Assessing the response of patients and spousal/partner caregivers to a new instrument measuring dyadic heart failure care types

Abstract

Background Nurse researchers are exploring new ways of understanding heart failure (HF), spousal/partner dyad’s self care. Aims To assess the response to a new instrument developed to measure dyadic HF care type in HF patients and spousal/partner caregivers and explore relationships between type and other variables. Methods Dyads answered a written criterion referenced question related to dyadic HF care type. The relationships between the dyadic care type and sociodemographic and clinical variables were explored using χ 2, ϕ coefficient. Degree of agreement within the dyad on particular type was assessed by kappa statistic. Results A total of 19 dyads were accrued. Patients were aged 71.7±9.7 years (mean±SD), male (n=15), and NYHA Class IIIB/IV (79%). Caregivers were aged 69.2±11.7 years, female (n=15), married for 45.2±14.1 years. HF patient and caregiver dyads were easily able to self select a dyadic type given specific criteria. Agreements ranged from 21% to 5%, by type, resulting in a kappa of 0.28 (p = 0.025) when patient self reported type was compared to their caregiver’s type. Conclusions Now that we are able to measure types of dyadic HF care, understanding how dyadic care type relates to self care outcomes is needed to advance the science.

Burden of caring

“…The typologies describe dyads that manage their situation (dealing with heart failure demands) in different ways; either individually in which the patient or the caregiver can take the lead, or jointly in which dyads can work together collaboratively or complementarily (15). Based on these typologies, a new instrument to assess the dyadic care type in patients with heart failure and their caregiving partners was developed (20). The typologies change over the illness trajectories with more often being patient oriented in mild to moderate heart failure and caregiver oriented in more advanced heart failure (21).…”

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

“…12 The scale gives a definition of self-care at a 9 th grade readability level and then directs the selection of one and only one statement that best describes how the individual and their care partner take care of the patient’s HF. For example, for the patient dyadic type, the patient selects the statement “I take care of the majority of my heart failure without any input from my caregiver.” If the dyad is congruent (agrees on dyadic type) the caregiver selects the statement “My care recipient takes care of the majority of his/her heart failure without any input from me.” The caregiver dyad type statement is similarly worded for the patient: “My care partner takes care of the majority of my heart failure without any input from me.” In the two relationally-oriented dyadic types the item uses we rather than I or his/her statements.…”

“…Evidence for preliminary validity have been reported previously. 9,12 To answer our question we collapsed the patient and caregiver types into a category titled individually-oriented and collapsed the collaborative and complementary types into a category titled relationally-oriented. We then adjudicated a dyad to be congruent if both patient and caregiver chose the same dyadic type orientation, either individual or relational.…”

“…An instrument to measure the care types, the Dyadic Symptom Management Type (DSMT) scale, was also developed and tested as part of this process. 12 In preliminary psychometric evaluation, the DSMT scale showed fair strength of agreement between patient and caregiver response when both partners were tested and dyads expressed no difficulties in understanding the item or selecting their particular type. 12 The next logical step after this rigorous process was to examine the relationship between dyadic orientation and patient reported outcomes.…”

Caring needs in patient-partner dyads affected by heart failure: An evaluation of the long-term effects of a dyadic psycho-educational intervention

“…The instrument could be helpful for understanding how different dyads relate to self-care and guide individualised support [131].…”