Study protocol for Video Images about Decisions to Improve Ethical Outcomes with Palliative Care Educators (VIDEO-PCE): a pragmatic stepped wedge cluster randomised trial of older patients admitted to the hospital

Abstract

Introduction Despite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams, contribute to this lack of communication. To address this gap, we designed an intervention to promote goals-of-care conversations and palliative care referrals in the hospital setting by using trained palliative care educators and video decision aids. This paper presents the rationale, design and methods for a trial aimed at addressing barriers to goals-of-care conversations for hospitalised adults aged 65 and older and those with Alzheimer’s disease and related Dementias, regardless of age. Methods and analysis The Video Image about Decisions to Improve Ethical Outcomes with Palliative Care Educators is a pragmatic stepped wedge, cluster randomised controlled trial, which aims to improve and extend goals-of-care conversations in the hospital setting with palliative care educators trained in serious illness communication and video decision aids. The primary outcome is the proportion of patients with goals-of-care documentation in the electronic health record. We estimate that over 9000 patients will be included. Ethics and dissemination The Institutional Review Board (IRB) at Boston Medical Center will serve as the single IRB of record for all regulatory and ethical aspects of this trial. BMC Protocol Number: H-41482. Findings will be presented at national meetings and in publications. This trial is registered at ClinicalTrials.gov. Trial registration number NCT04857060 ; ClinicalTrials.gov

The use of natural language processing in palliative care research: A scoping review

“…Clinical notes and electronic medical records were the most common primary data sources, used in 57 studies (69.5%). 21,23–27,29,30,33–36,40,42–46,48–52,54,55,57–64,66–68,70–73,75,79–93,95 Other primary sources included audio recordings ( n = 6, 7.3%), 6,28,32,38,39,65 administrative data ( n = 5, 6.1%), 37,47,53,77,...…”

“…These applications offer the possibility of several toolkits for natural language processing and also the possibility to develop codes based on the researchers' needs. Another interesting finding was that many of the studies used a combination of more than one 27 Elhazmi et al, 33 Ganguli et al, 36 George et al, 37 Hu et al, 44 Kehl et al, 48 Laios et al, 50 Lin et al, 57 Manz et al, 66 Agarwal et al, 74 Santos et al, 77 Sung et al, 82 Ye et al 93 Assessment of the impact of interventions 9 (10.9) Ando et al, 22 Greer et al, 42 Lakin et al, 51 Lefèvre et al, 56 Macieira et al, 64 Santarpia et al, 76 Steiner et al, 80 Udelsman et al, 87 Uyeda et al 89 Social and spiritual health 8 (9.7) Gray et al, 40 Johnson et al, 46,47 Masukawa et al, 67 Yoon et al, 94 Ando et al, 96 Ando et al 99 Topic identification 8 (9.7) Sarmet et al, 5 Ando et al, 21 Chan et al, 26 Davoudi et al, 29 Agaronnik et al, 52 Lucini et al, 61 Seale et al, 78 Wang et al 90 Advance care planning/EOL process measures/Code-status clarification/Goals of care documentation 8 (9.7)…”

“…100 It was the most frequently used single natural language processing software among the included studies in this review (~17%), particularly by the same research group (Lindvall et al). 25,40,42,47,51,52,54,58,59,63,71,[86][87][88] ClinicalRegex is implemented through Python using a Model View Controller architecture, which is common to graphical user interface (GUI) programs, 101 and leverages Tkinter, a GUI Python package. It is compatible with Research Patient Data Registry, the file format used by Partners HealthCare to deliver data, and there is also functionality for rudimentary user annotation of the clinical notes.…”

“…Clinical notes and electronic medical records were the most common primary data sources, used in 57 studies (69.5%). 21,[23][24][25][26][27]29,30,[33][34][35][36]40,[42][43][44][45][46][48][49][50][51][52]54,55,[57][58][59][60][61][62][63][64][66][67][68][70][71][72][73]75,[79][80][81][82][83][84][85][86][87][88][89]…”

Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults

“…The PCEs were social workers and nurses hired to coordinate with the palliative care team at each site and who received VitalTalk communication skills training via a highly structured series of video conferences. 27 Each morning, a list of eligible patients for intervention units was generated by each site's clinical data warehouse and provided to the PCEs, who used their clinical judgment to triage which patients they would engage. Newly admitted patients without documented GOC discussions were prioritized over patients with documented GOC recorded prior to the start of the intervention.…”