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Quantitative-Qualitative Discordance in Measuring Distress Among Intensive Care Unit Family Caregivers: A
Blair Wendlandt1, Scott Vasher2, Timothy Gee3
1Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Palliative Medicine Reports
|August 12, 2026
Summary
The Impact of Events Scale-Revised (IES-R) often misses distress in intensive care unit (ICU) family caregivers. Many caregivers experience physical or financial stress not captured by the IES-R, indicating a need for broader assessment tools.
Area of Science:
- Critical Care Medicine
- Psychological Outcomes
- Family Caregiver Support
Background:
- The Impact of Events Scale-Revised (IES-R) is a common tool for assessing outcomes in family caregivers of intensive care unit (ICU) patients.
- It remains unclear if IES-R scores accurately reflect the subjective distress experienced by these caregivers.
Purpose of the Study:
- To evaluate the concordance between IES-R scores and self-reported distress in family caregivers of ICU patients.
- To identify specific symptoms of distress not captured by the IES-R.
Main Methods:
- A secondary mixed-methods analysis was conducted.
- IES-R scores at 6 months were compared with qualitative data from semi-structured interviews on caregiver wellness and distress.
Main Results:
- Quantitative-qualitative discordance was observed in 22% of caregivers (4/18).
- Discordant cases featured low IES-R scores (indicating quantitative wellness) but reported qualitative distress, primarily physical and financial, not psychological symptoms.
- One in four ICU family caregivers reported distress not measured by the IES-R.
Conclusions:
- The IES-R effectively identifies caregivers with significant psychological distress.
- Additional outcome measures are necessary to capture the full spectrum of distress, including physical and financial challenges, experienced by ICU family caregivers.