Natural Language Processing to Assess End-of-Life Quality Indicators in Cancer Patients Receiving Palliative Surgery

Objective Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods. Materials and Methods This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes. Results For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839). Discussion Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction. Conclusions Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians’ and nurses’ notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.

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“… 10 Free-text data represent 70% to 80% of all data in EHRs and often provide more contextual information than structured data. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

Huang

Gray

Romero-Brufau

et al. 2021

Journal of the American Medical Informatics Association

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“…Our NLP software, ClinicalRegex, identifies predefined keywords or phrases within clinical notes, considering varieties in language and punctuation. 80–82 ClinicalRegex also allows for rapid semiautomated review that ensures that keywords have not been taken out of context. For each NLP process (ie, goals-of-care discussion), we have built a keyword library that identifies relevant documentation within clinical notes.…”

Section: Methodsmentioning

confidence: 99%

Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP-PEACE): the study protocol for a pragmatic stepped-wedge trial of older patients with cancer

et al. 2020

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IntroductionAdvance care planning (ACP) is associated with improved health outcomes for patients with cancer, and its absence is associated with unfavourable outcomes for patients and their caregivers. However, older adults do not complete ACP at expected rates due to patient and clinician barriers. We present the original design, methods and rationale for a trial aimed at improving ACP for older patients with advanced cancer and the modified protocol in response to changes brought by the COVID-19 pandemic.Methods and analysisThe Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly study is a pragmatic, stepped-wedge cluster randomised trial examining a Comprehensive ACP Program. The programme combines two complementary evidence-based interventions: clinician communication skills training (VitalTalk) and patient video decision aids (ACP Decisions). We will implement the programme at 36 oncology clinics across three unique US health systems. Our primary outcome is the proportion of eligible patients with ACP documentation completed in the electronic health record. Our secondary outcomes include resuscitation preferences, palliative care consultations, death, hospice use and final cancer-directed therapy. From a subset of our patient population, we will collect surveys and video-based declarations of goals and preferences. We estimate 11 000 patients from the three sites will be enrolled in the study.Ethics and disseminationRegulatory and ethical aspects of this trial include Institutional Review Board (IRB) approval via single IRB of record mechanism at Dana-Farber Cancer Institute, Data Use Agreements among partners and a Data Safety and Monitoring Board. We plan to present findings at national meetings and publish the results.Trial registration numberNCT03609177; Pre-results.

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“…For instance, at one institution, among patients receiving gastrostomy tubes, 90% died in the hospital or were severely disabled on discharge, but only 12% of those patients received a documented goals of care assessment prior to the procedure. Another institution with a 68% rate of documented goals of care discussions in patients undergoing gastrostomy tube placement, only 20% of those discussions occurred pre-procedure (53). Given the risks and discomfort involved in palliative surgical procedures, it is important that goals of care discussions precede any procedural intervention.…”

Section: What Surgeons Can Bring To the Palliative Care Teammentioning

confidence: 99%

Palliative surgery and the surgeon’s role in the palliative care team: a review

Louie¹,

Miner²

2022

Ann Palliat Med

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This review focuses on the role of palliative surgery in the care of the palliative care patient, and the appropriate role of the surgeon. The surgeon has much to bring to the palliative care team. The surgeon's role goes beyond the technical requirements of the palliative procedure, which itself must be strictly defined, and has recognized utility for improving quality of life in selected patients. These benefits may be substantial, but come at significant risk; requiring careful balancing of risks and benefits that is most completely understood by the surgeon. The surgeon's judgement can help determine which procedure best meets a patient's goals. The complex dialogue involved in the decision to undergo a palliative operation requires excellent communication between the palliative care team, the patient, and their family. Integrating the surgeon into the palliative care team could help with earlier initiation of those palliative discussions, and assist deliberation of palliative surgery. Surgeons also understand the importance of communication around palliative surgical interventions and have adapted several teaching models to the specifics of this crucial communication. A palliative team combining both surgeons and palliative care physicians may promote goalconcordant decision-making and remove barriers to communication and team engagement. The future of palliative surgery research will involve measures of success that go beyond physiology or mortality, to include more evaluations of communication and patient goals.

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Natural Language Processing to Assess End-of-Life Quality Indicators in Cancer Patients Receiving Palliative Surgery

Cited by 80 publications

References 14 publications

Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP-PEACE): the study protocol for a pragmatic stepped-wedge trial of older patients with cancer

Palliative surgery and the surgeon’s role in the palliative care team: a review

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