Population Health Sciences (B.G.K., W.Z., S.S., T.X., C.H.V.H.), Duke University School of Medicine, Durham, North Carolina, USA; Margolis Institute for Health Policy (B.G.K., R.W.H., C.H.V.H.), Duke University, Durham, North Carolina, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) (B.G.K., C.H.V.H.), Durham VA Medical Center, Durham, North Carolina, USA.
Population Health Sciences (B.G.K., W.Z., S.S., T.X., C.H.V.H.), Duke University School of Medicine, Durham, North Carolina, USA.
J Pain Symptom Manage. 2024 Dec;68(6):632-640.e2. doi: 10.1016/j.jpainsymman.2024.08.030. Epub 2024 Aug 28.
Family caregivers (FCGs) play a crucial role in care for people with serious illness, yet unpaid care is often overlooked in estimates of care recipient (CR) care costs.
This study quantifies the economic value of unpaid caregiving by FCGs between hospital discharge and end of life.
Trial participants were rural FCGs of CRs receiving palliative care during hospitalization. Caregiving hours were self-reported by FCGs over six months following hospital discharge. Economic value was assigned to hours based on wage data from the United States Bureau of Labor Statistics. Time was valued using 1) home health aide wages (proxy cost), 2) median national wage by FCG sex and education level (opportunity cost), 3) opportunity cost if employed and proxy cost otherwise (combination cost).
Of 282 FCGs, 94% were non-Hispanic White, 71% were female, 71% had a college degree, and 51% were in the workforce. FCGs of decedents (58%) compared to survivors reported significantly more caregiving hours per person-month (392 vs. 272), resulting in higher estimated economic value per person-month using opportunity ($12,653 vs. $8843), proxy ($5689 vs. $3955), and combined costing methods ($9490 vs. $6443) CONCLUSION: This study informs more complete economic evaluations of palliative care by estimating the economic value of unpaid caregiving. The high intensity of unpaid caregiving for people with serious illness, especially toward the end of life, should be considered when designing policies and interventions to support FCGs. Better methods for approximating economic value are needed to address potential inequities in current valuation approaches.
家庭照顾者（FCG）在照顾重病患者方面发挥着至关重要的作用，但在估计照顾对象（CR）的护理费用时，无偿护理往往被忽视。
本研究量化了 FCGS 在出院至死亡期间提供无偿护理的经济价值。
试验参与者为接受姑息治疗的农村 CR 的 FCGS。FCG 在出院后六个月内自我报告护理时间。根据美国劳工统计局的工资数据，将时间赋值给护理小时数。使用以下三种方法评估时间的经济价值：1）家庭健康助理工资（代理成本），2）按 FCG 性别和教育程度划分的全国中位数工资（机会成本），3）如果就业则为机会成本，否则为代理成本（组合成本）。
在 282 名 FCG 中，94%为非西班牙裔白人，71%为女性，71%拥有大学学历，51%在工作。与幸存者相比，死者的 FCG 报告的人均月护理时间显著更多（392 比 272），导致机会成本（12653 美元对 8843 美元）、代理成本（5689 美元对 3955 美元）和组合成本（9490 美元对 6443 美元）的估计经济价值更高。
本研究通过估计无偿护理的经济价值，为更全面的姑息护理经济评估提供了信息。在设计支持 FCGS 的政策和干预措施时，应考虑到重病患者特别是临终前的无偿护理强度。需要更好的方法来估算经济价值，以解决当前估值方法中的潜在不平等问题。
