Evidence map›Paper›PMID 40021345›Full record

ArticleAmerican journal of critical care : an official publication, American Association of Critical-Care Nurses2025

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

Danae G Dotolo, C Clare Pytel, Elizabeth L Nielsen, Alison M Uyeda, Jennifer Im, Ruth A Engelberg, Nita Khandelwal

Abstract read
In one paragraph

Article in American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Danae G DotoloDanae G. Dotolo is a research assistant professor, Cambia Palliative Care Center of Excellence and Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of Washington, Harborview Medical Center, Seattle.
C Clare PytelC. Clare Pytel is a research coordinator, Cambia Palliative Care Center of Excellence and Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle.
Elizabeth L NielsenElizabeth L. Nielsen is a research coordinator, Cambia Palliative Care Center of Excellence and Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of Washington, Harborview Medical Center, Seattle.
Alison M UyedaAlison M. Uyeda is a clinical and research fellow, Cambia Palliative Care Center of Excellence and Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of Washington, Harborview Medical Center, Seattle.
Jennifer ImJennifer Im is a doctoral candidate, Department of Health Systems and Population Health, University of Washington, Seattle.
Ruth A EngelbergRuth A. Engelberg is a research professor emeritus, Cambia Palliative Care Center of Excellence and Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of Washington, Harborview Medical Center, Seattle.
Nita KhandelwalNita Khandelwal is an associate professor, Cambia Palliative Care Center of Excellence and Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle.

Funding

Identifying opportunities to improve shared decision-making about intensity of care for patients with Alzheimer's disease and related dementiasR01NR018161 · NINR · UNIVERSITY OF WASHINGTON · PI CREUTZFELDT, CLAIRE JOHANNA, ENGELBERG, RUTH ANN · 2018 to 2022
$3.7M
Palliative Care Research Training GrantT32HL125195 · NHLBI · UNIVERSITY OF WASHINGTON · PI KROSS, ERIN KATHRYN, SHARMA, RASHMI K. · 2015 to 2024
$3.2M
Improving patient- and family-centered outcomes and value of care for patients with chronic illness who develop acute respiratory failureK23HL144830 · NHLBI · UNIVERSITY OF WASHINGTON · PI KHANDELWAL, NITA · 2019 to 2022
$715k
NHLBI NIH HHS K23 HL144830NHLBI NIH HHS T32 HL125195NINR NIH HHS R01 NR018161
6 · The paper itself

Abstract

backgroundCritically 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.

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

methodsThe 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.

resultsParticipants 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.

conclusionsParticipants 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.

Indexed as

Attitude of Health PersonnelCritical CareCritical IllnessFinancial StressIntensive Care UnitsAdultFemaleHumansInterviews as TopicMaleMiddle AgedPatient-Centered CareQualitative Research

Identifiers

PMID40021345
PMCPMC13480172

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.