Exploring the relationship of patient and informal caregiver characteristics with heart failure self-care using the actor-partner interdependence model: Implications for outpatient palliative care

Background: The convergence of prevalence, cost, symptom experience, community setting, and informal caregiving in heart failure ( HF ) has profound implications for outpatient palliative care. The majority of HF patients depend on informal caregiver's assistance. Dyadic ( patients and caregiver ) characteristics can complicate this assistance. Yet relatively little is known concerning dyadic characteristics' impact on self-care. HF self-care involves routine, daily treatment adherence and symptom monitoring ( self-care maintenance ), and symptom response ( self-care management ). Objective: Describe the dyadic characteristics of mood and perception of the relationship in HF patients and caregivers, then explore the relationship of the characteristics with self-care. Design: Prospective, cross sectional study of hospitalized HF patients in mixed dyads ( spousal/adult child/relative ) analyzed using Actor-Partner Interdependence Model ( APIM ) techniques. Measurements: Mood was measured by the Brief Symptom Inventory and Patient Health Questionnaire, perception of the relationship by the Dyadic Adjustment Scale, and self-care by the Self-care in Heart Failure Index. Results: In 40 dyads the average patient was a 71 year old male ( n = 30 ); caregiver was a 59 years old female ( n = 26 ). Overall self-care scores were consistently low. Patient depression scores were significantly greater than caregivers ( p = .0055 ). Greater caregiver anxiety were associated with lower caregiver maintenance scores ( p  <  .0001 ) but greater caregiver depression were associated with lower patient maintenance scores ( p  <  .0001 ). While patient and caregiver's perception of the relationship was associated with their self-care, more importantly, caregiver's perception of the relationship was associated with their confidence to engage in the patient's self-care ( p = .003 ). Discussion/Conclusion: This study suggests that caregivers, often unacknowledged or unmeasured, impact patient's day to day HF self-care. Palliative care clinicians need to talk to dyads with a history of poor self-care about their relationship.