Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness

Affiliations

¹ Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E., J.T., E.K.K., J.R.C.), Seattle, Washington, USA.
² Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biostatistics, University of Washington (L.C.B.), Seattle, Washington, USA.
³ Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biomedical Informatics and Medical Education, University of Washington (J.S., W.B.L., T.C.), Seattle, Washington, USA.
⁴ Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biomedical Informatics and Medical Education, University of Washington (J.S., W.B.L., T.C.), Seattle, Washington, USA; Department of Biobehavioral Nursing and Health Informatics, University of Washington (W.B.L.), Seattle, Washington, USA.
⁵ Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E., J.T., E.K.K., J.R.C.), Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.

PMID: 36423800
PMCID: PMC9928787
DOI: 10.1016/j.jpainsymman.2022.11.012

Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness

Alison M Uyeda et al. J Pain Symptom Manage. 2023 Mar.

. 2023 Mar;65(3):233-241.

doi: 10.1016/j.jpainsymman.2022.11.012. Epub 2022 Nov 22.

Affiliations

¹ Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E., J.T., E.K.K., J.R.C.), Seattle, Washington, USA.
² Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biostatistics, University of Washington (L.C.B.), Seattle, Washington, USA.
³ Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biomedical Informatics and Medical Education, University of Washington (J.S., W.B.L., T.C.), Seattle, Washington, USA.
⁴ Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Department of Biomedical Informatics and Medical Education, University of Washington (J.S., W.B.L., T.C.), Seattle, Washington, USA; Department of Biobehavioral Nursing and Health Informatics, University of Washington (W.B.L.), Seattle, Washington, USA.
⁵ Department of Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E, J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., L.C.B., R.A.E., J.S., W.B.L., T.C., J.T., E.K.K., J.R.C.), Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington (A.M.U., R.Y.L., L.R.P., S.R.P., L.D., R.A.E., J.T., E.K.K., J.R.C.), Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.

PMID: 36423800
PMCID: PMC9928787
DOI: 10.1016/j.jpainsymman.2022.11.012

Abstract

Context: Goals-of-care discussions are important for patient-centered care among hospitalized patients with serious illness. However, there are little data on the occurrence, predictors, and timing of these discussions.

Objectives: To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients.

Methods: This retrospective cohort study used natural language processing (NLP) to examine EHR-documented goals-of-care discussions for adults with chronic life-limiting illness or age ≥80 hospitalized 2015-2019. The primary outcome was NLP-identified documentation of a goals-of-care discussion during the index hospitalization. We used multivariable logistic regression to evaluate associations with baseline characteristics.

Results: Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; approximately 57% of these discussions occurred within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common for women (OR=1.26, 95%CI 1.18-1.36), older patients (OR=1.04 per year, 95%CI 1.03-1.04), and patients with more comorbidities (OR=1.11 per Deyo-Charlson point, 95%CI 1.10-1.13), cancer (OR=1.88, 95%CI 1.72-2.06), dementia (OR=2.60, 95%CI 2.29-2.94), higher acute illness severity (OR=1.12 per National Early Warning Score point, 95%CI 1.11-1.14), or prior advance care planning documents (OR=1.18, 95%CI 1.08-1.30). Documentation of these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95%CI 0.75-0.90).

Conclusion: Among hospitalized patients with serious illness, documented goals-of-care discussions identified by NLP were more common among patients with older age and increased burden of acute or chronic illness, and less common among racially or ethnically minoritized patients. This suggests important disparities in goals-of-care discussions.

Keywords: Ethnicity; Goals-of-care discussions; Palliative care; Race; Serious illness.

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Conflict of interest statement

Conflict of Interests: The authors have no financial conflicts of interest.

Figures

**Figure 1.. Timing of Goals-of-Care Discussions during Index Hospitalization^a**
a Graph shows for each day, the volume of discussions that day as a percentage of discussions that occurred during the first 21 days of hospitalization. Discussions occurring during this 3-week period represented 97.3% of all discussions that occurred the hospitalization. An additional 1.8% of the discussions had occurred by Day 35, with 0.8% occurring after day 35 – the latest taking place on Day 216. Of the 5,918 patients who had goals-of-care discussions during the index hospitalization, 3,390 (57.3%) had their initial discussion on Day 1 (i.e., fewer than 24 hours after admission). IQR = 3.

See this image and copyright information in PMC

References

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Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness

Affiliations

Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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