Supporting data for "The effects of a dyadic psychosocial intervention on the mutuality, psychological and quality of life outcomes of patients with heart failure and their family caregivers: A mixed-methods study"

Heart failure (HF) is a debilitating and progressive condition that significantly affects patients and family caregivers, who often function as care partners and jointly navigate the illness trajectory. Within this partnership, their relational dynamics are pivotal in shaping how dyads cope with HF. However, existing dyadic interventions have given limited attention to optimising relational dynamics.This study aimed to develop and evaluate the effects of a relationship-focused dyadic psychosocial intervention, titled ‘Coping and Thriving Together (CTT)’, on the mutuality, psychological and quality of life (QoL) outcomes of patients with HF and their family caregivers. It was conducted in two phases to achieve this overall aim.Phase one comprised a qualitative evidence synthesis to enhance understanding of how dyads cope with HF together. Thirty articles were included in the synthesis. The findings revealed that dyadic coping in patients with HF and caregivers is a dynamic process of adopting constructive or destructive strategies to respond to the communal and intertwined challenges brought by the disease, shaped by the interplay of individual, relational and social conditions. The findings of this phase informed the development of the intervention in the phase two.Phase two employed a sequential mixed-methods design comprising a randomised controlled trial to evaluate the effects of the CTT intervention and a qualitative study to explore the dyadic experiences of participating in the intervention. HF dyads were recruited from a hospital in China. Eligible dyads (n = 152) were randomly assigned to either the intervention group (n = 76) to receive a 12-week CTT intervention on enhancing mutual responsiveness during dyadic adaptation to HF, or the control group (n = 76) to receive usual care. The mutuality, resilience, self-compassion, anxiety, depression and QoL outcomes of patients and caregivers were evaluated at baseline (T0), immediately post-intervention (T1), and three months thereafter (T2). Semi-structured interviews were conducted with 30 dyads from the intervention group.The findings indicated that compared with those in the control group, patient participants in the intervention group exhibited significantly greater improvements in mutuality and resilience at T1 and T2. They also experienced greater reductions in anxiety and depression at T1, with only the effect on depression remaining significant at T2. For caregivers, those in the intervention group reported significantly greater improvements in mutuality, self-compassion and QoL at T1 and T2, and significantly greater reductions in anxiety at T1. However, no between-group difference was found in patients’ self-compassion or health-related QoL nor in caregivers’ resilience or depression. Mediation analyses showed that patients’ perceived mutuality significantly mediated the intervention effects on patients’ depressive symptoms, whereas caregivers’ perceived mutuality and self-compassion significantly mediated the intervention effects on caregivers’ QoL. Qualitative findings revealed that patient and caregiver participants perceived better relational dynamics, enhanced disease management, improved emotional well-being, more adaptive mindsets and more constructive daily living patterns.The findings highlight that the CTT intervention effectively improves the relational and individual well-being of patients and caregivers. This study advances dyadic care models in HF, offering a promising approach for supporting dyadic adaptation to HF.

心力衰竭（Heart Failure, HF）是一种使人衰弱且呈进行性发展的疾病，会对患者及其家庭照护者造成严重影响——后者往往同时作为照护伙伴，与患者共同应对疾病的病程轨迹。在这一照护伙伴关系中，二者的互动动态是决定伴侣双方如何共同应对心力衰竭的关键因素。然而，现有的二元照护干预方案对优化伴侣间互动动态的关注十分有限。
本研究旨在开发并评估一项以关系为核心的二元社会心理干预方案——「携手共克与成长（Coping and Thriving Together, CTT）」，对心力衰竭患者及其家庭照护者的相互性、心理健康与生活质量（Quality of Life, QoL）结局的影响。为达成这一总体研究目标，本研究分为两个阶段开展。
第一阶段为定性证据整合研究，旨在加深对伴侣双方如何共同应对心力衰竭的理解。本阶段共纳入30篇文献，研究结果显示，心力衰竭患者与照护者的二元应对过程是动态变化的：二者会采取建设性或破坏性策略，应对疾病带来的共性且相互交织的挑战，而这一过程受个体、关系与社会多层面因素的交互作用所塑造。第一阶段的研究结果为第二阶段的干预方案开发提供了依据。
第二阶段采用序贯混合研究设计，包含两部分：一是通过随机对照试验（Randomised Controlled Trial, RCT）评估CTT干预方案的效果，二是通过定性研究探索参与者参与干预的二元体验。本研究从中国某医院招募心力衰竭伴侣对，符合纳入标准的152对伴侣被随机分配至干预组（n=76）与对照组（n=76）：干预组接受为期12周的CTT干预，旨在提升双方在共同适应心力衰竭过程中的相互回应能力；对照组则接受常规照护。
研究分别在基线（T0）、干预结束即刻（T1）以及干预后3个月（T2）三个时间点，评估患者与照护者的相互性、心理弹性、自我同情、焦虑、抑郁及生活质量结局。此外，研究对干预组中的30对伴侣开展了半结构化访谈。
研究结果显示，与对照组患者相比，干预组患者在T1与T2时间点的相互性与心理弹性提升更为显著；其焦虑与抑郁水平在T1时间点下降更明显，且该改善效应仅在抑郁维度于T2时间点仍保持显著。对于照护者而言，干预组照护者在T1与T2时间点的相互性、自我同情与生活质量提升更为显著，且其焦虑水平在T1时间点下降更明显。但两组患者的自我同情、健康相关生活质量，以及照护者的心理弹性与抑郁水平均未出现显著组间差异。
中介分析结果显示，患者感知到的相互性在干预方案对患者抑郁症状的影响中发挥显著中介作用；而照护者感知到的相互性与自我同情，则在干预方案对其生活质量的影响中发挥显著中介作用。定性研究结果显示，患者与照护者均感知到干预后二者的互动关系得到改善、疾病管理能力提升、情绪状态好转、适应心态增强，且日常行为模式更具建设性。
本研究结果表明，CTT干预方案可有效改善心力衰竭患者与家庭照护者的关系状态与个体健康福祉。本研究推动了心力衰竭领域的二元照护模型发展，为支持伴侣双方共同适应心力衰竭提供了极具前景的解决方案。