The Influence of Caregiver Contribution to Self-care on Symptom Burden in Patients With Heart Failure and the Mediating Role of Patient Self-care

Abstract

Background Patients with heart failure experience high symptom burden, which can be mitigated with adequate self-care. Caregiver contribution to self-care has been theorized to improve patient symptom burden. The mediating role of patient self-care in this relationship has not been tested yet. Objectives The aim of this study was to test whether (a) caregiver contribution to self-care influences patient self-care, (b) patient self-care influences symptom burden, and (c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden. Methods In this study, the authors conducted a secondary analysis of the baseline and 3-month data from the MOTIVATE-HF trial, which enrolled 510 dyads (patient with heart failure and caregiver) in Italy. Multigroup confirmatory factor analysis was used to test measurement invariance. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test our hypotheses. Results On average, caregivers were 54 years old and mainly female, whereas patients were 72.4 years old and mainly male. Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β = 0.280, P < .001), which, in turn, was associated with lower symptom burden (β = −0.280, P < .001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β = −0.079; 95% bias-corrected bootstrapped confidence interval, −0.130 to −0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β = 0.238, P = .006). The model significantly accounted for 37% of the total variance in symptom burden scores (P < .001). Conclusions This study expands the situation-specific theory of caregiver contribution to heart failure self-care and provides new evidence on the role of caregiver contribution to self-care and patient self-care on symptom burden in heart failure.

Advances in the Science of Heart Failure Self-care

“…[13][14][15] So, studies that capture the contribution of caregivers to patients' self-care are important. Locatelli and colleagues 16 explored patient self-care as a mediator of the relationship between caregiver contributions to self-care and symptom burden. In a longitudinal study, caregivers contributing to the self-care of their patient achieved better patient self-care maintenance, which was associated with lower symptom burden.…”

“…This caregiver theme—begun by Graven et al 12 and addressed by Locatelli et al 16 —is expanded upon and refined in the excellent systematic review from Buck and colleagues 17 . In an update of their previous systematic review published in 2015, 18 64 new articles were synthesized to (1) describe the specific self-care activities in which caregivers participate, (2) determine whether the activities have changed over time, and (3) identify gaps in the science.…”