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Relationship and communication characteristics associated with agreement between heart failure patients and their Carepartners on patient depressive symptoms |
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| Authors: | Erin D Bouldin James E Aikens John D Piette Ranak B Trivedi |
| Institution: | 1. Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA;2. Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA;3. Ann Arbor Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA;4. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA;5. Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA;6. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA |
| Abstract: | Objectives: Informal caregivers who recognize patients’ depressive symptoms can better support self-care and encourage patients to seek treatment. We examined patient-caregiver agreement among patients with heart failure (HF). Our objectives were to (1) identify distinct groups of HF patients and their out-of-home informal caregivers (CarePartners) based on their relationship and communication characteristics, and (2) compare how these groups agree on the patients’ depressive symptoms. Method: We used baseline data from a comparative effectiveness trial of a self-care support program for veterans with HF treated in outpatient clinics from 2009-2012. We used a cross-sectional design and latent class analysis (LCA) approach to identify distinct groups of patient-CarePartner dyads (n?=?201) based on relationship and communication characteristics then evaluated agreement on patients’ depressive symptoms within these groups. Results: The LCA analysis identified four groups: Collaborative (n?=?102 dyads, 51%), Avoidant (n?=?33 dyads, 16%), Distant (n?=?35 dyads, 17%), and Antagonistic (n?=?31 dyads, 15%). Dyadic agreement on the patients’ depressive symptoms was highest in the Distant (Kappa (κ)?=?0.44, r?=?0.39) and Collaborative groups (κ?=?0.19, r?=?0.32), and relatively poor in the Avoidant (κ?=?–0.20, r?=?0.17) and Antagonistic (κ?=–0.01, r?=?0.004) groups. Patients in Avoidant (61%) and Antagonistic groups (74%) more frequently had depression based on self-report than patients in Collaborative (46%) and Distant (34%) groups. Conclusion: Caregiver relationships in HF tend to be either Collaborative, Avoidant, Distant, or Antagonistic. Patients’ depressive symptoms may negatively affect how they communicate with their caregivers. At the same time, improved patient-caregiver communication could enhance dyadic consensus about the patient’s depressive symptoms. |
| Keywords: | Caregivers heart failure depression communication proxy |