title: Balancing give and take between patients and their spousal caregivers in hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  Hematopoietic stem cell transplantation (HSCT) is a demanding treatment. Spouses of HSCT patients assume caregiving responsibilities that can induce feelings of burden and disrupt relationship equity. On the basis of equity theory, we propose a conceptual framework examining the individual and dyadic experience of HSCT patients and their caregivers. The model includes feelings of inequity, patient self-perceived burden, caregiver burden, and distress.
  
  
  METHODS
  The HSCT patients and their spousal caregivers were recruited prior to HSCT between March 2011 and September 2012. Each member of the dyad self-administered a questionnaire package.
  
  
  RESULTS
  Seventy-two dyads were included in the path analyses. Our model demonstrated an inadequate statistical fit; however, with one modification, an adequate to good fit was obtained: χ2(df) = 6.01(5), normed χ2= 1.20, standardized root mean square residual = 0.048, comparative fit index = 0.99, Tucker-Lewis index = 0.96, and root-mean-square error of approximation = 0.05 (90% CI, 0.00-0.18). As hypothesized, pre-HSCT caregiver burden mediates the relationship between caregiver underbenefit and caregiver distress. However, patient self-perceived burden was not associated with patient distress; rather, patient perception of overbenefit was related to patient distress. In our modified model, the results demonstrate that patient overbenefit influenced caregiver burden; however, there was not a reciprocal influence, because caregiver variables did not affect patient variables.
  
  
  CONCLUSIONS
  Our proposed theoretical framework describes patients' and caregivers' individual experience of distress before HSCT but does not as clearly encompass the dyadic experience. Addressing perceived imbalances and providing psycho-education on role changes within HSCT dyads before transplantation may be a useful prehabilitation strategy for preventing distress.
authors.affiliation: Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Beattie
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lebel
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Petricone-Westwood
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada.|Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, ON, Canada.|The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.affiliation: School of Psychology, University of Ottawa, Ottawa, ON, Canada.|Department of Psychology, The Ottawa Hospital, Ottawa, ON, Canada.|The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Harris
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.|Ontario Cancer Institute, Toronto, ON, Canada.|University of Toronto, Toronto, ON, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Devins
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Lothar
authors.initials: L
authors.lastname: Huebsch
authors.affiliation: Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.|The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Tay
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000601:surgery; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: cancer; caregiver burden; couple; equity theory; hematopoietic stem cell transplantation; oncology