A qualitative analysis of stigmatizing language in birth admission clinical notes

Barcelona, Veronica; Scharp, Danielle; Idnay, Betina; Moen, Hans; Goffman, Dena; Cato, Kenrick; Topaz, Maxim

doi:10.1111/nin.12557

Cited by 12 publications

(4 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are consistent with others who have documented that physicians communicate in the EHR differently (more negatively) when caring for patients from some minority groups [9,17], which may ultimately result in adverse and inequitable health outcomes for patients. Our results also align with other papers that found that stigmatizing language is more commonly used in EHRs for minorities [39][40][41][42][43]. Those papers used language guidelines [39] and experts [40] to identify stigmatizing language.…”

Section: Discussionsupporting

confidence: 90%

Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis

Bilotta,

Tonidandel,

Liaw

et al. 2024

JMIR Med Inform

View full text Add to dashboard Cite

Background Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias. Objective We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias. Methods In this cross-sectional study, we extracted EHR notes for patients who were aged 18 years or older; had more than 5 years of diabetes diagnosis codes; and received care between 2006 and 2014 from family physicians, general internists, or endocrinologists practicing in an urban, academic network of clinics. The race and ethnicity of patients were defined as White non-Hispanic, Black non-Hispanic, or Hispanic or Latino. We hypothesized that Sentiment Analysis and Social Cognition Engine (SEANCE) components (ie, negative adjectives, positive adjectives, joy words, fear and disgust words, politics words, respect words, trust verbs, and well-being words) and mean word count would be indicators of bias if racial differences emerged. We performed linear mixed effects analyses to examine the relationship between the outcomes of interest (the SEANCE components and word count) and patient race and ethnicity, controlling for patient age. To validate this approach, we asked clinicians to indicate the extent to which they thought variation in the use of SEANCE language domains for different racial and ethnic groups was reflective of bias in EHR notes. Results We examined EHR notes (n=12,905) of Black non-Hispanic, White non-Hispanic, and Hispanic or Latino patients (n=1562), who were seen by 281 physicians. A total of 27 clinicians participated in the validation study. In terms of bias, participants rated negative adjectives as 8.63 (SD 2.06), fear and disgust words as 8.11 (SD 2.15), and positive adjectives as 7.93 (SD 2.46) on a scale of 1 to 10, with 10 being extremely indicative of bias. Notes for Black non-Hispanic patients contained significantly more negative adjectives (coefficient 0.07, SE 0.02) and significantly more fear and disgust words (coefficient 0.007, SE 0.002) than those for White non-Hispanic patients. The notes for Hispanic or Latino patients included significantly fewer positive adjectives (coefficient −0.02, SE 0.007), trust verbs (coefficient −0.009, SE 0.004), and joy words (coefficient −0.03, SE 0.01) than those for White non-Hispanic patients. Conclusions This approach may enable physicians and researchers to identify and mitigate bias in medical interactions, with the goal of reducing health disparities stemming from bias.

show abstract

Section: Discussionsupporting

confidence: 90%

Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis

Bilotta,

Tonidandel,

Liaw

et al. 2024

JMIR Med Inform

View full text Add to dashboard Cite

show abstract

“…In this paper, we, therefore, zoom in on how members of executive hospital boards (hereafter: board member(s)) and nurses use talk as a relational dance of positions in times of crisis. Although the importance of talk has been acknowledged for frontline nursing work (Barcelona et al, 2023;Dahlke & Hunter, 2020;Lopez-Deflory et al, 2023b;Marey-Sarwan et al, 2022) it seems overlooked in the nursing leadership and governance literature (see Cummings et al, 2021;Kanninen et al, 2021). However, Verhoeven et al (2023) showed that such a discursive leadership perspective can be supportive for comprehending the relational processes and interdependencies between board members and nurses.…”

Section: Introductionmentioning

confidence: 99%

Board talk: How members of executive hospital boards influence the positioning of nursing in crisis through talk

Verhoeven,

Marres,

van de Loo

et al. 2023

Nursing Inquiry

View full text Add to dashboard Cite

Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk—as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.

show abstract

“…Recent research has begun to qualitatively examine stigmatizing language in the EHR in pregnancy and birth settings. 23 Stigmatizing language use hinders the development of authentic relationships between pregnant people and clinicians, contributing to inequity. The relationship-centered care framework 24 describes four principles to improve clinical relationships: 1) clinicians should acknowledge each person's uniqueness and life experiences, with a focus on internal and externally expressed authenticity; 2) clinicians should use empathy instead of a detached or neutral approach to people seeking care and demonstrate empathy through their affect and emotion; 3) relationships require reciprocal influence and can benefit both the person seeking care and the clinician; and 4) there is a moral basis to relationships between people seeking care and clinicians centering genuine relationships between humans.…”

mentioning

confidence: 99%

“…Recent research has begun to qualitatively examine stigmatizing language in the EHR in pregnancy and birth settings. 23 …”

mentioning

confidence: 99%

The Power of Language in Hospital Care for Pregnant and Birthing People

Barcelona,

Horton,

Rivlin

et al. 2023

Obstetrics &Amp; Gynecology

Self Cite

View full text Add to dashboard Cite

Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.

show abstract

A qualitative analysis of stigmatizing language in birth admission clinical notes

Cited by 12 publications

References 54 publications

Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis

Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis

Board talk: How members of executive hospital boards influence the positioning of nursing in crisis through talk

The Power of Language in Hospital Care for Pregnant and Birthing People

Contact Info

Product

Resources

About