From the Critical Care and Pulmonary Consultants (Dr Van Pelt); and the Department of Psychiatry (Dr Schulz) and the Department of Critical Care Medicine (Drs Chelluri and Pinsky), University of Pittsburgh.
Correspondence to: David Van Pelt, MD, 1400 S Potomac St, Ste 110, Aurora, CO 80012; e-mail:firstname.lastname@example.org
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Funding/Support: This work was supported in part by the National Institutes of Health [Grants AG11979, HL67181, and HL07820].
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
We thank Dr Kulkarni for the thoughtful comments regarding our manuscript on post-ICU informal caregiver burden.1 Dr. Kulkarni identifies two interesting causes of burden that were not discussed in our article: loss of income and “inappropriate worry.”
Few studies have considered the financial impact of critical illness on informal caregivers. As the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) trial showed, the potential for loss of income by families of survivors of critical illness can be substantial.2 Although we did not investigate financial outcomes in our most recent article, we reported in an earlier study that up to 14% of caregivers stopped working in order to provide care for their loved ones.3
Dr Kulkarni’s concept of inappropriate worry highlights the complexity of identifying correlates and causes of burden. Dr Kulkarni’s research found that the severity of patient illness did not correlate directly with the degree of caregiver burden. A similar phenomenon has probably been observed in studies of post-ICU informal caregivers. Azoulay et al4 found that caregivers showed more symptoms of posttraumatic stress when caregivers felt that the information provided was incomplete. Cameron et al5 found that the Pearlin caregiver mastery score correlated with caregiver emotional distress. Although the terminology used in each of these studies differs, they are probably tapping a similar latent variable—caregiver comprehension of the patient’s illness.
Moreover, we believe that these studies highlight an important problem in the current state of research of caregiver burden. Burden in acute illness is a new field of investigation that is very complex and has been studied with a remarkable diversity of instruments examining an equally varied number of outcomes in both the ICU and post-ICU settings (Fig 1). Furthermore, burden research has historically been concerned with caregiving in chronic disease, such as dementia. As a result, we know a great deal about determinants of burden among caregivers providing support to older outpatients with functional disability but relatively little about the unique factors causing burden in caregivers of acutely ill patients. It is only after a better understanding of the determinants of informal caregiver burden is developed that we will be able to test the hypothesis suggested by Kulkarni that meeting the needs of family caregivers in the ICU will improve their post-ICU outcomes.
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