Academic Journal
How ICU clinicians document 'Futility': A 10-year analysis of critical care notes using natural language processing notes.
| Τίτλος: | How ICU clinicians document 'Futility': A 10-year analysis of critical care notes using natural language processing notes. |
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| Συγγραφείς: | Brender TD; Hospital Medicine Section, San Francisco VA Health Care System, San Francisco, CA, United States of America; Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States of America., Stumpf N; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Stanford University, Stanford, CA, United States of America., Vossler K; Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States of America., Kim S; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Stanford University, Stanford, CA, United States of America., Mills H; Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States of America., Lee A; Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States of America., Yang HY; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America., Heintz T; Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America., Espejo E; Division of Geriatrics, University of California, San Francisco, San Francisco, CA, United States of America., Boscardin J; Division of Geriatrics, University of California, San Francisco, San Francisco, CA, United States of America., Pantilat S; Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America., Chapman AC; Department of Medicine, the Division of Critical Care and Palliative Medicine, University of California, San Francisco, San Francisco, CA, United States of America; Department of Surgery, University of California, San Francisco, San Francisco, CA, United States of America., Widera E; Division of Geriatrics, University of California, San Francisco, San Francisco, CA, United States of America; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States of America., Smith AK; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States of America., Cobert J; Anesthesia Service, San Francisco VA Health Care System, University of California, San Francisco, San Francisco, CA, United States of America; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States of America. Electronic address: Julien.cobert@ucsf.edu. |
| Πηγή: | Journal of critical care [J Crit Care] 2026 Aug; Vol. 94, pp. 155526. Date of Electronic Publication: 2026 Mar 23. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: W.B. Saunders Country of Publication: United States NLM ID: 8610642 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8615 (Electronic) Linking ISSN: 08839441 NLM ISO Abbreviation: J Crit Care Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia Pa : W.B. Saunders Original Publication: Orlando, FL : Grune & Stratton, c1986- |
| Ιατρικοί όροι (MeSH): | Medical Futility* , Natural Language Processing* , Intensive Care Units* , Critical Care*, Humans |
| Περίληψη: | Background: ICU patients frequently receive treatments clinicians perceive are futile which can cause conflict between clinicians, patients and families. Medical futility lacks a consensus definition, yet this ambiguous and contentious term is used in medical notes. Research Question: What themes are associated with futility mentions in ICU notes? How have themes' frequencies changed over time? Study Design/methods: Mixed methods study of ICU notes (e.g., H&P, progress notes) written by clinicians (e.g., physicians, nurses) for adult patients at a large hospital system from 2010 to 2020. Neural network models identified terms most associated with "futile" or "futility." Distributional semantic analysis grouped terms into themes. Regression modeling explored longitudinal changes in themes' frequencies. Results: Across 2,460,169 notes for 9912 patients, the annual average count of unique notes with futility mentions was 137 per 100,000 and unchanged from 2010 to 2020. 8 themes were identified among terms most associated with the words "futile" or "futility." The most represented themes were Decision Making (annual average 18% [95% CI: 16%-19%]), Assessing, Prognosticating, and End-of-Life Outcomes (15%, 13%-16%), and Identifying Sentiments (13%, 10%-15%). Recording Code Status was the least represented theme in 2010 (4%) and increased over time (9% in 2020, P = 0.001). Interpretation: Use of futility was rare and stable across a decade of ICU notes. Semantic analysis indicates clinicians use futility in heterogeneous contexts. Changes in themes' frequencies may reflect clinicians' evolving conceptions of medical futility. These findings could guide development of EHR-based interventions to address perceived futile treatments which contribute to clinicians' moral distress. (Published by Elsevier Inc.) |
| Competing Interests: | Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Julien Cobert reports financial support was provided by National Institute on Aging. Alex Smith reports financial support was provided by National Institute on Aging. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Critical care; Ethics; Futility; Linguistics; Machine learning; Natural language processing |
| Entry Date(s): | Date Created: 20260324 Date Completed: 20260610 Latest Revision: 20260610 |
| Update Code: | 20260611 |
| DOI: | 10.1016/j.jcrc.2026.155526 |
| PMID: | 41875516 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1557-8615 |
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| DOI: | 10.1016/j.jcrc.2026.155526 |