Khandelwal Nita, Downey Lois, May Peter, Pytel C Clare, Moore Stanley J, Elketami Addy, Nielsen Elizabeth, Engelberg Ruth
Cambia Palliative Care Center of Excellence.
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
Ann Am Thorac Soc. 2025 Aug;22(8):1217-1226. doi: 10.1513/AnnalsATS.202408-865OC.
Major knowledge gaps persist in understanding factors that contribute to family financial hardship and its association with other family-reported outcomes when patients experience critical illness. We sought to identify factors associated with family financial hardship and associations with family-reported outcomes. We conducted a prospective cohort study at three hospitals within a large academic healthcare system in the Pacific Northwest of the United States. Participants included family members of patients who were admitted to the intensive care unit (ICU) (4/2019-2/2023) and diagnosed with a chronic life-limiting illness or severe acute illness. Clustered bivariate and multiple linear regression models evaluated potential predictors of financial hardship. Clustered linear and probit regression models, adjusted for prespecified covariates, measured associations of 3 hardship with family-reported outcomes. A total of 783 family participants provided information on financial hardship 1 month after patients' ICU admission by responding to a modified version of the Comprehensive Score for financial Toxicity instrument. Financial hardship was greater for respondents who were younger ( = 0.019), had less education ( = 0.034), were the patient's spouse ( = 0.016), lived with the patient ( = 0.018), had dependent children at home ( < 0.001), experienced work-status changes related to patient's illness ( < 0.001), had poorer health ( < 0.001), lacked emotional support ( = 0.001), assessed hardship while the patient was alive ( = 0.005), or had been in the hospital longer ( = 0.011). Reported hardship was lower when the patient had a cancer diagnosis ( = 0.030), and it varied by racial-ethnic group ( = 0.003) and insurance type ( = 0.045). Financial hardship was associated ( < 0.001) with increased family depression and anxiety and with reduced emotional preparedness and quality of life at 1 and 3 months after the patient's ICU admission. For family of critically ill patients, social and demographic factors may play a larger role in financial hardship than clinical factors. Financial hardship is predictive of lower family quality of life. These findings add to the literature demonstrating the prevalence and adverse consequences of financial hardship, its inequitable distribution, and the need for evidence on supports and interventions to mitigate poor outcomes and inequities.
在理解导致家庭经济困难的因素及其与患者患重病时家庭报告的其他结果之间的关联方面，仍然存在重大的知识空白。我们试图确定与家庭经济困难相关的因素以及与家庭报告结果的关联。我们在美国太平洋西北地区一个大型学术医疗系统内的三家医院进行了一项前瞻性队列研究。参与者包括入住重症监护病房（ICU）（2019年4月至2023年2月）并被诊断患有慢性限期疾病或严重急性疾病的患者的家庭成员。聚类双变量和多元线性回归模型评估了经济困难的潜在预测因素。聚类线性和概率回归模型在对预先指定的协变量进行调整后，测量了三种困难与家庭报告结果之间的关联。共有783名家庭参与者通过回答经修改的财务毒性综合评分工具，在患者入住ICU后1个月提供了有关经济困难的信息。年龄较小（ = 0.019）、受教育程度较低（ = 0.034）、是患者配偶（ = 0.016）、与患者同住（ = 0.018）、家中有受抚养子女（ < 0.001）、经历与患者疾病相关的工作状态变化（ < 0.001）、健康状况较差（ < 0.001）、缺乏情感支持（ = 0.001）、在患者在世时评估困难（ = 0.005）或住院时间更长（ = 0.011）的受访者经济困难更大。当患者被诊断患有癌症时，报告的困难较低（ = 0.030），并且因种族 - 族裔群体（ = 0.003）和保险类型（ = 0.045）而异。经济困难与患者入住ICU后1个月和3个月时家庭抑郁和焦虑增加以及情感准备和生活质量降低相关（ < 0.001）。对于重症患者的家庭，社会和人口因素在经济困难中可能比临床因素发挥更大作用。经济困难预示着家庭生活质量较低。这些发现为文献增添了证据，证明了经济困难的普遍性和不良后果、其不公平分布以及需要有关支持和干预措施的证据以减轻不良结果和不公平现象。
