Dyadic Analyses of the Influence of Chronic Conditions on the Biopsychosocial Wellbeing and Health-Promoting Behaviors of Individuals with Advanced Cancer and Their Family Caregivers.

Abstract

This dissertation examined the influence of pre-existing chronic health conditions on the biopsychosocial wellbeing and health-promoting behaviors of individuals with advanced breast, colorectal, lung or prostate cancers and their family caregivers (N=484 dyads). The first study examined how the number of patient and caregiver chronic conditions influenced their engagement physical activity, diet and sleep behaviors over time. The second study explored the relationship between cancer and non-cancer related symptom distress (predictors), cancer-related threat appraisals (mediators) and individual- and family-related self-efficacy for coping with cancer (outcomes). In this analysis, dyadic comorbidity burden was considered as a moderator of these relationships in a multigroup framework. In the third study, patient and caregiver meaning-based coping were tested as mediators and moderators of the relationship between chronic health conditions and quality of life.

Building on the actor-partner interdependence model (APIM) for dyadic analysis, each study considered independent (actor) and interdependent (partner) effects. In each study, actor and partner effects were evident. Results from the first study indicated that patients’ number of chronic conditions was associated with their own exercise and sleep behaviors and the sleep behaviors of caregivers. In addition, caregivers’ number of chronic conditions was associated with their own exercise, diet and sleep behaviors and the exercise behaviors of patients. Results from the second study indicated that patient and caregiver symptom distress influenced their own threat appraisals and self-efficacy, and in some cases, the threat and self-efficacy of their dyadic partner. In addition, differences were seen when comparing model results from the four dyadic comorbidity burden groups. In the third study, patient and caregiver number of chronic conditions negatively influenced their quality of life and the quality of life of their dyadic partner. Caregiver meaning-based coping was a mediator, but not a moderator, of this relationship.

Approximately 7 out of 10 dyads had a patient or caregiver with multiple chronic conditions. Overall, the findings suggest that it is important to consider how the chronic conditions of both patients and caregivers, in addition to the advanced cancer, influence their health-related outcomes. Research, practice and policy efforts should consider patient and caregiver wellbeing.