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

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. To examine the occurrence, predictors, and timing of electronic health record (EHR)-docum...

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Published in:Journal of pain and symptom management Vol. 65; no. 3; pp. 233 - 241
Main Authors: Uyeda, Alison M., Lee, Robert Y., Pollack, Lauren R., Paul, Sudiptho R., Downey, Lois, Brumback, Lyndia C., Engelberg, Ruth A., Sibley, James, Lober, William B., Cohen, Trevor, Torrence, Janaki, Kross, Erin K., Curtis, J. Randall
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.03.2023
Subjects:
Adult
Advance Care Planning
Anesthesia
Chronic Disease
Ethnicity
Female
Goals
Goals-of-care discussions
Humans
Pain Medicine
Palliative care
Race
Retrospective Studies
Serious illness
Terminal Care
Palliative care
Goals-of-care discussions
Serious illness
Ethnicity
Race
ISSN:0885-3924, 1873-6513, 1873-6513
Online Access:Get full text
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Summary: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. To examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions for hospitalized patients. 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. 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). 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.
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ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2022.11.012