Variation in Serious Illness Communication among Surgical Patients Receiving Palliative Care.

Abstract

<b><i>Background:</i></b> Natural language processing (NLP), a form of computer-assisted data abstraction, rapidly identifies serious illness communication domains such as code-status confirmation and goals of care (GOC) discussions within free-text notes, using a codebook of phrases. Differences in the phrases associated with palliative care for patients with different types of illness are unknown. <b><i>Objective:</i></b> To compare communication of code-status clarification and GOC discussions between patients with advanced pancreatic cancer undergoing palliative procedures and patients admitted with life-threatening trauma. <b><i>Design:</i></b> Retrospective cohort study. <b><i>Setting/Subjects:</i></b> Patients with in-hospital admissions within two academic medical centers. <b><i>Measurements:</i></b> Sensitivity and specificity of NLP-identified communication domains compared with manual review. <b><i>Results:</i></b> Among patients with advanced pancreatic cancer (<i>n</i> = 523), NLP identified code-status clarification in 54% of admissions and GOC discussions in 49% of admissions. The sensitivity and specificity for code-status clarification were 94% and 99% respectively, while the sensitivity and specificity for a GOC discussion were 93% and 100%, respectively. Using the same codebook in patients with life-threatening trauma (<i>n</i> = 2093), NLP identified code-status clarification in 25.9% of admissions and GOC discussions in 6.3% of admissions. While NLP identification had 100% specificity, the sensitivity for code-status clarification and GOC discussion was reduced to 86% and 50%, respectively. Adding dynamic phrases such as "ongoing discussions" and phrases related to "family meetings" increased the sensitivity of the NLP codebook for code status to 98% and for GOC discussions to 100%. <b><i>Conclusions:</i></b> Communication of code status and GOC differ between patients with advanced cancer and those with life-threatening trauma. Recognition of these differences can aid in identification in patterns of palliative care delivery.