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Objectives: The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF. Method: A cross-sectional design was used to examine 60 couples living with HF. Multilevel modeling was used to examine partner and within-dyad effects of engagement in HF behaviors on depressive symptoms. Results: Just over one quarter (27%) of couples had both members experiencing at least mild depressive symptoms. Controlling for stage of HF and one's own level of engagement, one's partner's level of engagement was significantly associated with one's level of depressive symptoms; higher levels of engagement by one's partner were associated with lower levels of depressive symptoms. Additionally, spouses had lower levels of depressive symptoms when they had similar levels of engagement to their partner with HF; spouses had higher levels of depressive symptoms when they had higher levels of engagement than their partner with HF. Conclusion: Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implication for Profession and Patient Care Impact Reporting Method Patient or Public Contribution To examine the role of nurse–patient mutuality on three self‐care behaviours in chronic illness patients.A cross‐sectional multi‐centre study was conducted.Mutuality was measured with the Nurse–Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self‐care was measured with the Self‐care of Chronic Illness Inventory (SC‐CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self‐care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver.The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self‐care. Developing and going beyond was significantly associated with self‐care maintenance and self‐care monitoring behaviours. Point of reference was significantly associated with self‐care maintenance behaviour. Deciding and sharing care was significantly associated with self‐care monitoring and self‐care management behaviours.The mutuality between nurse and patient may be a novel area of research to support and improve patient self‐care behaviours with implications for clinical practice and education.Mutuality between nurse and patient increases patient engagement, symptom recognition, decision‐making process and patient‐centred approach favouring the development of self‐care behaviours.Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self‐care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self‐care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad.STROBE checklist for cross‐sectional studies was followed in this study.Patients were involved in the sample of the study. [ABSTRACT FROM AUTHOR]

This study assessed the impact of affectionate behaviors and communication problems on the mental quality of life (mQoL) in couples with fibromyalgia. Dyadic multilevel modeling in 204 fibromyalgia couples found that people with fibromyalgia (PwFM) who engaged in high levels of affectionate behaviors with their partner had improved mQoL. There was no significant association between affectionate behaviors and mQoL for their partners. Similarly, when PwFM and their partners had more communication problems within the couple, they had poor mQoL. Both models found that higher levels of pain interference for PwFM were significantly associated with poorer mQoL for both members of the couple. Young partners were significantly more likely to report poorer mQoL. Findings highlight the importance of the interpersonal context of fibromyalgia and the protective roles that affectionate behaviors and positive communication can play. Clinicians should include the partner in the care plan and treat the couple as one unit to better optimize the health of both members. [ABSTRACT FROM AUTHOR]

Background and Objectives Increasingly, older adults and their families are expected to manage complex conditions with little support. In the case of heart failure (HF), symptom monitoring and management are critical in preventing acute exacerbations and poor clinical outcomes. The current study examined the role of dyadic confidence on engagement in HF care behaviors by patients and their spouses. Research Design and Methods A cross-sectional design was used to examine 60 couples living with HF. Three dyadic confidence variables were created to represent average level of confidence, gap in confidence, and direction of gap within each couple. A series of multilevel models were used to examine dyadic engagement in HF maintenance, management, and consulting behaviors and the role of dyadic confidence. Results Patients were significantly more engaged in HF maintenance behaviors than spouses; couples were more collaborative in their engagement in HF management and consulting behaviors. Average level of confidence in the dyad was significantly associated with patient engagement in all three HF behaviors. Spouse engagement was associated with more congruence in confidence and having higher levels of confidence than their partners with HF. Women were significantly more engaged in HF behaviors than men, regardless of role. Discussion and Implications The study employed a dyadic approach to HF care and a novel approach to confidence. Findings confirm the social nature of confidence and its important role in HF. Clinicians have opportunities to optimize patient outcomes by fostering greater collaboration within couples. [ABSTRACT FROM AUTHOR]

