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. 2017 Jan;25(1):185-194.
doi: 10.1007/s00520-016-3385-x. Epub 2016 Sep 8.

The influence of dyadic symptom distress on threat appraisals and self-efficacy in advanced cancer and caregiving

Katrina R Ellis  1 , Mary R Janevic  2 , Trace Kershaw  3 , Cleopatra H Caldwell  2 , Nancy K Janz  2 , Laurel Northouse  4
Affiliations

The influence of dyadic symptom distress on threat appraisals and self-efficacy in advanced cancer and caregiving

Katrina R Ellis et al. Support Care Cancer. 2017 Jan.

Abstract

Purpose: Physical and psychological symptoms experienced by patients with advanced cancer influence their well-being; how patient and family caregiver symptom distress influence each other's well-being is less understood. This study examined the influence of patient and caregiver symptom distress on their threat appraisals and self-efficacy to cope with cancer.

Methods: We conducted a secondary analysis of baseline data from an RCT that enrolled patients with advanced cancer and their family caregivers (N = 484 dyads). Structural equation modeling and the actor-partner interdependence mediation model (APIMeM) were used to examine two models: threat appraisals as a mediator of the relationship between symptom distress and individual and family-related self-efficacy; and, self-efficacy (individual and family dimensions) as mediators of the relationship between symptom distress and threat appraisals.

Results: Data suggest the self-efficacy mediation model was the preferred model. More patient and caregiver symptom distress was directly associated with their own lower self-efficacy and more threatening appraisals. Patient and caregiver individual self-efficacy also mediated the relationship between their own symptom distress and threat appraisals. There were also significant interdependent effects. More patient symptom distress was associated with less caregiver family-related self-efficacy, and more caregiver symptom distress was directly associated with more threatening patient appraisals.

Conclusions: Patient and caregiver symptom distress influenced their own and in some cases each other's cognitive appraisals. Limitations of this study include the use of cross-sectional data and assessments of individually-focused (vs. family-focused) threat appraisals. These findings highlight the need to consider the management of patient and caregiver symptoms during advanced cancer.

Keywords: Advanced cancer; Caregiving; Cognitive appraisal; Dyad; Self-efficacy; Symptoms.

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Figures

Figure 1
Figure 1
Threat Mediated Model Testing the Influence of Patient and Caregiver Symptom Distress on Threat Appraisals (Mediator) and Efficacy
Figure 2
Figure 2
Efficacy Mediated Model Testing the Influence of Patient and Caregiver Symptom Distress on Self-Efficacy (Mediator) and Threat Appraisals
Figure 3
Figure 3
Path Analysis Results: the Influence of Patient and Caregiver Symptom Distress on Threat Appraisals and Efficacy
Figure 4
Figure 4
Path Analysis Results: the Influence of Patient and Caregiver Symptom Distress on Efficacy and Threat Appraisals
See this image and copyright information in PMC

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