The following is a summary of “Predictors of Documented Goals-of-Care Discussion for Hospitalized Patients With Chronic Illness,” published in the MARCH 2023 issue of Pain Management by Uyeda, et al.

The discussion of goals of care is crucial in providing patient-centered care to hospitalized patients with serious illnesses, but there was limited information on when and how often these discussions occur. For a study, researchers sought to examine the occurrence, predictors, and timing of electronic health record (EHR)-documented goals-of-care discussions among hospitalized patients. 

Researchers used natural language processing (NLP) to analyze EHR-documented goals-of-care discussions for adults with chronic life-limiting illnesses or aged≥80 who were hospitalized between 2015-2019. The primary outcome was the identification of documented goals-of-care discussions during hospitalization using NLP. The researchers used multivariable logistic regression to determine the associations between baseline characteristics and documented goals-of-care discussions.

The study’s results showed that out of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization, with approximately 57% occurring within 24 hours of admission. In the multivariable analysis, the documented goals-of-care discussions were more common among women (odds ratio [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). However, documenting these discussions was less common for racially or ethnically minoritized patients (OR=0.823, 95% CI 0.75-0.90).

In conclusion, the study suggested that there were significant disparities in goals-of-care discussions among hospitalized patients with serious illnesses. NLP-identified documented goals-of-care discussions were more common among patients with older age and increased burden of acute or chronic illness, but less common among racially or ethnically minoritized patients.

Reference: jpsmjournal.com/article/S0885-3924(22)00973-3/fulltext