Title : Effects of a family-based self-care intervention using acceptance and commitment therapy on patients with chronic heart failure and their family caregivers: A randomized controlled trial
Background: Chronic heart failure (CHF) is a common illness associated with high mortality and increased risk of rehospitalization. Self-care management that provides psychoeducational support to CHF families is an approach to improve patients’ health-related quality of life (HRQOL) by reducing the negative impact of HF and empowering both patients and their family caregivers (FCs) to effectively participate in CHF care. This report aimed to evaluate the effectiveness of a family-based self-care intervention using Acceptance and Commitment Therapy (ACT) in improving HRQOL and other related health outcomes in Chinese patients with CHF and their FCs.
Methods: A parallel-group, assessor-blinded, stratified, randomized controlled trial (RCT) was used. The patient-FC dyads were randomly with a 1:1 ratio allocated to intervention and control groups using online-generated randomization. The two groups received four 2-hour videoconferences via smartphone each week. In the intervention group, patient- FC dyads underwent brief HF self-care education and dyad ACT to enhance their understanding of CHF self-care, explore their psychological challenges during CHF care, and develop skills to overcome these obstacles, facilitated by two trained registered nurses. The control group received CHF educational lectures. The primary outcome measured was HRQOL of patients and their FCs. Assessments were conducted via smartphone interview by blinded research assistants at baseline (T0), immediately post-intervention (T1), and at a three-month follow-up (T2). Data analysis followed the intention-to-treat principle and utilized generalized estimating equations.
Results: Between June 3, 2022, and February 23, 2023, 160 CHF patients (mean age 64.71±12.58 years old, 55.0% male) and their FCs (mean age 55.93±14.28 years old, 30.6% males, 65.2% patients’ spouses) participated in this study. After intervention, patients with CHF in the intervention group showed significant improvements in disease specific HRQOL measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at both T1 (β = 3.87, p < .001; Cohen’s d = 0.51) and T2 (β = 5.81, p < .001; d = 0.75), with medium effect sizes compared to the control group. However, FCs in the intervention group did not show significant positive effects, despite displaying better generic HRQOL as assessed using the EuroQoL five-dimension five-level instrument (EQ-5D-5L) at T1 (β = 0.02, p = .070, d = 0.21) and T2 (β = 0.03, p = .109, d = 0.20), as well as measured by the EuroQoL visual analogue scale (EQ-VAS) at T1 (β = 3.78, p = .088, d = 0.18) and T2 (β = 4.08, p = .071, d = 0.16), in comparison to the control group. Additionally, the intervention group demonstrated significant positive effects compared to the control group in patient self-care behaviors (d = 0.63-0.90), caregiver burden (d = 0.30-0.39), and psychological flexibility (d = 0.31-0.72) for both patients and FCs at T1 and T2.
Conclusions: The family-based CHF self-care intervention using ACT delivered through smartphone videoconferencing sessions for the CHF condition was effective at improving the patient HRQOL and HF self-care and enhancing the psychological flexibility for both patients and FCs compared to HF education alone.