Assessing Perceptions of Positive and Negative Content within Goals of Care Notes.

Context: Clinician documentation of negative content in electronic health record notes is known to exist.

Objectives: To assess community members and clinicians perceptions about negative content within goals of care conversation (GOCC) notes.

Methods: We conducted a mixed-methods study of community member and clinician perspectives about positive, neutral and negative content within GOCC notes written by clinicians across 14 hospitals.

The Influence of Hospital Policies on Clinicians' Decisions to Withhold or Withdraw Life-Sustaining Treatment.

Background: There is considerable variation in clinicians' approaches to decisions to withhold or withdraw life sustaining treatment (LST) across US hospitals. These differences are not explained by patient preferences alone and are likely influenced by other factors (eg, hospital policies, hospital culture, state laws, medical society guidelines).

Research Question: How do hospital policies influence clinician approaches to decisions to withhold or withdraw LST among patients admitted to an ICU?

Study Design And Methods: We conducted semistructured interviews with ICU nurses and physicians at 3 geographically diverse hospital systems across the United States between July and October 2024.

The Impact of the Unknown: Patient Experiences With Uncertainty in Sarcoidosis.

Background: Individuals with sarcoidosis face many sources of illness uncertainty, including diagnostic delays, unpredictable therapeutic efficacy and toxicity, and disease-associated morbidity and mortality. Patient perspectives on illness uncertainty in sarcoidosis have not been evaluated critically and offer an opportunity for providers to contextualize and prioritize gaps in care and patient support.

Research Question: How do patients with sarcoidosis describe their lived experiences with the disease and challenges they face in receiving care?

Study Design And Methods: We conducted semistructured qualitative interviews with patients with biopsy-proven pulmonary sarcoidosis receiving treatment for the disease who were seen at a tertiary sarcoidosis center of excellence.

Consideration of Sociodemographics in Machine Learning-Driven Sepsis Risk Prediction.

Objectives: Use of machine learning (ML) and artificial intelligence (AI) in prediction of sepsis and related outcomes is growing. Guidelines call for explicit reporting of study data demographics and stratified performance analyses to assess potential sociodemographic bias. We assessed reporting of sociodemographic data and other considerations, such as use of stratified analyses or use of so-call "fairness metrics", among AI and ML models in sepsis.

Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study.

Abortion bans enacted by numerous US states between 2022 and 2024 offered little guidance to health care systems on pragmatic implementation. Early studies identified meaningful impacts to obstetric and gynecological patients and clinicians and strategies for institutions to support clinicians in these specialties. There is widespread concern regarding the legal implications of these bans on all specialties, and the impact of institutional responses to abortion bans on clinicians outside of obstetrics and gynecology is unknown.

US Physicians' Perceived Impacts of Abortion Bans in Pulmonary and Critical Care Medicine.

Background: Eighteen US states implemented abortion bans between 2022 and 2024. Although emerging evidence shows bans have impacted obstetrics and gynecology, little is known about their impact on other specialties. We hypothesize that pulmonary and critical care medicine may be adversely impacted due to the time-sensitive, high-acuity needs of their patients.

Health System Purchasing Professionals' Approaches to Considering Equity in Procurement.

Background: Continuing data on racial bias in pulse oximeters and artificial intelligence have sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.

Research Question: How do health care purchasing professionals integrate equity concerns into purchasing decision-making?

Study Design And Methods: Between August 2023 and March 2024, we conducted semistructured interviews via videoconferencing with health care purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns currently are integrated into health care purchasing decision-making.

Ideal Postdischarge Follow-Up After Severe Pneumonia or Acute Respiratory Failure: A Qualitative Study of Primary Care Clinicians in Diverse Settings.

Background: Most patients discharged after hospitalization for severe pneumonia or acute respiratory failure receive follow-up care from primary care clinicians, yet guidelines are sparse.

Research Question: What do primary care clinicians consider to be ideal follow-up care after hospitalization for severe pneumonia or acute respiratory failure and what do they perceive to be barriers and facilitators to providing ideal follow-up?

Study Design And Methods: We conducted, via videoconferencing, semistructured interviews of 20 primary care clinicians working in diverse settings from five US states and Washington, DC. Participants described postdischarge visits, ongoing follow-up, and referrals for patients recovering from hospitalizations for pneumonia or respiratory failure bad enough to be hospitalized and to require significant oxygen support or seeking treatment at the ICU.

Racial, Ethnic, and Socioeconomic Differences in Critical Care Near the End of Life: A Narrative Review.

Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Regional variation in financial hardship among US veterans during the COVID-19 pandemic.

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform.

Inequities in Indirect Cost Rates Between Historically Black Colleges and Universities and Other Institutions.

Purpose: Federal research grants provide support for the indirect costs (IDCs) of research infrastructure that are not specific to particular research projects but are nonetheless essential to enable research. Institutions independently negotiate IDC rates. The authors sought to identify whether inequities exist in negotiated IDC rates between historically Black colleges and universities (HBCUs) and other universities (non-HBCUs).

Whose Good Death? Valuation and Standardization as Mechanisms of Inequality in Hospitals.

Although most clinicians have come to perceive invasive life-sustaining treatments as overly aggressive at the end of life, some of the public and greater proportions of some socially disadvantaged groups have not. Drawing on 1,500+ hours of observation in four intensive care units and 69 interviews with physicians and patients' family members, I find inequality occurs through two mechanisms complementary to the cultural health capital and fundamental causes explanations prevalent in existing health disparities literature: in valuation, as the attitudes and values of the socially disadvantaged are challenged and ignored, and in standardization, as the outcomes preferred by less advantaged groups are defined as inappropriate and made harder to obtain by the informal and formal practices and policies of racialized organizations. I argue inequality is produced in part because wealthier and White elites shape institutional preferences and practices and, therefore, institutions and clinical standards to reflect their cultural tastes.

Interviews with primary care physicians identify unmet transition needs after ICU.

Aim: We sought to explore unmet needs in transitions of care for critical illness survivors that concern primary care physicians.

Findings: Semi-structured interviews with primary care physicians identified three categories of concerns about unmet transition needs after patients' ICU stays: patients' understanding of their ICU stay and potential complications, treatments or support needs not covered by insurance, and starting and maintaining needed rehabilitation and assistance across transitions of care.

Conclusion: Given current constraints of access to coordinated post-ICU care, efforts to identify and address the post-hospitalization needs of critical illness survivors may be improved through coordinated work across the health system.

Hospital Discharge Summaries Are Insufficient Following ICU Stays: A Qualitative Study.

Unlabelled: Primary care providers (PCPs) receive limited information about their patients' ICU stays; we sought to understand what additional information PCPs desire to support patients' recovery following critical illness.

Design: Semistructured interviews with PCPs conducted between September 2020 and April 2021.

Setting: Academic health system with central quaternary-care hospital and associated Veterans Affairs medical center.

Patients' Adaptations After Acute Respiratory Distress Syndrome: A Qualitative Study.

Background: Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery.

Financial Toxicity After Acute Respiratory Distress Syndrome: A National Qualitative Cohort Study.

Objectives: The financial burdens and subsequent related distress of medical care, referred to as financial toxicity, may limit access to beneficial treatments. However, financial toxicity after acute care is less described-and may be an important but underexplored mechanism preventing full recovery after critical illnesses such as acute respiratory distress syndrome. We sought to identify the mechanisms by which financial toxicity manifested in patients with acute respiratory distress syndrome, protective factors against such toxicity, and the consequences of financial toxicity to survivors' lives following acute respiratory distress syndrome.