Dyadic Heart Failure Care Types

Qualitative Evidence for a Novel Typology

Abstract

Background: 

Compared with other chronic illness populations, relatively little is known about heart failure (HF) patient and caregiver spousal/partner dyads and what effect dyadic interactions have on self-care.

Objective: 

The aim of this study was to present a new typology of patient and caregiver dyadic interdependence in HF care, presenting exemplar cases of each type: patient oriented, caregiver oriented, collaboratively oriented, complementarily oriented.

Methods: 

Stake’s instrumental case study methodology was used. Interviews were unstructured, consisting of open-ended questions exploring dyad’s experiences with HF, audiorecorded, and transcribed. Cases were selected because they exhibited the necessary characteristics and also highlighted a unique, little understood variation in self-care practice. Each case represents a dyad’s discussion of caring for HF in their normal environment.

Results: 

From 19 dyads, 5 exemplar case studies illustrate the 4 dyadic types. A fifth, incongruent case, defined as a case where the patient and caregiver indicated incongruent dyadic types, was included to highlight that not all dyads agree on their type. A major theme of Sharing Life infused all of the dyad’s narratives. This typology advances the science of dyadic interdependence in HF self-care, explains possible impact on outcomes, and is an early theoretical conceptualization of these complex and dynamic phenomena.

Conclusion: 

The cases illustrate how long-term dyads attempt to share the patient’s HF care according to established patterns developed over the trajectory of their relationship. In keeping with the interdependence theory, these couples react to the patient’s declining ability to contribute to his/her own care by maintaining their habitual pattern until forced to shift. This original pattern may or may not have involved the dyad working together. As the patient’s dependence on the caregiver increases, the caregiver must decide whether to react out of self-interest or the patient’s interest. Continued study of the typology is needed in nonspousal/partner dyads.