Examining the Conceptual Model of Compassion Fatigue in Spouse Caregivers of Women with Breast Cancer

Thesis (Ph.D.)--University of Washington, 2023Purpose: The overall purpose of the dissertation was to develop a comprehensive theoretical framework of compassion fatigue in family caregivers, with three specific aims addressed through separate manuscripts. Specific Aim 1 involved synthesizing a conceptual definition of compassion fatigue in family caregivers by reviewing relevant literature. Specific Aim 2 focused on evaluating a measurement model of compassion fatigue in spouse caregivers of women with breast cancer. Specific Aim 3 examined the structural model of compassion fatigue in spouse caregivers by testing the hypothesized relationships between antecedent and consequent variables.Methods: Study 1 employed a scoping review approach, incorporating Rodgers’ Evolutionary Model for concept analysis, to identify essential properties, antecedents, and consequences of compassion fatigue in family caregivers from existing literature. Study 2 and Study 3 utilized secondary data from the Family Home Visitation Program, a randomized controlled trial of a couple-focused cognitive-behavioral intervention for spouse caregivers and women with newly diagnosed breast cancer. The analyses included baseline data from 214 spouse caregivers. Study 2 utilized exploratory and confirmatory factor analysis to evaluate the proposed measurement model for compassion fatigue. Study 3 evaluated a measurement model of the caregiver’s empathic response and used structural equation modeling to examine the relationships among caregiver's empathic response, compassion fatigue, and depressed mood and physical symptoms in spouse caregivers. Results: Study 1 established an integrated conceptual framework of compassion fatigue in family caregivers, serving as a foundation for the dissertation study. Study 2 confirmed a three-factor model had the best fit for the data, indicating that powerlessness, emotional isolation, and emotional disengagement significantly contributed to the level of compassion fatigue experienced by spouse caregivers. Study 3 revealed that spouse caregivers’ empathic response could be organized into three domains: empathic ability, emotional contagion, and empathic concern. Spouse caregivers’ empathic response predicted compassion fatigue, and subsequently led to caregivers’ depressed mood and physical symptoms. The impact of empathic response on the two negative outcomes was fully mediated by compassion fatigue, highlighting the risk factor nature of empathic response in caregiving. Conclusion: This dissertation addressed an important gap in the literature by providing a comprehensive understanding of compassion fatigue in spouse caregivers. The derived Empathic Response measure (9-item) and Compassion Fatigue measure (16-item) contribute to the development and validation of family caregiver-specific instruments for assessing empathic response and compassion fatigue. Future studies should explore potential moderators and thresholds of compassion fatigue, include diverse caregiving populations, and consider the influence of social determinants of health on compassion fatigue in family caregivers. Early detection and intervention in family caregivers experiencing compassion fatigue can effectively alleviate compassion stress, enhance family coping, and ultimately improve the quality of care family members provide to their loved ones