Background:Family caregivers of patients with a destination therapy left ventricular assist device play a central and formalized role in postimplant care. We aimed to characterize longitudinal stress, predictors and correlates of stress, and coping processes among left ventricular assist device caregivers.Methods:We performed a sequential, exploratory, mixed-methods study from 6 diverse left ventricular assist device programs. The primary outcome for the quantitative analysis was the Perceived Stress Scale-10 at 6 months (0–40). Based on the quantitative findings and guided by the Transactional Model of Stress and Coping, semistructured interviews explored causes of stress and coping processes. Integration was performed during the qualitative and interpretation phase.Results:A total of 96 caregivers met inclusion criteria for quantitative analysis. Mean (SD) Perceived Stress Scale score was 14.3 (5.5) preimplant and 11.8 (6.9) at 6 months. Preimplant, only decreased preparedness for caregiving was associated with higher Perceived Stress Scale score at 6 months. At 6 months, increased caregiver depressive symptoms, decreased caregiver preparedness for caregiving, and lower patient quality of life were associated with higher Perceived Stress Scale score. Qualitative analysis of 25 caregivers revealed the causes of stress coalesced around 3 themes: (1) lack of preparedness to be a caregiver, (2) uniqueness of stress for the caregiver and patient situation, and (3) caregiving responsibilities physically and emotionally impacting caregivers. To cope with stress, most caregivers employed emotion-focused coping.Conclusions:In family caregivers of patients with a left ventricular assist device, higher perceived stress was associated with lower caregiver preparedness, higher caregiver depressive symptoms, and lower patient quality of life. Emotion-focused coping strategies were common for caregivers. Future work should better prepare caregivers for this role and support them through the caregiving experience.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344576.

中文翻译：

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目标治疗左心室辅助装置患者家庭护理人员的压力和应对：一项多中心混合方法研究

背景：使用目标治疗左心室辅助装置的患者的家庭护理人员在植入后护理中发挥着核心和正式的作用。我们的目的是描述左心室辅助装置护理人员的纵向压力、压力的预测因素和相关因素以及应对过程。方法：我们对 6 个不同的左心室辅助装置项目进行了顺序、探索性、混合方法研究。定量分析的主要结果是 6 个月 (0–40) 时的感知压力量表 10。基于定量研究结果并在压力和应对交易模型的指导下，半结构化访谈探索了压力和应对过程的原因。在定性和解释阶段进行整合。结果：共有 96 名护理人员符合定量分析的纳入标准。植入前平均 (SD) 感知压力量表得分为 14.3 (5.5)，6 个月时为 11.8 (6.9)。植入前，只有降低的护理准备与 6 个月时较高的感知压力量表评分相关。在 6 个月时，看护者抑郁症状的增加、看护者对看护准备的减少以及患者生活质量的降低与较高的感知压力量表评分相关。对 25 名护理人员的定性分析揭示了压力的原因围绕 3 个主题：(1) 缺乏成为护理人员的准备，(2) 护理人员和患者情况的压力的独特性，以及 (3) 护理责任对护理人员的身体和情感产生影响. 为了应对压力，大多数护理人员采用以情绪为中心的应对方式。结论：在左心室辅助装置患者的家庭护理人员中，较高的感知压力与较低的护理人员准备程度、较高的护理人员抑郁症状和较低的患者生活质量相关。以情绪为中心的应对策略对于看护者来说很常见。未来的工作应该更好地让护理人员为这个角色做好准备，并通过护理经验支持他们。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02344576。