How the dyads of heart failure patients and their informal caregivers cope with the disease process: A qualitative evidence synthesis

Abstract

Background: Heart failure is a debilitating, progressive condition that poses significant challenges for patients and their caregivers. Successful coping with the disease relies on the concerted efforts of patients and caregivers. However, previous reviews on this topic have focused on the coping experiences of patients or informal caregivers separately, without considering the dynamic interaction between them. Objectives: The aim of this review was to synthesise qualitative data on the experience of dyadic coping with heart failure from patient-caregiver dyads' perspectives. Methods: A systematic literature search was conducted of nine electronic databases from their inception to 8 July 2023. Manual searching of the reference lists of relevant articles was also conducted. Articles were deemed eligible if they focused on elucidating the experiences of patients with heart failure and their informal caregivers in living with heart failure. The Critical Appraisal Skills Programme tool for qualitative studies was used to assess the methodological quality of the included studies. Thematic synthesis was used to synthesise the findings. Results: Thirty articles were included in the review. Three analytical themes developed from the findings: (1) communal and intertwined challenges in dyadic disease coping, (2) interplay of individual, relational and social conditions shaping the dyadic coping experience and (3) dyadic coping strategies along the disease course. Patients' progressive and debilitating disease conditions disrupted the shared lives of the dyads, leading to communal and intertwined challenges for the patients and their caregivers. The dyadic coping experience was shaped by the interplay of individual illness perception, relational dynamics and social supportive context. Redefining relationship boundaries, adjusting disease-management patterns, co-regulating emotions, amplifying positive change and seeking meaning were crucial strategies for dyads to cope with and normalise the disease in daily life. Conclusions: This synthesis revealed that dyadic coping for heart failure patients and caregivers is a dynamic process of adopting constructive or destructive strategies to respond to the communal and intertwined challenges brought by the disease, shaped by the interplay of individual, relational and social conditions. A dyadic approach is warranted to support patients and caregivers in mitigating stressors and promoting sustainable positive dyadic coping.