Who Is Most Burdened in Health Care? An Analysis of Responses to the ICAN Discussion Aid

J Am Board Fam Med. 2023 Apr 3;36(2):277-288. doi: 10.3122/jabfm.2022.220251R1. Epub 2023 Mar 22.


Objective: To create a model based on patients' characteristics that can predict the number of burdens reported using the ICAN Discussion Aid, to target use of this tool to patients likeliest to benefit.

Patients and methods: Six hundred thirty-five patients (aged ≥18 years) completed the ICAN Discussion Aid at a Scottsdale, Arizona, family medicine clinic. Patient characteristics were gathered from their health records. Regression trees with Poisson splitting criteria were used to model the data.

Results: Our model suggests the patients with the most burdens had major depressive disorder, with twice as many overall burdens (personal plus health care burdens) than patients without depression. Patients with depression who were younger than 38 years had the highest number of personal burdens. A body mass index (BMI) of 26 or greater was associated with increased health care burden versus a BMI below 26.

Conclusion: The number of burdens a patient will report on the ICAN Discussion Aid can be approximated based on certain patient characteristics. Adults with major depression, a BMI of 26 or greater, and younger age may have greater reported burdens on ICAN, but this finding needs to be validated in independent samples.

Keywords: Arizona; Behavioral Medicine; Burden of Illness; Caregiver Burden; Chronic Disease; Clinical Medicine; Communication; Family Medicine; ICAN Discussion Aid; Mental Health; Patient-Centered Care; Shared Decision-Making.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care Facilities
  • Delivery of Health Care
  • Depressive Disorder, Major* / diagnosis
  • Depressive Disorder, Major* / therapy
  • Humans