Perceived Stress and Depressive Symptoms as Predictors of Decisional Conflict in Dyads Considering a Left Ventricular
Colleen K McIlvennan1,2, Daniel D Matlock1,3, Larry A Allen1,2
1Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.
Insights
Patient and caregiver stress significantly increases decisional conflict when considering a left ventricular assist device (LVAD). Patient depression also contributes to their own decisional conflict regarding LVAD implantation.
Area of Science:
- Cardiology
- Psychology
- Medical Decision-Making
Background:
- The decision to pursue a left ventricular assist device (LVAD) imposes significant caregiving and medical decision-making burdens on loved ones.
- The interplay between emotional states and conflict in patient-caregiver dyads concerning LVAD decisions is under-researched.
Purpose of the Study:
- To investigate the associations between patient and caregiver depression and stress and their respective decisional conflict when considering LVAD implantation.
- To examine actor and partner effects within patient-caregiver dyads regarding LVAD decision-making.
Main Methods:
- Employed the Actor-Partner Interdependence Model to analyze data from 162 patient-caregiver dyads.
- Assessed decisional conflict, depressive symptoms, and perceived stress using validated scales at the initiation of LVAD evaluation.
Main Results:
- Decisional conflict was highly correlated within patient-caregiver dyads.
- Increased perceived stress in both patients and caregivers significantly predicted greater decisional conflict for themselves (actor effects).
- Patient depressive symptoms predicted patient decisional conflict, but caregiver depressive symptoms did not predict their own decisional conflict.
Conclusions:
- Patient and caregiver stress are key predictors of decisional conflict in the LVAD decision-making process.
- Patient depression also contributes to their own decisional conflict.
- Findings underscore the importance of addressing psychological well-being in patient-caregiver dyads facing serious illness decisions.
Background:
The decision to pursue a left ventricular assist device (LVAD) commits loved ones to major caregiving responsibilities and, often, medical decision-making. How emotional domains overlap within patients and their caregivers and contribute to conflict around the decision to pursue LVAD remains largely unexplored.
Methods And Results:
The associations within and between individuals in patient-caregiver dyads considering LVAD were estimated in a specific type of structural equation model known as the Actor-Partner Interdependence Model. This model tested whether each person's depression and stress predicted their own decisional conflict (actor effects), as well as their partner's decisional conflict (partner effects). At the time of study enrollment when a formal LVAD evaluation was initiated, 162 patient-caregiver dyads completed assessments of decisional conflict using the Decisional Conflict Scale, depressive symptoms using the Patient Health Questionnaire-2, and stress using the Perceived Stress Scale. Across both models, decisional conflict was significantly correlated within patient-caregiver dyads (β=0.47 and 0.44, for depression and perceived stress models, respectively, P<0.001). Greater perceived stress in both the patient (β=0.18; P<0.05) and caregiver (β=0.28; P<0.001) was significantly related to greater decisional conflict (both actor effects). Greater patient depressive symptoms were related to greater patient decisional conflict (β=0.16; P<0.05), whereas caregiver depression symptoms was not related to their own decisional conflict (β=0.07; P=0.37). There were no partner effects identified between decisional conflict and perceived stress or depressive symptoms.
Conclusions:
Patient and caregiver conflict over the decision to pursue an LVAD was highly correlated in this sample, with greater perceived stress significantly predicting greater decisional conflict in both patients and caregivers. Depressive symptoms in patients also predicted greater patient decisional conflict. No partner effects were identified in predicting decisional conflict. These results contribute to a larger body of work acknowledging the importance of patient-caregiver well-being in serious illness. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344576.
Related Concept Videos
02:45Self-Discrepancy Theory
01:14Frustration and Conflict: Avoidance-Avoidance, Double-Approach Avoidance
01:20Psychological Responses to Stress
01:20Lazarus's Cognitive Appraisal Theory
Primary Appraisal:...
01:27Mitral Stenosis IV: Nursing Management
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...