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Lexical associations can characterize clinical documentation trends related to palliative care and metastatic cancer.

作者信息

Yang Hao Yuan, Raghunathan Karthik, Widera Eric, Pantilat Steven Z, Brender Teva, Heintz Timothy A, Espejo Edie, Boscardin John, Mills Hunter, Lee Albert, Berchuck Jacob, Cobert Julien

机构信息

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.

Department of Anesthesia and Perioperative Care, Duke University, Durham, NC, USA.

出版信息

Sci Rep. 2025 May 18;15(1):17245. doi: 10.1038/s41598-025-01828-z.


DOI:10.1038/s41598-025-01828-z
PMID:40383724
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12086223/
Abstract

Palliative care is known to improve quality of life in advanced cancer. Natural language processing offers insights to how documentation around palliative care in relation to metastatic cancer has changed. We analyzed inpatient clinical notes using unsupervised language models that learn how words related to metastatic cancer (e.g. "mets", "metastases") and palliative care (e.g. "palliative care", "pal care") appear relationally and change over time. We included any note from adults hospitalized at the University of California, San Francisco system. The primary outcome was how similarly terms related to metastatic cancer and palliative care appeared in notes using a mathematical approach (cosine similarity). We used word2vec to model language numerically as vectors. Relational data between vectors was captured using cosine similarity. We performed linear regression to identify changes in these relationships of terms over time. As a sensitivity analysis, we performed the same analysis per year restricted only to patients with an ICD-9/10 diagnosis code for metastatic cancer. Metastatic cancer and palliative care terms appeared in similar contexts in clinical notes each year, suggesting a close relationship in documentation. However, over time, this relationship weakened, with these terms becoming less commonly used together as measured by cosine similarities. We found similar trends when we retrained models just on patients with a diagnosis code for metastatic cancer. Text in clinical notes offers unique insights into how medical providers document palliative care in patients with advanced malignancies and how these documentation practices evolve over time.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/12086223/c2874dd151a7/41598_2025_1828_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/12086223/b421c1635f0f/41598_2025_1828_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/12086223/c2874dd151a7/41598_2025_1828_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/12086223/b421c1635f0f/41598_2025_1828_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/12086223/c2874dd151a7/41598_2025_1828_Fig2_HTML.jpg

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Lexical associations can characterize clinical documentation trends related to palliative care and metastatic cancer.

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本文引用的文献

[1]
"My Mom Is a Fighter": A Qualitative Analysis of the Use of Combat Metaphors in ICU Clinician Notes.

Chest. 2024-11

[2]
Palliative Care for Patients With Cancer: ASCO Guideline Update.

J Clin Oncol. 2024-7-1

[3]
Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study.

J Cancer Res Clin Oncol. 2024-4-12

[4]
Do goals of care documentation reflect the conversation?: Evaluating conversation-documentation accuracy.

J Am Geriatr Soc. 2024-8

[5]
Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19.

JAMA Netw Open. 2024-2-5

[6]
The impact of cancer metastases on COVID-19 outcomes: A COVID-19 and Cancer Consortium registry-based retrospective cohort study.

Cancer. 2024-6-15

[7]
Measuring Implicit Bias in ICU Notes Using Word-Embedding Neural Network Models.

Chest. 2024-6

[8]
A certified de-identification system for all clinical text documents for information extraction at scale.

JAMIA Open. 2023-7-4

[9]
Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review.

Support Care Cancer. 2022-12

[10]
"Note Bloat" impacts deep learning-based NLP models for clinical prediction tasks.

J Biomed Inform. 2022-9

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