Abstract

BackgroundHigh quality serious illness communication requires good understanding of patients’ values and beliefs for their treatment at end of life. Natural Language Processing (NLP) offers a reliable and scalable method for measuring and analyzing value- and belief-related features of conversations in the natural clinical setting. We use a validated NLP corpus and a series of statistical analyses to capture and explain conversation features that characterize the complex domain of moral values and beliefs. The objective of this study was to examine the frequency, distribution and clustering of morality lexicon expressed by patients during palliative care consultation using the Moral Foundations NLP Dictionary.MethodsWe used text data from 231 audio-recorded and transcribed inpatient PC consultations and data from baseline and follow-up patient questionnaires at two large academic medical centers in the United States. With these data, we identified different moral expressions in patients using text mining techniques. We used latent class analysis to explore if there were qualitatively different underlying patterns in the PC patient population. We used Poisson regressions to analyze if individual patient characteristics, EOL preferences, religion and spiritual beliefs were associated with use of moral terminology.ResultsWe found two latent classes: a class in which patients did not use many expressions of morality in their PC consultations and one in which patients did. Age, race (white), education, spiritual needs, and whether a patient was affiliated with Christianity or another religion were all associated with membership of the first class. Gender, financial security and preference for longevity-focused over comfort focused treatment near EOL did not affect class membership.ConclusionsThis study is among the first to use text data from a real-world situation to extract information regarding individual foundations of morality. It is the first to test empirically if individual moral expressions are associated with individual characteristics, attitudes and emotions.

Highlights

  • High quality serious illness communication requires good understanding of patients’ values and beliefs for their treatment at end of life

  • The objective of this study is to identify specific moral rhetoric used by patients in palliative care consultations and analyze if emotions, self-reported EOL preferences, religion and spiritual needs are associated with differences in moral expressions

  • Latent class models After identifying how many moral words were being used in the different dimensions of morality and their vice-virtue subcategories, we explored the results of the latent class analysis (LCA)

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Summary

Introduction

High quality serious illness communication requires good understanding of patients’ values and beliefs for their treatment at end of life. Treatments that are inconsistent with patient preferences are associated with some negative outcomes, such as higher healthcare utilization costs [6], lower quality of life, and physical and psychological distress [7]. Some PC research has focused on the relation between underlying factors such as beliefs, norms and values and preferences, sometimes leading to EOL decisions [7,8,9]. Studies found that religion is one factor in a patient’s desire to request lifesustaining treatments even when a palliative care (PC) physician thinks such treatments are ineffective [10, 11]. Spiritual beliefs are often documented in surveys and previous research has already explored the importance of these beliefs in seriously ill, hospitalized populations [8, 12,13,14]

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