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.