0
Correspondence |

Less-Obvious Predictors of Post-ICU Informal Caregiver Burden FREE TO VIEW

Hrishikesh S. Kulkarni, MD
Author and Funding Information

From the Department of Anesthesia and Perioperative Care, University of California-San Francisco.

Correspondence to: Hrishikesh S. Kulkarni, MD, 5030 Centre Ave, Apt 456, Pittsburgh, PA 15213; e-mail: drhkulkarni@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):1024. doi:10.1378/chest.10-1140
Text Size: A A A
Published online

To the Editor:

In a recent issue of CHEST (January 2010), Van Pelt and colleagues1 showed how predictors of caregiver burden vary over time. As their study emphasized the need to broaden the focus of patient- and caregiver-specific interventions, we have suggestions that can help to direct future research in this area.

The hospital admission of a seriously ill family member often imposes a substantial financial burden on the family, and this contributes to the overall burden on the caregiver.2 In a multicentric study comprising 2,123 admissions, the patients’ critical illness meant the loss of a major source of their family’s income for 29% of the caregivers.3 Hence, although the level of patient dependency on caregivers did not affect caregiver outcomes in the study by Van Pelt and colleagues,1 any data (either in this or future studies) on how many patients significantly contributed to the family income prior to admission and whether the number of patients returning to work varied over the time can reveal how the change in the financial situation influences the caregiver burden.

The authors also suggested that caregiver burden may be affected by less-obvious factors like the caregiver’s perception of the patient’s suffering. We have earlier highlighted the concept of “inappropriate worry.” We correlated worry among caregivers 48 to 72 h after patient admission with their perception of change in the patients’ critical state and found a clear discrepancy.4 Out of 76 family members, only 50% experienced worry that was in keeping with the change in the patients’ condition. In the remaining 50%, the worry was incongruous. We also found that in more than one-half the cases, there was a discrepancy between the objective change in the patients’ acute status (measured as the change in the Acute Physiology and Chronic Health Evaluation II score since admission) and the caregivers’ perception of the change (subjective change) in the patients’ critical state.4 Although our study was cross-sectional, the long-term effects of this discrepancy, as well as whether mitigating this discrepancy relieves caregiver burden, remain to be explored. Finally, discerning whether satisfying relevant caregiver needs during a patient’s hospital course and follow-up has a long-term effect on the caregiver is another area that could help to identify targets to reduce caregiver burden.

Van Pelt DC, Schulz R, Chelluri L, Pinsky MR. Patient-specific, time-varying predictors of post-ICU informal caregiver burden: the caregiver outcomes after ICU discharge project. Chest. 2010;1371:88-94. [CrossRef] [PubMed]
 
Levy MM.Angus DC, Carlet J. The burden of caregiving on families of ICU survivors. Surviving Intensive Care. 2004; New York, NY Springer-Verlag:63-72
 
Covinsky KE, Goldman L, Cook EF, et al; SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment The impact of serious illness on patients’ families. JAMA. 1994;27223:1839-1844. [CrossRef] [PubMed]
 
Kulkarni HS, Kulkarni KR, Mallampalli A, Karnad DR, Parkar SR, Guntupalli KK. Comparison of anxiety, depression and post-traumatic stress disorder symptoms in the relatives of critically ill patients in an American and Indian public hospital. Chest. 2008;1344:100801
 

Figures

Tables

References

Van Pelt DC, Schulz R, Chelluri L, Pinsky MR. Patient-specific, time-varying predictors of post-ICU informal caregiver burden: the caregiver outcomes after ICU discharge project. Chest. 2010;1371:88-94. [CrossRef] [PubMed]
 
Levy MM.Angus DC, Carlet J. The burden of caregiving on families of ICU survivors. Surviving Intensive Care. 2004; New York, NY Springer-Verlag:63-72
 
Covinsky KE, Goldman L, Cook EF, et al; SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment The impact of serious illness on patients’ families. JAMA. 1994;27223:1839-1844. [CrossRef] [PubMed]
 
Kulkarni HS, Kulkarni KR, Mallampalli A, Karnad DR, Parkar SR, Guntupalli KK. Comparison of anxiety, depression and post-traumatic stress disorder symptoms in the relatives of critically ill patients in an American and Indian public hospital. Chest. 2008;1344:100801
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543