In the 1990s, heart failure (HF) emerged as a significant public health threat and has since reached epidemic proportions. Despite advances in medical treatment, the prognosis of patients with HF remains extremely poor. Failure to self-manage pharmacological and non-pharmacological care plans (e.g., low sodium diet), is a main predictor of rehospitalization for an acute exacerbation in HF patients. Accumulating evidence suggests that depressive symptoms in patients with HF are associated with poor self-management, particularly in the area of adherence to the recommended regimen. Compounding the problem, depression also is a substantial problem in family caregivers due to the stress related to their support role. Family or significant others’ support has a positive impact on patients’ self-management skills and quality of life, and subsequently on outcomes in heart disease and other chronic diseases. Although depressive symptoms of both patient and family caregivers contribute to poor self-management and decreased quality of life, most have not included family members and have focused on educational self-management without addressing depressive symptoms in patients or family members.
With the rising costs of health care, family members are playing an increasing role in the care of chronically ill patients. The family-based intervention in this proposal addresses the public health goal of improving the health status of adults with chronic disease through self-management and improved quality of life of both patient and family caregiver.
The cognitive-educational therapy (CET) proposed in this study combines cognitive behavioral therapy and a self-management education intervention to improve depressive symptoms of both patients and spousal caregivers, thereby improving patients’ self-management behaviors. The purpose of this randomized controlled repeated measures (baseline, 3-month, & 6-month) study is to examine effects of CET on patients’ self-management behaviors and on quality of life and depressive symptoms in both members of the patient-spouse dyad. A total of 48 HF patient-spouse dyads will be randomly assigned to CET intervention (four 90-minute weekly sessions) and control groups. The dyads will complete separate questionnaires (self-management behaviors, depression, & quality of life) and patients will complete 24-hour urine collection and use an electronic device for monitoring adherence to medication. The results of this pilot study will provide preliminary data for a proposal will be submitted to NIH (R01) and other highly competitive national grants.