Self-Efficacy and Adherence among Caregivers of Patients Implanted with Left Ventricular Assist Devices

Abstract

Purpose We explored caregiving variables that may significantly affect treatment outcomes in patients with left-ventricular assist devices (LVAD) post-hospital discharge. Specific aims were to examine the pattern and change of caregivers’ self-efficacy (ie, self-confidence) and adherence to support patients with LVAD care over 6 months. Methods This observational study included 34 adults designated as primary caregivers for patients implanted with durable LVAD for the first time. Caregivers' demographics, self-efficacy, and adherence data were collected at 1, 3, and 6 months post-discharge. Caregivers completed LVAD Self-Efficacy (21 items) and Home Management Adherence (17 items) Scales. Both instruments use 0 to 5 response scales; higher scores imply better outcomes. Data were analyzed with SPSS 25.0. Results Caregivers’ mean age was 54.0 ± 13.8 years, mostly White (60%), female (70%), and had some college education or higher (62.5%). Half were married with some form of health condition (52.5%) managed by medications (55%). Caregivers’ self-efficacy scores significantly increased over time: Mean = 4.37 ± .64 (month 1), 4.63 ± .53 (month 3), and 4.80 ± .44 (month 6), p = .007. On the contrary, their adherence scores significantly decreased over time: Mean = 2.60 ± 1.50 (month 1), 1.89 ± 1.50 (month 3), and 1.90 ± 1.52 (month 6), p = .039. Conclusion We report the first longitudinal data describing the caregivers' self-efficacy and adherence in helping patients perform daily LVAD care post-hospital discharge. As expected, caregivers' confidence increased over time. The decrease in adherence may be related to patients' increasing independence with self-management over time or caregiver complacency. Future research should examine the mechanism of the presently observed self-efficacy and adherence patterns in large patient-caregiver dyad study. Additional studies are needed to determine the degree to which caregiving behaviors affect patient outcomes, and to obtain empirical data supporting or refuting the need for 24/7 caregiver assistance for LVAD implant selection and long-term care.