C22-09 Family Caregiver Preparedness After Medical Intensive Care Unit Admission: A Mixed-methods Study

Rationale Family caregivers are integral to the care of patients admitted to the intensive care unit (ICU) and are often responsible for managing complex care needs for patients who survive to hospital discharge. Little is known about ICU family member preparedness for caregiving. We conducted a mixed methods analysis to measure caregiver preparedness at hospital discharge and to identify predictors of preparedness. Methods This secondary, convergent parallel mixed methods analysis used data from a completed prospective cohort study. At the time of at hospital discharge family caregivers of patients who survived a medical ICU admission for acute cardiorespiratory failure completed the Preparedness for Caregiving Scale (PCS), an 8-item scale that assesses self-rated preparedness for key domains of caregiving with a mean total score of 0-4. Caregivers were categorized as either feeling “prepared” (PCS > =3) or “unprepared” (PCS<3). Nineteen patient and caregiver characteristics were selected a priori and underwent bivariate analysis for association with caregiver preparedness; directed acyclic graphs were then used to construct adjusted logistic regression models for each variable with a statistically significant association (p < 0.05). To further explore contributors to preparedness, we used content analysis of caregiver free text responses to the open-ended question, “Is there anything else you would like to be better prepared for?”. Results A total of 59 caregivers were included in the study. Forty-two (71%) were women, 45 (76%) were white, and mean age was 59 years (SD 15). Only 52% of caregivers felt prepared for caregiving at hospital discharge. After adjusting for relevant confounders, patient severity of illness at enrollment as measured by the APACHE II score was associated with increased odds of caregiver preparedness (OR 1.13, 95% CI 1.02-1.25, p = 0.012). We identified an interaction between caregiver employment status and caregiver gender: for female caregivers, working full or part time was associated with decreased odds of preparedness (OR 0.10, 95% CI 0.02 to 0.56, p = 0.008) as compared to caregivers who were unemployed. This association did not exist for men. From the qualitative data, we identified three additional domains that influenced caregiver preparedness, which are shown in Table 1. Conclusions Our findings suggest that family caregiver preparedness is complex and influenced by both patient and caregiver characteristics as well as broader social support networks and experiences with ICU clinicians. We identified potential targets for future interventions to increase caregiver preparedness, including increased information from the healthcare team and leveraging existing friend and family support. This abstract is funded by: NIH (see below)