Risk Factors and Consequences of Financial Hardship among Family of Critically Ill Patients

Rationale: 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. Objectives: We sought to identify factors associated with family financial hardship and associations with family-reported outcomes. Methods: 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. Results: 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 (P = 0.019), had less education (P = 0.034), were the patient's spouse (P = 0.016), lived with the patient (P = 0.018), had dependent children at home (P < 0.001), experienced work-status changes related to patient's illness (P < 0.001), had poorer health (P < 0.001), lacked emotional support (P = 0.001), assessed hardship while the patient was alive (P = 0.005), or had been in the hospital longer (P = 0.011). Reported hardship was lower when the patient had a cancer diagnosis (P = 0.030), and it varied by racial-ethnic group (P = 0.003) and insurance type (P = 0.045). Financial hardship was associated (P < 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. Conclusions: 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.