Background and Objectives To examine the involvement of persons with dementia (PWDs) in everyday decision making from the perspectives of hospitalized PWDs and their family caregivers, and to identify determinants thereof. Research Design and Methods Using multilevel modeling, we examined cross-sectional data collected prospectively from 42 family care dyads regarding the care values of the PWD. Results Both members of the dyad rated the PWD, on average, as being “somewhat involved”. There was a significant amount of variability around the average perceptions of PWD involvement in decision making for both PWDs (χ 2 = 351.02, p <.001) and family caregivers (χ 2 = 327.01, p <.001). Both PWDs and family caregivers were significantly more likely to perceive greater PWD involvement in decision making when the family caregiver reported the PWD as valuing autonomy. Additionally, PWDs were significantly more likely to report greater involvement when they had greater cognitive function. Finally, family caregivers perceived significantly greater involvement of the patient in decision making when they reported less strain in the relationship. Together, autonomy, relationship strain, cognitive function, and care-related strain accounted for 38% and 46% of the variability in PWDs’ and family caregivers’ perceptions, respectively, of the PWD’s decision-making involvement. Discussion and Implications Although research indicates that decision-making abilities decline with advancing dementia, these results imply that working with families to support PWDs in their value of autonomy and mitigate strain in the dyad’s relationship may help prolong PWDs’ decision-making involvement. [ABSTRACT FROM AUTHOR]

Dementia is a predominant problem in older adults, affecting African American individuals at higher rates than other ethnic groups; yet, African American older adults use fewer formal services. To identify factors influencing formal service use by African American individuals with dementia and their caregivers, an integrative review of the literature was performed using four databases from 1990 to July 2017. Fourteen articles (nine quantitative, five qualitative) describing formal service use were included in the review. Three main themes were identified: Formal Service Need, Expectations of Formal Service Providers, and Formal Service Use. Recommendations to improve formal service use are suggested. [ABSTRACT FROM AUTHOR]

Objective:Many difficult decisions are made in the inpatient hospital setting regarding the daily care of persons with dementia (PWDs). Incongruent perceptions of the PWD's care values limit the family caregiver's ability to make surrogate decisions. The objectives of this pilot study were to describe and identify determinants of incongruent perceptions in the hospital setting. Methods:Using multilevel modeling (MLM), we examined cross-sectional data collected from 42 PWD-family caregiver dyads. Results:There was a significant amount of incongruence, on average, for all four subscales representing the PWD's care values: autonomy = −0.33 (p< .001); burden = −.49 (p< .001); safety/quality of care = −.26 (p< .001); and social interactions = −.21 (p= .004). Family caregivers (CG) rated the importance of care values to the PWD as lower than the PWD rated the importance. Determinants of greater incongruence included higher relationship strain and fewer positive dyadic interactions. Conclusion:Our findings reveal significant levels of incongruence in perceptions of the PWD's values among dementia care dyads in the hospital setting. Our analysis suggests a potential impact of relationship variables on incongruence. Further research is needed around this overlooked interpersonal context for supporting the dementia care dyad in the hospital setting. [ABSTRACT FROM PUBLISHER]

Despite the importance of both members of the adult patient–care partner dyad, a majority of research on illness management is focused on the patient or the care partner. The basic principle of the Theory of Dyadic Illness Management is that illness management is a dyadic phenomenon; the theory focuses extensively on the dyad as an interdependent team. The way dyads appraise illness as a unit influences the ways in which they engage in behaviors to manage illness together in a recursive fashion that influences dyadic health. Optimizing the health of both members of the dyad is a goal of the theory. In turn, the health of the dyad can feedback to influence how they appraise and manage illness together. Finally, dyadic illness management is an inherently variable process that is influenced by several contextual factors. Supportive evidence and implications for practice and future research are presented. [ABSTRACT FROM AUTHOR]

