Time to Talk Money? Intensive Care Unit Clinicians' Perspectives on Addressing Patients' Financial Hardship.

Abstract

Background: Critically ill patients and their families commonly experience financial hardship, yet this experience is inadequately addressed by clinicians providing care in the intensive care unit. Understanding clinicians' perspectives on the barriers to addressing financial hardship provides an opportunity to identify and mitigate those barriers and improve patient outcomes.

Objective: To characterize intensive care unit clinicians' experiences with and perceived barriers to addressing financial hardship with their patients.

Methods: The study entailed a thematic analysis of semistructured interviews of 17 physicians, nurses, and social workers providing care to critically ill patients in a large academic health care system in the US Pacific Northwest.

Results: Participants recognized the importance of addressing financial hardship as an integral part of patient-centered care but identified barriers influencing their comfort with and capacity to address financial hardship. Barriers fit into 2 themes: "(dis)comfort addressing financial hardship" and "values-based concerns." (Dis)comfort addressing financial hardship was influenced by systems- and practice-based barriers. Participants discussed concerns about real and perceived conflicts of interest when patient, family, clinician, and institutional priorities were not aligned.

Conclusions: Participants recognized financial hardship as an important consequence of critical illness that negatively affected patient and family outcomes, yet they described barriers to adequately addressing this topic. Normalizing discussions about the financial impacts of critical illness and systematically screening for financial hardship may be a first step in mitigating these barriers.