Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review

Examining Heart Failure Informal Care Partners Using Person and System Levels and Domains: A Meta-Synthesis

BACKGROUND

Within the last decade, system and policy-level changes have driven substantial shifts in heart failure (HF) care from hospital to home, requiring greater support from informal care partners. What has not been examined is the state of the care partner science by person and system-level domains using qualitative studies to understand impact across multiple person and system levels.

OBJECTIVES

(1) Identify by person and system levels and domain what is known about informal care partners and (2) Identify gaps in the caregiving science and suggest ways to move forward.

METHODS

This secondary analysis of a large HF systematic review is guided by the National Institute on Minority Health and Health Disparities and MIRACLE frameworks and uses meta-synthesis techniques with critical realist approaches to synthesize and interpret the themes across papers.

RESULTS

Using data from 46 papers and 1695 care partners, we identified patterns occurring across 6 domains (biological, behavioral, affective, physical/built environment, sociocultural environment, and healthcare system) and on 4 levels (individual, interpersonal, community, and societal). Existing research predominantly addressed affective and behavioral domains, followed by health system and sociocultural domains. Few studies focused on biological and physical/built environment domains, leaving large gaps in what is known about caregiving at the cellular (biological) and societal (community and societal) levels.

CONCLUSIONS

HF caregiving continues to be studied at a very rudimentary level. This synthesis also reveals critical gaps in what is known about caregiving within the physical/built environment domain and at the community and societal levels.

Cross-Cultural Adaption and Psychometric Evaluation of Chinese Version of the Caregiver Contribution to Self-Care of Heart Failure Index

To translate and adapt the English version of the Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) to Chinese, and further to investigate the psychometric properties of the Chinese version of CC-SCHFI in a cohort of caregivers of people with heart failure. CC-SCHFI translation and cross-cultural adaption were performed. 240 caregivers were recruited to complete the instrument. The internal construct reliability was evaluated by Cronbach's α and item-to-total correlations. The concurrent validity was tested by using the CACHS which also measures caregivers' contribution to HF self-care. Psychometric analysis was performed with confirmatory factor analysis (CFA). We evaluated 4-factor structure for caregiver contribution to self-care maintenance scale, 1-factor structure for caregiver contribution to self-care management scale and 2-factor structure for confidence in contributing to self-care scale. All the subjects successfully completed the interviews in an average of 12.3 ± 3.2 min. The internal consistency reliability analysis of the CC-SCHFI showed Cronbach α of 0.83. All items showed adequate discrimination, with the item-total correlation coefficient of greater than 0.4. The scores of CC-SCHFI scales were significantly correlated with the CACHS scale scores. The correlation coefficients ranged from 0.341 to 0.765, indicating acceptable concurrent validity. For CFA, all factor loadings were significant at > 0.30 and generally medium to high. The simplified Chinese version of CC-SCHFI is a psychometrically reliable instrument with empirically supported validity, which can be applied to clinical evaluation of the contribution of caregivers to HF self-care. Compared with CACHS, CC-SCHFI can be more easily completed and simultaneously maintains acceptable concurrent validity. Further studies are warranted to investigate the combined use of these two instruments among other populations.

Palliative care for patients with heart failure and family caregivers in rural Appalachia: a randomized controlled trial

BACKGROUND

Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints.

METHODS

This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients' (a) HF-related health status and depression/anxiety scale scores; and from caregivers' (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants.

RESULTS

The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p < .05) and lower depression/anxiety scores at 6 months, the study endpoint. The family caregivers in the intervention group had significantly lower scores on caregiving burden (p < .05) and depression/anxiety (p < .01) at 3 months. The mean helpfulness rating was M = 4.46 out of 5 (SD = 0.49).

CONCLUSIONS

The FamPALcare intervention was found to be effective at improving patient HF-related health status and reducing caregiver burden and improving both patient and caregiver depression and anxiety scores. The FamPALcare HF intervention was found feasible and consistently delivered (fidelity). The FamPALcare intervention's cost-effectiveness and helpfulness ratings information will be used to plan for subsequent clinical trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153890, Registered on 4 November 2019, https://clinicaltrials.gov/ct2/show/NCT04153890 .