Division of Nursing and Health Sciences, Gordon College, Barnesville, Georgia, USA.
J Cardiovasc Nurs. 2010 Mar-Apr;25(2):142-8. doi: 10.1097/JCN.0b013e3181bf93a0.
: Caregivers (CGs) of heart failure (HF) patients are increasingly assuming greater responsibilities in symptom assessment, evaluation, and decision making and may be asked to serve as proxies. The purpose of this study was to examine the degree of congruence between HF patients and their primary CG on symptom assessment and self-care management behaviors.
: The sample consisted of 70 HF patients receiving home healthcare and their designated CG. Patients were primarily between 40 and 85 years of age and female (60%). Caregivers were predominately female (76%) and spouses (43%). Congruence in symptom assessment and management between HF patients and their designated CGs was measured in this descriptive cross-sectional study using the Heart Failure Symptom Survey and Self-care of Heart Failure Index.
: The Spearman correlation coefficient and concordance correlation coefficient were used to assess the degree of congruence on symptom evaluation scores from the Heart Failure Symptom Survey. Dyads had the strongest correlations on ratings of the HF patients' symptoms of extremity edema, difficulty concentrating, and dizziness. Lower congruence (Spearman correlation <0.40) was found on feeling depressed, shortness of breath at night, and shortness of breath when lying down. Scores on the Self-care of Heart Failure Index self-care management and self-care confidence scales were not significantly different within the HF dyads.
: Based on moderate levels of correlations on most HF symptoms in this study, the CG as proxy appears to be a reasonable substitute for patient responses in a community setting. However, greater family preparation for symptom assessment is warranted to improve congruence for future symptom assessment.
心力衰竭（HF）患者的照护者（CGs）在症状评估、评价和决策方面承担的责任越来越大，可能会被要求作为代理人。本研究的目的是检验HF患者与其主要照护者在症状评估和自我护理管理行为上的一致程度。
样本包括70名接受家庭医疗护理的HF患者及其指定的照护者。患者主要年龄在40至85岁之间，女性占60%。照护者主要为女性（76%），配偶占43%。在这项描述性横断面研究中，使用心力衰竭症状调查和心力衰竭自我护理指数来测量HF患者与其指定照护者在症状评估和管理方面的一致性。
使用Spearman相关系数和一致性相关系数来评估心力衰竭症状调查中症状评估分数的一致程度。在对HF患者的肢体水肿、注意力不集中和头晕症状的评分上，二元组的相关性最强。在感到抑郁、夜间呼吸急促和躺下时呼吸急促方面，一致性较低（Spearman相关性<0.40）。在HF二元组中，心力衰竭自我护理指数的自我护理管理和自我护理信心量表得分没有显著差异。
基于本研究中大多数HF症状的中等程度相关性，在社区环境中，照护者作为代理人似乎是患者反应的合理替代。然而，有必要加强家庭在症状评估方面的准备，以提高未来症状评估的一致性。
