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Disparities in Advance Care Planning: Gaps in Clinical Notes on Comfort VS. Life-Sustaining Treatment Preferences
Abstract   Open access   Peer reviewed

Disparities in Advance Care Planning: Gaps in Clinical Notes on Comfort VS. Life-Sustaining Treatment Preferences

Yuwen Ji, Alaa Albashayreh and Stephanie Gilbertson-White
Innovation in aging, Vol.9(Supplement_2)
12/01/2025
DOI: 10.1093/geroni/igaf122.3571
PMCID: PMC12763772
url
https://doi.org/10.1093/geroni/igaf122.3571View
Published (Version of record) Open Access

Abstract

Background Goal-concordant care is essential, yet disparities in advance care planning (ACP) persist. Electronic health record (EHRs) documentation of specific preferences, such as comfort and life-sustaining treatments (LST) and natural language processing (NLP) to extract free-text data, provides real-world information to explore patterns. Objective To identify predictors associated with documentation of specific preferences in a cohort of older adults with chronic conditions. Methods In a dataset of records from 14,729 older adults with heart failure, cancer, or dementia from a large academic medical center, we used a validated NLP model, Priorities-BERT (accuracy= 90.91%), to categorize documented care preferences from 3.6 million EHR notes into four groups: comfort-only, LST-only, mixed, or none. Logistic regression identified factors associated with each preference category (vs. no preference). Results The mean age of the sample was 78.67 years (SD = 6.05). Female patients (vs. male) (OR = 1.11, 95% CI: 1.04–1.19), heart failure (OR =1.59, 95% CI: 1.34–1.89), dementia (OR = 1.33, 95%CI: 1.25-1.43), were associated with higher odds of having any priorities of care documented. Increasing age was associated with lower odds of LST (OR = 0.94, 95%CI: 0.94-0.95). Patients with heart failure (OR = 1.50, 95%CI: 1.39-1.61) or dementia (OR = 1.56, 95% CI: 1.42-1.71) were more likely to have comfort preferences documented. Conversely, cancer patients were more likely to have LST documented (OR = 1.12, 95%CI: 1.03-1.21). Conclusion Significant disparities existed across these three diagnoses in documentation ACP preferences. Targeted clinical and health-system interventions are needed to promote equitable and timely ACP conversations for patients likely to benefit from this care.
 Dementia Electronic Health Records Heart Failure Older People Advance directives Documentation Natural language processing Preferences

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