How ICU clinicians document 'Futility': A 10-year analysis of critical care notes using natural language processing...

Area of Science:

• Medical ethics
• Clinical informatics
• Healthcare communication

Background:

• Treatments perceived as futile are common in intensive care units (ICUs), leading to clinician-patient/family conflict.
• A lack of consensus definition for medical futility contributes to its ambiguous and contentious use in clinical documentation.

Purpose of the Study:

• To identify themes associated with mentions of "futility" in intensive care unit (ICU) clinical notes.
• To analyze changes in the frequency of these themes over time.

Main Methods:

• A mixed-methods study analyzed 2,460,169 ICU notes from 2010-2020.
• Neural networks identified terms associated with "futile" or "futility."
• Distributional semantic analysis and regression modeling explored themes and their longitudinal changes.

Main Results:

• Futility mentions were rare (137 unique notes per 100,000 annually) and stable from 2010-2020.
• Eight themes emerged, with "Decision Making" (18%), "Assessing, Prognosticating, and End-of-Life Outcomes" (15%), and "Identifying Sentiments" (13%) being most frequent.
• "Recording Code Status" theme increased significantly from 4% in 2010 to 9% in 2020 (P=.001).

Conclusions:

• The infrequent and stable use of "futility" in ICU notes suggests its consistent, albeit rare, application.
• The heterogeneous contexts of futility mentions indicate varying clinician interpretations.
• Observed theme frequency shifts may reflect evolving clinician perspectives on medical futility, potentially informing interventions for moral distress.