title: The Impact of Relationship Quality on Health-Related Outcomes in Heart Failure Patients and Informal Family Caregivers: An Integrative Review.
abstract: BACKGROUND
  Relationships can have positive and negative impacts on health and well-being. Dyadic relationships between heart failure (HF) patients and their informal family caregivers may affect both patient and caregiver outcomes.
  
  
  OBJECTIVE
  The aim of this study is to synthesize the literature to date on the associations between HF patient-caregiver relationship quality and communication and patient and caregiver health outcomes.
  
  
  METHODS
  An integrative review of the literature was conducted. Computerized literature searches in Medline, PsycInfo, CINAHL, Web of Science, and EMBASE yielded 13 articles of HF patients and caregivers. Included articles were reviewed and double-coded by 2 independent coders.
  
  
  RESULTS
  Included articles measured relationship quality or aspects of communication within an HF patient-caregiver dyad and used both cross-sectional and longitudinal designs. Results of the longest prospective study suggested that better relationship quality between HF patients and their informal family caregivers was related to a reduced risk for mortality in patients. Results of 11 of the 12 other studies were consistent to the reference study, suggesting that better relationship quality and communication were related to reduced mortality, increased health status, less distress, and lower caregiver burden.
  
  
  CONCLUSIONS
  Relationship quality and communication seem to matter in the health and well-being of both HF patients and their informal family caregivers. More research is needed to elucidate mechanisms and to design effective relationship-focused interventions.
authors.affiliation: Stephanie A. Hooker, MS Doctoral Student, Department of Psychology, University of Colorado Denver. Megan E. Grigsby, BA Doctoral Student, Department of Psychology, University of Colorado Denver. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, Edith Clemmer Steinbreight Chair of Gerontology, and Director, School of Nursing, Biobehavioral Research Center, University of Pennsylvania, Philadelphia. David B. Bekelman, MD, MPH Associate Professor of Medicine and Nursing, Department of Veterans Affairs, Eastern Colorado Health Care System, Denver; Department of Medicine and College of Nursing, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Hooker
authors.forename: Megan E
authors.initials: ME
authors.lastname: Grigsby
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
mesh_terms: D017028:Caregivers; D005195:Family Relations; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D063868:Patient Outcome Assessment