Background: African American older adults are suggested to be two times more likely to develop Alzheimer's disease and related dementias (ADRD) compared to non‐Latinx White older adults. As a result, there is a need for more African American caregivers. The largest group of caregivers of African American persons living with ADRD, African American adult daughters, must navigate decision making related to formal care. Formal care—paid health care services for older adults usually associated with an institution— is important in the treatment of ADRD and maintaining quality of life. Method: Guided by the NIA Health Disparities Research Framework, Black Family Social‐Ecological Context Model, and Superwoman Schema, this presentation will describe a clinical trial that is designing a culturally tailored prototype intervention to support the formal care decision‐making process for African American persons living with ADRD and evaluating the feasibility and efficacy of the prototype intervention. The prototype intervention focuses on both members of the dyad's quality of life as well as formal care utilization by the African American person living with ADRD. The design process will recruit 76 African American dementia dyads (70 dyads for quantitative and qualitative data collection to aid in the development of the prototype intervention and 6 dyads to use design thinking approaches to develop the prototype intervention) and will be tested with 20 African American dementia dyads using a pretest posttest design with two follow ups at 1 month and 3 months post intervention. Result: Data will be presented regarding factors influencing the feasibility of implementing a dyadic intervention as an early‐stage investigator. We will focus on the planning process (e.g., IRB approval, study setup, and project management), recruitment strategies (e.g., recruitment videos), recruitment challenges (e.g., consent and eligibility), and mutual engagement of both members of the dyad. Conclusion: In the early stages of planning and recruitment of dementia dyads, there are challenges and key strategies to consider when conducting a dyadic clinical trial as an early‐stage investigator. [ABSTRACT FROM AUTHOR]

Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child–Turcotte–Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P <.05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P <.001). Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer can negatively impact quality of life of the patient and his spouse caregiver, but interventions rarely target the health of both partners simultaneously. We tested the feasibility and preliminary efficacy of a partnered strength training program on the physical and mental health of prostate cancer survivors (PCS) and spouse caregivers.Methods: Sixty-four couples were randomly assigned to 6 months of partnered strength training (Exercising Together, N = 32) or usual care (UC, N = 32). Objective measures included body composition (lean, fat and trunk fat mass (kg), and % body fat) by DXA, upper and lower body muscle strength by 1-repetition maximum, and physical function by the physical performance battery (PPB). Self-reported measures included the physical and mental health summary scales and physical function and fatigue subscales of the SF-36 and physical activity with the CHAMPS questionnaire.Results: Couple retention rates were 100 % for Exercising Together and 84 % for UC. Median attendance of couples to Exercising Together sessions was 75 %. Men in Exercising Together became stronger in the upper body (p < 0.01) and more physically active (p < 0.01) than UC. Women in Exercising Together increased muscle mass (p = 0.05) and improved upper (p < 0.01) and lower body (p < 0.01) strength and PPB scores (p = 0.01) more than UC.Conclusions: Exercising Together is a novel couples-based approach to exercise that was feasible and improved several health outcomes for both PCS and their spouses.Implications For Cancer Survivors: A couples-based approach should be considered in cancer survivorship programs so that outcomes can mutually benefit both partners.Trial Registration: ClinicalTrials.gov NCT00954044. [ABSTRACT FROM AUTHOR]

Purpose: Computer-based, patient-reported symptom survey tools have been described for patients undergoing chemotherapy. We hypothesized that patients undergoing radiotherapy might also benefit, so we developed a computer application to acquire symptom ratings from patients and generate summaries for use at point of care office visits and conducted a randomized, controlled pilot trial to test its feasibility.Methods: Subjects were randomized prior to beginning radiotherapy. Both control and intervention group subjects completed the computerized symptom assessment, but only for the intervention group were printed symptom summaries made available before each weekly office visit. Metrics compared included the Global Distress Index (GDI), concordance of patient-reported symptoms and symptoms discussed by the physician and numbers of new and/or adjusted symptom management medications prescribed.Results: One hundred twelve patients completed the study: 54 in the control and 58 in the intervention arms. There were no differences in GDI over time between the control and intervention groups. In the intervention group, more patient-reported symptoms were actually discussed in radiotherapy office visits: 46/202 vs. 19/230. A sensitivity analysis to account for within-subjects correlation yielded 23.2 vs. 10.3 % (p = 0.03). Medications were started or adjusted at 15.4 % (43/280) of control visits compared to 20.4 % (65/319) of intervention visits (p = 0.07).Conclusions: This computer application is easy to use and makes extensive patient-reported outcome data available at the point of care. Although no differences were seen in symptom trajectory, patients who had printed symptom summaries had improved communication during office visits and a trend towards a more active symptom management during radiotherapy. [ABSTRACT FROM AUTHOR]