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2023 HSR&D/QUERI National Conference Abstract

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4123 — Caregiver and Care Team Perspectives About Sources of Psychological Distress Among Family Caregivers of Veterans in Critical Care: a Qualitative Study

Lead/Presenter: Amanda Blok,  COIN - Ann Arbor
All Authors: Blok AC ((Center for Clinical Management Research, Ann Arbor)), Weston LE (Center for Clinical Management Research, Ann Arbor) Iwashyna TJ (Center for Clinical Management Research, Ann Arbor) Krein SL (Center for Clinical Management Research, Ann Arbor)

Family caregivers often experience psychological distress during a critical care hospitalization, which can compromise their well-being and ability to effectively function in a supportive role. Our objective was to identify and better understand sources of psychological distress in family caregivers during a Veteran’s critical care hospitalization, to compare caregiver and clinical team member perspectives, and examine how differences in these perspectives might provide opportunities for intervention to mitigate family caregiver psychological distress development.

We conducted a directed content analysis of semi-structured interviews with 20 family caregivers of Veterans in critical care and 12 clinical team members. We examined family caregiver and care team member perceptions related to the patient’s health status, healthcare system, family, and financial factors. Specifically, we focused on factors contributing to or protecting caregivers from psychological distress.

Family caregivers reported healthcare system issues, unknowns around the patient condition, their own family functioning, and their role as caregiver as the predominant factors that contributed to their psychological distress. Clinical team members primarily attributed caregiver psychological distress during hospitalization to the need to process medical information, often related to the patient’s medical status and treatments. Several predominant factors that family caregivers identified as the source of their psychological distress—healthcare system and family functioning—were not mentioned by clinical team members as considered or addressed in current practice. Rather, the strategies clinical team members reported using to support caregivers focused primarily on information processing, including clear, frequent, and thorough information exchange. The appropriate exchange of information was identified by family caregivers as a foremost factor contributing to a positive experience during critical care.

What clinical team members do can make a powerful difference in the family caregiver experience during critical care. However, there are healthcare system and family functioning factors that heavily influence caregiver psychological distress during critical care hospitalization that have not been considered by clinical teams and remain unaddressed.

Our findings highlight several key areas related to the healthcare system and family functioning as targets for intervention to mitigate psychological distress development in family caregivers of Veterans in critical care.