Natural language processing and network analysis in patients withdrawing from life-sustaining treatments: a retrospective cohort study

BMC Palliative Care

Research Article

Shao-Yi Cheng¹  Jaw-Shiun Tsai¹  Tai-Yuan Chiu¹  Wei-Chin Tsai²  Kuang-Cheng Kuo³  Hsien-Liang Huang⁴  Yun-Cheng Tsai⁵ 

[1] Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, 100, Taipei, Taiwan (R.O.C.);Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., North Dist., 300, Hsinchu City, Taiwan (R.O.C.);Department of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan (R.O.C.);Department of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan (R.O.C.);Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, 7 Chung-Shan South Road, 100, Taipei, Taiwan (R.O.C.);Department of Technology Application and Human Resource Development, National Taiwan Normal University, 162, Section 1, Heping E. Rd., 106, Taipei City, Taiwan (R.O.C.);

关键词: Withdrawing treatment;    Palliative care;    Natural language processing;    Terminal care;    Hospice care;   

DOI  :  10.1186/s12904-022-01119-8

 received in 2022-03-27, accepted in 2022-12-07,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundProviding palliative care to patients who withdraw from life-sustaining treatments is crucial; however, delays or the absence of such services are prevalent. This study used natural language processing and network analysis to identify the role of medications as early palliative care referral triggers.MethodsWe conducted a retrospective observational study of 119 adult patients receiving specialized palliative care after endotracheal tube withdrawal in intensive care units of a Taiwan-based medical center between July 2016 and June 2018. Patients were categorized into early integration and late referral groups based on the median survival time. Using natural language processing, we analyzed free texts from electronic health records. The Palliative trigger index was also calculated for comparison, and network analysis was performed to determine the co-occurrence of terms between the two groups.ResultsBroad-spectrum antibiotics, antifungal agents, diuretics, and opioids had high Palliative trigger index. The most common co-occurrences in the early integration group were micafungin and voriconazole (co-correlation = 0.75). However, in the late referral group, piperacillin and penicillin were the most common co-occurrences (co-correlation = 0.843).ConclusionTreatments for severe infections, chronic illnesses, and analgesics are possible triggers for specialized palliative care consultations. The Palliative trigger index and network analysis indicated the need for palliative care in patients withdrawing from life-sustaining treatments. This study recommends establishing a therapeutic control system based on computerized order entry and integrating it into a shared-decision model.

【 授权许可】

CC BY   
© The Author(s) 2022

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