THE IMPACT OF SERIOUS ILLNESS ON PATIENTS FAMILIES

Objective.-To examine the impact of illness on the families of serious ly ill adults and to determine the correlates of adverse economic impa ct. Design.-Data were collected during the Study to Understand Prognos es and Preferences for Outcomes and Risks of Treatment (SUPPORT), a pr ospective cohort study of outcomes, preferences, and decision making i n seriously ill hospitalized adults and their families. Setting.-Five tertiary care hospitals in the United States. Participants.-The 2661 s eriously ill patients in nine diagnostic categories who survived their index hospitalization and were discharged home were eligible for this analysis, Surrogate and/or patient interviews about the impact of ill ness on the family were obtained for 2129 (80%) of these patients (mea n age, 62 years; 43% women; 6-month survival, 75%). Outcome Measures.- Surrogates and patients were surveyed to determine the frequency of ad verse caregiving and economic burdens, Multivariable analyses were per formed to determine correlates of loss of family savings. Results.-One third (34%) of patients required considerable caregiving assistance f rom a family member. In 20% of cases, a family member had to quit work or make another major life change to provide care for the patient. Lo ss of most or all of the family savings was reported by 31% of familie s, whereas 29% reported loss of the major source of income. Patient fa ctors independently associated with loss of the family's savings on mu ltivariable analysis included poor functional status (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.10 to 1.78 for patients needing assistance with three or more activities of daily living), lower fami ly income (OR, 1.74; 95% CI, 1.37 to 2.21 for those with annual income s below $25 000), and young age (OR, 2.85; 95% CI, 2.13 to 3.82 for th ose younger than 45 years compared with those 65 years or older). Conc lusions.-Many families of seriously ill patients experience severe car egiving and financial burdens. Families of younger, poorer, and more f unctionally dependent patients are most likely to report loss of most or all of the family's savings.