Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX.
Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX.
Chest. 2022 Jun;161(6):1609-1619. doi: 10.1016/j.chest.2022.01.023. Epub 2022 Jan 22.
The COVID-19 pandemic has presented new challenges surrounding end-of-life planning and has been associated with increased online discussion about life support.
How has online communication about advance care planning (ACP) and specific life-sustaining interventions (LSIs) changed during the pandemic?
Conversations on Twitter containing references to LSIs (eg, "ECMO") or ACP (eg, "DNR/DNI") were collected between January 2019 and May 2021. User account metadata were used to predict user demographic information and to classify users as organizations, individuals, clinicians, or influencers. The number of impressions was compared across these user categories and the content of tweets analyzed by using natural language processing models to identify topics of discussion and associated emotional sentiment.
There were 202,585 unique tweets about LSIs and 67,162 unique tweets about ACP. Users who were younger, male, or influencers were more likely to discuss LSIs online. Tweets about LSIs were associated with more positive emotional sentiment scores than tweets about ACP (LSIs, 0.3; ACP, -0.2; P < .001). Among tweets about ACP, most contained personal experiences related to the death of loved ones (27%) or discussed discrimination through do-not-resuscitate orders directed at the elderly and disabled (19%). Personal experiences had the greatest retweet-to-tweet-ratio (4.7), indicating high levels of user engagement. Tweets about discrimination contained the most negative net sentiment score (-0.5).
The observed increase in tweets regarding LSIs and ACP suggests that Twitter was consistently used to discuss treatment modalities and preferences related to intensive care during the pandemic. Future interventions to increase online engagement with ACP may consider leveraging influencers and personal stories. Finally, we identified do-not-resuscitate-related discrimination as a commonly held public fear, which should be further explored as a barrier to ACP completion and can be proactively addressed by clinicians during bedside goals-of-care discussions.
COVID-19 大流行带来了围绕临终规划的新挑战，并与有关生命支持的在线讨论增加有关。
大流行期间，关于预先护理计划（ACP）和特定生命维持干预措施（LSI）的在线沟通方式发生了哪些变化？
收集了 2019 年 1 月至 2021 年 5 月期间在 Twitter 上包含 LSI（例如“ECMO”）或 ACP（例如“DNR/DNI”）引用的对话。用户帐户元数据用于预测用户的人口统计信息，并将用户分类为组织、个人、临床医生或影响者。对这些用户类别之间的印象数量进行了比较，并通过使用自然语言处理模型分析推文的内容来识别讨论的主题和相关的情感情绪。
有 202585 条关于 LSI 的独特推文和 67162 条关于 ACP 的独特推文。年轻、男性或有影响力的用户更有可能在网上讨论 LSI。关于 LSI 的推文与关于 ACP 的推文相比，具有更积极的情感情绪评分（LSIs，0.3；ACP，-0.2；P<0.001）。在关于 ACP 的推文中，大多数包含与亲人死亡有关的个人经历（27%）或讨论了针对老年人和残疾人的不复苏命令的歧视（19%）。个人经历的转发率最高（4.7），表明用户参与度很高。关于歧视的推文包含最负面的净情绪评分（-0.5）。
关于 LSI 和 ACP 的推文数量增加表明，在大流行期间，Twitter 一直被用于讨论与重症监护相关的治疗方式和偏好。未来增加对 ACP 的在线参与的干预措施可能需要利用有影响力的人和个人故事。最后，我们确定了与不复苏相关的歧视是一个普遍存在的公众担忧，这应该进一步探讨，作为 ACP 完成的障碍，并可以由临床医生在床边治疗目标讨论中主动解决。
Zotero 插件
