Family caregivers are asked to provide patient care, specifically assisting symptom management, at home, but their reliability of symptom management and assessment for patients is challenged because of the low agreement between patients' and caregivers' symptom reports. There is a gap in the knowledge in that a lack of a theory or model has been used to illustrate the scenario of a low level of congruence of symptom perception between patients and caregivers. The study developed the framework of Empathic Accuracy of Symptom Perception (EASP) based on Davis's Empathy Model and Ickes's Empathic Accuracy. Given's Family Care Model was used to support empathic accuracy in the context of the caregiving environment. EASP was conceptually defined as the similarities in the cognitive appraisal of patients' cancer symptom experiences between family caregivers and patients. Empathetic accuracy was operationally defined as congruence of pain and fatigue severity and frequency. The specific aim of this research was to examine how caregivers' emotionality (caregiver depression) and caregivers' threats of caregiving (caregiver burden) predict EASP (congruence of pain and fatigue severity and frequency), when taking into account contextual factors of caregivers (age, sex, education, relationship to patients, observation of the total number of patients' symptoms, and living arrangement). This is a cross-sectional, descriptive study using the data from the study entitled Family Home Care for Cancer- A Community-Based Model (# R01Ca-79280). A total of 225 cancer patient-caregiver dyads were examined regarding their reports on severity and frequency of patients' pain and fatigue in the seven days prior to the baseline interview.The results show that congruence of pain and fatigue severity and frequency between patients and caregivers was at a fair-to-moderate level (ICC = 0.3 ~ 0.5). The Odds Ratio (OR) of caregivers' congruence versus noncongruence of pain severity was decreased by a higher score of caregiver depressive symptoms, a greater number of patient symptoms, and caregivers living with patients, while congruence was increased by caregiver self-esteem. The OR of caregivers' underestimation versus congruence of pain frequency was decreased by 46% when one point of schedule interruption increased (95% CI of exp [-0.62] = 0.4 - 0.83). The OR of caregivers' underestimation versus congruence of fatigue severity was increased 10% by caregivers perceiving one more patient symptom (95% CI of exp [-1.02] = 0.81 - 1.01). The OR of caregivers' underestimation versus congruence of fatigue frequency was decreased by 23 % when caregivers recognized one more patient symptom (95% CI of exp [-0.14] = 0.77 - 0.97). Developing the EASP framework can enrich knowledge of family caregivers' empathy related to symptom management. Clinical care providers need to acknowledge that caregivers' awareness of patient symptoms and their congruence of symptom perception may be a sign of caregiver burden and caregiver depressive symptoms; therefore, caregiver burden and depression may be detected early. Nursing research is encouraged to integrate the EASP framework that can develop the approaches for caregivers' empathic accuracy and also to strengthen the generalization of this framework. Health policies are needed to advocate for family caregivers as partners in the health care system to ensure that care resources are available and the coordination for patients and their families occurs.
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