An integrated positivity and dyadic paradigm to advance family caregiving in heart failure

This invited commentary refers to ‘Determinants of preparedness in family caregivers of patients with heart failure’, by X. Li et al., https://doi.org/10.1093/eurjcn/zvae107. Li et al.1 reported a prospective cross-sectional study that explained the impact of psychosocial adjustment of Chinese family caregivers of patients with heart failure on their perceived preparedness. The results showed that a lower perceived uncertainty in illness, better family relationship quality, and greater perceived social support of family caregivers were relating to a higher level of preparedness. Positive aspects of caregiving serve as a highly important psychological attribute to mediate the identified relationships. Family caregiving serves as a highly important informal care to buffer the demand of HF on formal care service. However, as a progressive debilitating disease characterized by recurrent pattern of cardiac decompensation, caregiving for HF is usually associated with enormous physical and emotional burden. Preparedness, which defines as the caregivers’ readiness to fulfil the emotional and physical care needs of the patients,2 is not only related to positive patients’ outcomes3 but also determines the sustainability of the family caregiving endeavours.4 By identifying the factors explaining preparedness, this paper sheds light on the development of supportive strategies for caregivers in a HF context. More importantly, this paper highlights the imperative role of positive aspects of caregiving (PAC) in improving preparedness. This finding conforms to a substantial amount of literature that highlights the ‘power’ of PAC in driving the motivation, commitment, and care quality of the family caregivers.5 Explained by an integrative theoretical paradigm of stress-coping and meaning-making, PAC is more likely to be evolved from the successful experience of the in coping with the challenging caregiving endeavours and the ability to frame the demanding caregiving tasks in a meaningful schemata.6 This paper provides evidence to explicitly delineate this process. Whereas a lower perceived uncertainty in illness and better social support are important factors to favour the primary and secondary appraisal of the stressors associated with HF caregiving, the higher dyadic relationship quality may create an interpersonal context that encourage meaning-focused coping. Among the literature, caregiver supportive strategies for HF tend to be developed based on the stress-coping paradigm to regulate the stressors and coping resources; less attention is given to support caregivers to make meaning to the journey of taking care of the HF patients. According to the study by Li et al.,1 enhancing the dyadic relationship quality may be the strategy to promote meaning-making. This comes to a broader question about how to conceptualize a ‘good dyadic relationship quality’ when the dynamicity of the HF disease course and caregiving journey are being considered. The Theory of Dyadic Illness Management7 may shed light on this question. Central to this theory is that illness management is a dyadic phenomenon in which congruency in illness appraisal and shared care with effective dyadic collaboration (including shared decision-making, shared care communication, and greater reciprocity within the dyads)8 are crucial to enable better dyadic health outcomes. This may imply that optimizing caregiving support for HF patients should take place in a dyadic context, with the effort placed on how to enrich the social dynamic between the patients and caregivers. Optimizing caregiving support is, hence, a humanity-based endeavour, with the central focus rests on how to enrich the life experience of the actors (i.e. patients and caregivers) in the human encounter complicated by the HF disease process. Nevertheless, even though the study by Li recruited patient-caregiver dyad, the investigation can be further strengthened by using a dyadic approach to design the measurement model. This is particular important for capturing the relationship quality which us grounded in social interaction within the caregiver and patient dyads. Actor–partner independent model would be a better data analytic strategy to address the mutual influence on the dyadic outcomes. Besides, the cross-sectional study design also cannot preclude the possibility that it is the ‘preparedness of caregiving’ in predicting caregiving gain and PAC.9 Continuing the scientific dialogues on how to optimize the HF caregiving in a positivity and dyadic paradigm is imperative to augment the informal care of HF. Doris Sau-fung Yu (Conceptualization [lead], Writing—original draft [lead], Writing—review & editing [lead]) Conflict of interest: none declared.