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

Hospitalized patients with serious illnesses need goals-of-care conversations. There needs to be more data on these discussions’ occurrence, predictors, and timing. To examine hospitalised patients’ EHR-documented goals-of-care discussions, predictors, and timing. This retrospective cohort study used natural language processing (NLP) to analyze EHR-documented goals-of-care discussions for adults with a chronic life-limiting illness or age  ≥80 hospitalized 2015–2019. NLP-identified goals-of-care discussion during index hospitalization was the main outcome. Multivariable logistic regression assessed baseline associations.

Nearly 5,918 (36.4%) of 16,262 consecutive, eligible patients without missing data had a documented goals-of-care discussion during hospitalization, 57% within 24 hours of admission. In multivariable analysis, documented goals-of-care discussions were more common in 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 Racial and ethnic minority patients documented these discussions less often (OR=0.823, 95%CI 0.75-0.90). 

In hospitalized patients with serious illnesses, NLP-identified goals-of-care discussions were more common in older patients with more acute or chronic illnesses and less common in racially or ethnically minority patients. This suggests significant goals-of-care differences.