Cited by 3Palliative Care and End-of-Life IssuesElectronic Health Records SystemsNursing Diagnosis and Documentation

Performance of predefined search patterns for identifying documented goals-of-care discussions in inpatient electronic Health records

Open access
Lee, Robert Y., Uyeda, Alison M., Li, Kevin S., Sibley, James, Cohen, Trevor, Lober, William B., Dotolo, Danae G., Engelberg, Ruth A. +1 more·2025·Journal of Palliative Medicine

Abstract

Objective:To characterize the sensitivity and predictive value of predefined search terms for identifying documented goals-of-care discussions in health records of hospitalized patients with serious illness. Methods:We evaluated the performance of 30 previously published and investigator-defined search terms codified into regular expressions (a type of pattern-based text search) in detecting goals-of-care documentation in a 2974-note corpus of electronic health record notes belonging to 159 inpatients enrolled in a U.S. clinical trial over 2020–2021. Results:Compared to conventional chart abstraction, search terms for “goals of care” and synonyms such as “GOC” had poor sensitivity (range: 29.5–38.3%) and modest positive predictive value (PPV; range: 48.3–61.7%) for identifying notes with goals-of-care documentation. Combinations of search terms demonstrated modest performance (sensitivity 62.0%, PPV 59.4%, F1 0.61) but fell short of more complex natural language processing models. Conclusion:In certain contexts, predefined regular-expression-based search terms may have suboptimal sensitivity and predictive value for identifying documented goals-of-care discussions.

Integrity signals

Registry

Crossref · 10.1089/jpm.2024.0496

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Goals-of-care discussions are difficult to measure using rule-based methods.

    “This is especially important for linguistically complex outcomes such as goals-of-care discussions, which are difficult to measure using rule-based methods.12”
  • Goals-of-care discussions are frequently documented in unstructured text such as progress notes or other inconspicuous locations, making historical discussions difficult for clinicians to unearth during clinical care.

    “Additionally, because goals-of-care discussions are frequently documented in unstructured text such as progress notes or other inconspicuous locations, documentation of historical discussions can be difficult for clinicians to unearth during clinical care.12–14”
  • Minor differences in operational definitions (e.g., the inclusion vs. exclusion of routine code status discussions) can lead to important differences in the choice of best measurement tools.

    “Differences in the performance of rule-based methods across these studies12,20 illustrates how minor differences in operational definitions (e.g., the inclusion vs. exclusion of routine code status discussions) can lead to important differences in the choice of best measurement tools.”

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Lee, R. Y., Uyeda, A. M., Li, K. S., Sibley, J., Cohen, T., Lober, W. B., Dotolo, D. G., Engelberg, R. A., & Kross, E. K.
Affiliations
University of Washington (US)
Corresponding author
Lee, Robert Y.
Venue
Journal of Palliative Medicine
Published
2025-07-01
Volume
28
Issue
7
Pages
952-959
ISSN
  • 1096-6218 (ISSN-L)
  • 1557-7740
OpenAlex
W4409171387
Cited by
3
References
26
Citations by year
2026: 2 · 2025: 1
FWCI
2.72
Type
journal article
Language
en
Open access
Locations
  • Journal of Palliative Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (T32HL125195, K23HL161503)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
Keywords
goals of care discussions, electronic health records, text mining, medical records review, hospitalized patients, serious illness, sensitivity and predictive value, palliative care
MeSH terms
Adult, Aged, Aged, 80 and over, Documentation, Female, Humans, Inpatients, Male, Middle Aged, Natural Language Processing, Patient Care Planning, United States, Electronic Health Records

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review