From the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts (SGW); Harvard Medical School, Boston, Massachusetts (SGW, LZ, DBH, CPR, SEW); Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (YCL, LZ); Mass General Brigham, Enterprise Analytics, Boston, Massachusetts (ADC, AN); Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts (CPR); Department of Medicine, Massachusetts General Hospital, Boston, MA (SEW); and Mass General Brigham, Office of the Chief Medical Officer, Boston, Massachusetts (SEW).
J Addict Med. 2023;17(4):424-430. doi: 10.1097/ADM.0000000000001145. Epub 2023 Jan 31.
The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient- and provider-level differences.
All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context.
There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98).
The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.
用于描述物质使用障碍患者的语言会影响污名化程度，并影响临床决策。本研究评估了临床记录中是否存在污名化语言（SL），并检测了患者和提供者层面的差异。
纳入了 2020 年 12 月至 2021 年 11 月期间，在一个大型医疗系统中与物质相关诊断相关的所有患者的所有自由文本记录。开发了一种自然语言处理算法，使用国家药物滥用研究所的“用词很重要”清单来识别上下文语境中的 SL 使用情况。
共 30391 名患者的 546309 份记录中，有 100792 份（18.4%）包含 SL。共有 18727 名患者（61.6%）至少有一份包含 SL 的记录。使用最频繁的 SL 是“滥用”和“物质滥用”。护士使用 SL 的可能性最低（4.1%），而医师助理使用 SL 的可能性最高（46.9%）。与女性患者相比，男性患者的记录中更有可能出现 SL（调整后的优势比[aOR]，1.17；95%置信区间[CI]，1.11-1.23），年龄在 18 至 24 岁的年轻患者比年龄在 45 至 54 岁的患者出现 SL 的可能性更小（aOR，0.55；95%CI，0.50-0.61），亚裔患者比白人患者出现 SL 的可能性更小（aOR，0.45；95%CI，0.36-0.56），而西班牙裔患者比非西班牙裔患者出现 SL 的可能性更小（aOR，0.88；95%CI，0.80-0.98）。
大多数物质相关诊断患者的记录中至少有一份包含 SL。患者记录中出现 SL 还与一些患者特征差异相关。这项工作表明，需要更多关于 SL 使用的临床干预。
