Abstract 6: Financial Concerns Are Common Among Family Members of Severe Stroke Patients: A Mixed Methods Study

Abstract

Background: Stroke has a large aggregate financial impact, however the prevalence and predictors of cost concerns among family members of severe stroke patients are unknown. Methods: Family surrogate decision makers of severe stroke patients were recruited from the BASIC and OASIS projects in a South Texas community. Clinical information was obtained from medical charts. Patient and family member sociodemographic information was obtained from surveys, conducted at baseline and 3-, 6-, and 12-months post-stroke. The primary outcome was presence of cost concerns among family members, defined as being “very worried” or “moderately worried” about being able to pay stroke-related medical costs at any time point. Exploratory multivariable logistic regression models identified factors associated with cost concerns. A subset of participants also completed qualitative semi-structured interviews exploring the nature of cost concerns. Results: Of 2,917 stroke cases between April 2016 and September 2020, 465 were eligible, and 318 family members of 256 stroke patients participated. Patients were 52% female, 58% Mexican American (MA), with mean age of 75 (SD 14), and mean National Institutes of Health Stroke Scale score of 15 (SD 11). Family members were 76% female, 63% MA, with mean age of 56 (SD 13). Of 256 patients, 118 (46%) had a family member who reported having cost concerns. In a fully adjusted model (see Table), MA ethnicity and lack of insurance were associated with greater cost concerns. Cost concerns were less common over time and with patient death, and were less common among family members who were neither a spouse nor child of the patient. Interview data revealed that concerns were most often related to costs of post-acute care (excerpts included in the Table). Conclusions: Nearly half of all severe stroke patients have a family member with concerns about affording their medical care. Providers should seek to elicit cost concerns and provide resources to address them.