Dyadic strain mediates the association of shared care with caregiver burden in caregivers of patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health Background Many patients with heart failure (HF) need family caregivers’ support to manage HF efficiently, but caregivers commonly experience a burden due to their caregiving responsibility. The term, shared care, reflects a system of interpersonal interactions characterized by exchange of support between members of a patient-caregiver dyad in illness management. Higher levels of shared care are associated with better patient self-care and health outcomes, but it is not known whether shared care influences caregivers' burden. Dyadic relationship quality between dyad members also influences caregivers' burden. We hypothesize that dyadic relationship quality may mediate the association of shared care with caregiver burden. Purpose The purpose of this study was to examine the association of shared care with caregiver burden and determine whether dyadic relationship quality mediates the association of shared care with caregiver burden in caregivers of patients with HF. Methods In this cross-sectional study, primary caregivers of patients with HF completed questionnaire surveys about shared care using the Shared Care Instrument (SCI), caregiver burden using the Zarit Burden Interview, and dyadic relationship quality using the Dyadic Relationship Scale (DRS). The SCI has communication, decision making, and reciprocity subscales. The DRS has positive interaction and dyadic strain subscales. A series of multiple parallel models were used to test the mediation effect of dyadic relationship quality with 5000 bootstrap samples while controlling age, sex, education, and type of dyadic relationship. Result Of the 143 caregivers (mean age= 56 years), most were female (76%) and in a spousal relationship with patients (73%). Among SCI subscales, only shared care communication was directly associated with caregiver burden (B = -.5247, P = .0006, 95% CI: -.8199 to -.2296) when age, sex, education, and DRS scores were controlled. There was a significant indirect effect of shared care communication on caregiver burden (B = -.2090, 95% CI: -.4225 to -.0022; Figure 1), indirect effect of shared decision-making on caregiver burden (B = -.3559, 95% CI: -.5984 to -.1588; Figure 2), and indirect effect of shared care reciprocity on caregiver burden (B = -.2342, 95% CI: -.5508 to -.0499; Figure 2) through dyadic strain. Positive interactions within dyad members did not mediate the association of shared care with caregiver burden. Conclusion Better shared care in HF management was associated with low dyadic strain, which reduced caregivers’ burden. These findings underpin the need to improve shared care and reduce dyadic strain for caregivers of patients with HF.