IS ECONOMIC HARDSHIP ON THE FAMILIES OF THE SERIOUSLY ILL ASSOCIATED WITH PATIENT AND SURROGATE CARE PREFERENCES

Background: Serious illness often causes economic hardship for patient s' families. However, it is not known whether this hardship is associa ted with a preference for the goal of care to focus on maximizing comf ort instead of maximizing life expectancy or whether economic hardship might give rise to disagreement between patients and surrogates over the goal of care. Methods: We performed a cross-sectional study of 315 8 seriously ill patients (median age, 63 years; 44% women) at 5 tertia ry medical centers with 1 of 9 diagnoses associated with a high risk o f mortality. Two months after their index hospitalization, patients an d surrogates were surveyed about patients' preferences for the primary goal of care: either care focused on extending life or care focused o n maximizing comfort. Patients and surrogates were also surveyed about the financial impact of the illness on the patient's family. Results: A report of economic hardship on the family as a result of the illnes s was associated with a preference for comfort care over life-extendin g care (odds ratio, 1.26; 95% confidence interval, 1.07-1.48) in an ag e-stratified bivariate analysis. Similarly, in a multivariable analysi s controlling for patient demographics, illness severity, functional d ependency, depression, anxiety, and pain, economic hardship on the fam ily remained associated with a preference for comfort care over life-e xtending care (odds ratio, 1.31; 95% confidence interval, 1.10-1.57). Economic hardship on the family did not affect either the frequency or direction of patient-surrogate disagreements about the goal of care. Conclusions: In patients with serious illness, economic hardship on th e family is associated with preferences for comfort care over life-ext ending care. However, economic hardship on the family does not appear to be a factor in patient-surrogate disagreements about the goal of ca re.