“Cardiotoxic” and “cardioprotective” partner support for patient activation and distress: Are two better than one?

• Published date: 01 July 2023
• Author: Anna Bertoni,Giada Rapelli,Miriam Parise,Ariela F. Pagani,Silvia Donato
• Date: 01 July 2023
• DOI: http://doi.org/10.1111/fare.12694

RESEARCH

“Cardiotoxic”and “cardioprotective”partner support

for patient activation and distress: Are two better

than one?

Anna Bertoni

1

| Giada Rapelli

2

| Miriam Parise

1

|

Ariela F. Pagani

3

| Silvia Donato

1

1

Department of Psychology, Family Studies

and Research University Centre, Università

Cattolica del Sacro Cuore, Milano, Italy

2

Psychology Research Laboratory, Istituto

Auxologico Italiano IRCCS, Milan, Italy

3

Department of Humanities, University of

Urbino, Urbino, Italy

Correspondence

Anna Bertoni,Department of Psychology,

Family Studiesand Research UniversityCentre,

UniversitàCattolica del Sacro Cuore,Milano,

Largo Gemelli,1—20123 Milano, Italy.

Email: anna.bertoni@unicatt.it

Abstract

Objective: The study aimed to test whether the presence

of a partner was always beneficial to people with cardiac

disease and how different types of partner behaviors

promoted or hindered their activation and distress.

Background: Cardiac disease challenges not only patients

but also their partners, whose support is not always effective.

Method: A cross-sectional dyadic research design, in which

both partners completed a self-report questionnaire during

hospitalization, was adopted. The associations between

partner support and patient outcomes were tested using

stepwise regression analysis.

Results: The mere presence of a partner was not associated

with distress or activation of a person with cardiac illness.

On the contrary, the quality of partner support is differently

linked with outcomes of person with cardiac illness; in partic-

ular, partner support for activation is significantly associated

with lower levels of depression, anxiety, and somatization of

person with cardiac disease, whereas overprotection is signif-

icantly associated with lower levels of activation.

Conclusion: Partner support may be a double-edged sword:

Partners may be a powerful ally in illness management but

also a barrier to it when partner support is ineffective.

Implications: This study highlights the importance of inte-

grating partners in cardiac recovery programs and provides

suggestions for thedesign of couple-based interventions.

[Correction added on Feb 15, 2023, after first online publication: The affiliation “Department of Psychology, Catholic University of the

Sacred Heart, Milan, Italy”has been removed for the author Giada Rapelli ]

Received: 27 May 2021 Revised: 26 January 2022 Accepted: 5 February 2022

DOI: 10.1111/fare.12694

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and

reproduction in any medium, provided the original work is properly cited.

© 2022 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2023;72:1335–1350. wileyonlinelibrary.com/journal/fare 1335

KEYWORDS

cardiac disease, couple relationship, distress, partner support, patient

activation, patient engagement

Despite increasing survival rates and prolonged life expectancy, cardiac diseases, especially their

acute manifestations, still represent important causes of death and disability. Cardiac disease

contributes to patients’mood disorders, such as depression and anxiety (Cohen et al., 2015;

Protogerou et al., 2015; Spatola et al., 2018,2021), which are significant risk factors for poor

prognosis and adherence to medical recommendations, high mortality, and low quality of life

(Alvarenga & Byrne, 2016). Although there has been much research on individual psychological

outcomes after an acute cardiac event, some studies have started to underline the relational

nature of the disease, exploring how the quality of partner support is associated with patient

outcomes. In fact, the partner can have an impact on illness adjustment but may be also

affected by stress related to the illness (Franks et al., 2002; Rapelli et al., 2020a,2021).

People with cardiac disease who are part of a couple were found to have a better adjustment

to the illness, a more optimistic perception of recovery and consequences of the illness, better

adherence, and higher survival rates compared with their single counterparts (Bertoni

et al., 2015; DiMatteo, 2004). The partner, in fact, embodies the closest and most supportive

person in times of major stressors, such as illness (Bodenmann & Cina, 2000; King &

Reis, 2012), as well as in everyday life (Bertoni & Bodenmann, 2010; Bertoni et al., 2012;

Donato et al., 2014,2015; Pagani et al., 2015). In addition, partners can play an important role

in the care process and particularly in patients’lifestyle changes (e.g., with dietary, physical,

and medical regimens), thereby potentially contributing to or impeding patients’activation in

their treatment (i.e., patients’active involvement in their treatment, referring to the knowledge,

skills, trust, and behaviors necessary to manage their health; Hibbard et al., 2004).

Recent studies have found that activation—that is, when a person with cardiac disease is

active—is likely to lead to better health-related outcomes, including less likelihood of emer-

gency department visits or being obese, smoking cessation, having clinical indicators in the nor-

mal range, better disease self-management, and greater adherence to medical recommendations

and drug regimens (Graffigna et al., 2017; Greene & Hibbard, 2012). Partner presence can posi-

tively influence health outcomes for people with cardiac disease (Molloy et al., 2009; Vujcic

et al., 2015); however, few studies have analyzed the quality of partner support and how it is

associated with the degree to which a patient is active in self-care (Rapelli et al., 2020b,2022).

CARDIAC DISEASE MANAGEMENT: THE ROLE OF PARTNER

SUPPORT

Ample evidence shows that, compared with people with cardiac disease who are not married,

married individuals report more health-promoting behaviors, such as smoking cessation, adher-

ence to special diets and rehabilitation attendance (Blikman et al., 2014; Maeda et al., 2013),

faster recovery (Berkman & Glass, 2000; Rankin-Esquer et al., 2000), and higher self-efficacy

(Maeda et al., 2013). Scholars argued that these effects are influenced by marital status as a

proxy for partner support (Case et al., 1992; Vujcic et al., 2015), but few studies have explored

the effects of how partner support is provided, examining different types of partner behaviors—

from positive and supportive to less skillful or inadequate behaviors specific to heart disease. In

fact, partners vary in their ability to provide support to each other (Donato et al., 2020). Fur-

thermore, the stress caused by the illness and by caregiving may elicit unsupportive or hostile

reactions in partners. For instance, research on diabetes management focusing on partners’

social control behaviors, has shown that social control without an adequate reinforcement or

1336 FAMILY RELATIONS