D12-09 Health-related Social Needs of Patients With Chronic Obstructive Pulmonary Disease Admitted to the Intensive Care Unit: A Mixed Methods Study

Abstract Introduction Unequal distribution of social determinants of health (SDOH) within a community leads to individual health-related social needs (HRSN). For patients with chronic obstructive pulmonary disease (COPD), disparate social structures amplify illness severity. HRSN assessments are feasible and acceptable in primary care and emergency medicine; little is known about their acceptability to patients and caregivers during critical illness. We sought to understand the accuracy and feasibility of HRSN assessments for patients with severe COPD in the intensive care unit (ICU). Methods We recruited adult patients with acute exacerbations of COPD admitted to the medical ICU for 12 hours and their caregivers. Participants reported basic demographics, completed the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) and the Epic SDOH questionnaires. Participants were approached chronologically after survey completion and conveniently sampled to complete individual or dyad interviews to identify facilitators and barriers to discussing HRSN. Survey concordance was reported. Median scores and the proportion of matching responses were compared using the Mann Whitney U test and Spearman correlation coefficient respectively. Interview transcripts were coded and thematically analyzed using the Health Equity Implementation Framework. Results Twenty-seven patient-caregiver dyads, five patients, and three caregivers completed surveys (74% response rate). Six dyads, eight patients, and 10 caregivers completed interviews (49% response rate). Patients’ median age was 66.5 years, 53% were women, and 88% identified as Black or African American. Twenty (63%) had Stage E COPD and eight (25%) required invasive mechanical ventilation. Patients were unemployed (disability or retired, 100%), though stably housed (94%). Of all HRSN, patients reported the most difficulty accessing medications or health care (42%), utilities (32%), and food (26%). HRSN survey concordance between patients and caregivers was 80% for PRAPARE and 70% for Epic; there were no significant differences between patient and caregiver responses. Qualitative analysis revealed participants found discussions of income and insurance intrusive; they were open to discussing other HRSN. Patients and caregivers did not perceive the context of HRSN discussion (ICU, hospital, clinic) to be important. Participants identified three key communication preferences in HRSN discussion promoting independence, educating on illness management, and displaying compassion to engender trust. Discussion This is the first mixed-methods study to quantify HRSN in ICU patients with COPD, despite the well-established role of SDOH in modifying COPD outcomes. Surrogate HRSN report was concordant. Participants were open to discussing most HRSN except for financial issues, which aligns with recent qualitative studies. This abstract is funded by: Bucksbaum Institute at the University of Chicago