dyads’ agreement on that orientation and the caregivers’ HF-related knowledge impacted caregiver engagement in self-care maintenance or adherence and monitoring behaviors. It is assumed that caregivers will engage in HF care. Our study suggests that caregivers will engage if they agree with the patient on who is providing that care and are knowledgeable. The Dyadic Symptom Management Type scale is a 1-item question that can be administered in the clinical setting by a palliative care nurse in less than 2 minutes to assess agreement and target teaching.

Shared heart failure knowledge and self-care outcomes in patient-caregiver dyads

“…Importantly, our findings are similar to another recent dyadic study in HF that found that better patient knowledge was important to self-care adherence, but only in concert with patient and caregiver agreement on how HF disease management was handled within the dyad. 55…”

Heart Failure Care Dyadic Typology

“…The next mixed method study [25][26][27] was prospectively designed to describe dyadic engagement in HF self-care. We enrolled 78 mixed (spousal, adult child, other) dyads.…”

“…This suggests to us that we need to examine the role of dyadic congruence or agreement on type more closely if we expect caregivers to engage in daily self-care behaviors. 25…”

Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)—A Scoping Review

“…HF patients usually have a partner with whom they make day-to-day decisions about symptom management but also about diet and how to deal with worsening symptoms. Dyadic HF research has shown that good relationships with a partner and other people [ 12 , 13 ], knowledge regarding HF of each member of the dyad [ 14 ], congruence in symptom assessment, and agreement on who is providing self-care [ 15 ] influence HF behavior and may determine a patient’s outcome. Within this dyad, caregivers influence patient self-care and patients influence caregiver’s contribution to self-care.…”