Does an intervention designed to improve self-management, social support and awareness of palliative-care address needs of persons with heart failure, family caregivers and clinicians?

AIMS AND OBJECTIVES: To conduct a formative evaluation of the iPad-Enhanced Shared Care Intervention for Partners (iSCIP) among persons with heart failure (HF), family caregivers and clinicians. Together, persons with HF and family caregivers are referred to as partners. BACKGROUND: There is growing awareness of the caregiver's contributions to HF self-management, social support and reciprocal benefits of interventions that involve both partners. The iSCIP engages both partners in a six-session psychosocial intervention to address three preventable causes of poor outcomes in a HF population: poor self-management skills, inadequate social support and underutilisation of palliative care. An iPad app is used to organise the intervention. The goals of the iSCIP are to engage partners in HF self-management, communication about the HF patient's care values and preferences, and future planning. DESIGN: A qualitative focus group design was used. METHODS: Seven clinicians and eight partners participated in focus groups to explore their experiences, needs and reaction to the iSCIP content and technologies employed. Open-ended questions and closed-ended surveys were used to collect data. Deductive content analysis was used to analyse the qualitative data. NVivo software was used for qualitative data analysis. Bayesian statistical models were used to analyse numeric data. RESULTS: The iSCIP met partners' and clinicians' needs to improve self-management, communicate about care values and preferences and plan for the future. Quantitative analysis of numeric data supported our qualitative findings, in that both groups rated the intervention components useful to very useful. IMPLICATIONS FOR PRACTICE: These findings add to the growing evidence of the feasibility and acceptability of programs that address care values and preferences, and care planning. The iSCIP can be used as a guide for developing interventions and software applications, which involve both partners in care and palliative-care discussions.

Refinement of the Shared Care Instrument-Revised: a measure of a family care interaction.

This study's purpose was to evaluate the psychometric properties of the Shared Care Instrument-Revised (SCI-R) in a sample of family care dyads. The SCI-R was developed to measure the construct of shared care, which is a system of three constructs (communication, decision making, reciprocity) used in family care to exchange support. An important aspect of evaluating the SCI-R was to create a measure that is statistically sound and meaningful for patient and caregivers. Surveys were mailed to randomly selected home health dyads, which included 223 patients and 220 caregivers. Reliability and confirmatory factor analysis, and concurrent validity were examined. Internal consistency reliability of the patient subscales ranged from 0.74 to 0.76, and from 0.72 to 0.78 for caregiver subscales. Factor analysis supported the underlying theoretical basis of the SCI-R. Construct validity also was supported using the hypothesis-testing approach. One major challenge in family care research is to develop methods and tools to study the dynamic characteristics of close relationships. The findings from this study support further use of SCI-R to study how shared care facilitates the exchange of support and the influence shared care has on outcomes for both patients and caregivers.

Dyadic relationship scale: a measure of the impact of the provision and receipt of family care.

PURPOSE: This study evaluated the psychometric properties of the Dyadic Relationship Scale (DRS), which measures negative and positive dyadic interactions from the perspective of both the patient and the family caregiver. An important aspect of evaluating the DRS was that it be statistically sound and meaningful for both members of the dyad. DESIGN AND METHODS: The study used a cross-sectional design. Survey packages were mailed to home health care patients and their family caregivers. The unit of analysis was the dyad, and exploratory and confirmatory factor analyses were conducted. We examined the reliability, discriminant, and concurrent validities of the instrument. RESULTS: The data supported a two-factor DRS that included negative dyadic strain (patient alpha =.84; caregiver alpha =.89) and positive dyadic interaction (patient alpha =.86; caregiver alpha =.85). The analysis supported the DRS's construct, discriminant, and concurrent validity, as well as its reliability for both patients and family caregivers. IMPLICATIONS: Using the DRS to measure the impact of family care on positive and negative interactions inclusive of patients and caregivers can assist in identifying areas of difficulty and guide interventions to improve outcomes for both members of the dyad.

Psychometric evaluation of the Shared Care Instrument in a sample of home health care family dyads.

Researchers have studied negative effects of caregiving on a family caregiver; however, less is known about positive aspects of exchanging assistance for both members of a family caregiving dyad. In a previous naturalistic inquiry the author indentified a basis for studying caregiving interactions was a construct called shared care. The three components of shared care identified in the naturalistic inquiry were communication, decision making, and reciprocity. The Shared Care Instrument (SCI) was developed to measure the construct. The purpose of this study was to assess the psychometric properties of the SCI, and to assess its construct and criterion-related validity, A sample of home care family dyads (110 patients and 109 family members) returned usable survey questionnaires. Results indicated the Cronbach's alphas for the patient group for the SCI subscales ranged from .78 to .84, and .77 to .79 for family members. Factor analysis supported the underlying theoretical basis and factor structure of the SCI. Criterion-related validity was also supported. Therefore, the results of this study provide initial evidence for the reliability and validity of the SCI for use with family caregiving dyads. The findings support the need for additional testing of the SCI.

Shared care dyadic intervention: outcome patterns for heart failure care partners.

Up to half of heart failure (HF) patients are readmitted to hospitals within 6 months of discharge. Many readmissions are linked to inadequate self-care or family support. To improve care, practitioners may need to intervene with both the HF patient and family caregiver. Despite the recognition that family interventions improve patient outcomes, there is a lack of evidence to support dyadic interventions in HF. Thus, the purpose of this study was to test the Shared Care Dyadic Intervention (SCDI) designed to improve self-care in HF. The theoretical base of the SCDI was a construct called Shared Care. Shared Care represents a system of processes used in family care to exchange support. Key findings were as follows: the SCDI was acceptable to both care partners and the data supported improved shared care for both. For the patient, there were improvements in self-care. For the caregivers, there were improvements in relationship quality and health.