Chest ( IF 9.5 ) Pub Date : 2022-01-22 , DOI: 10.1016/j.chest.2022.01.023 Vishal R Patel 1 , Sofia Gereta 1 , Christopher J Blanton 1 , Alexander L Chu 1 , Akash P Patel 1 , Michael Mackert 2 , David Zientek 1 , Nico Nortjé 3 , Anjum Khurshid 4 , Christopher Moriates 1 , Gregory Wallingford 5
|
Background
The COVID-19 pandemic has presented new challenges surrounding end-of-life planning and has been associated with increased online discussion about life support.
Research Question
How has online communication about advance care planning (ACP) and specific life-sustaining interventions (LSIs) changed during the pandemic?
Study Design and Methods
Conversations on Twitter containing references to LSIs (eg, “ECMO”) or ACP (eg, “DNR/DNI”) were collected between January 2019 and May 2021. User account metadata were used to predict user demographic information and to classify users as organizations, individuals, clinicians, or influencers. The number of impressions was compared across these user categories and the content of tweets analyzed by using natural language processing models to identify topics of discussion and associated emotional sentiment.
Results
There were 202,585 unique tweets about LSIs and 67,162 unique tweets about ACP. Users who were younger, male, or influencers were more likely to discuss LSIs online. Tweets about LSIs were associated with more positive emotional sentiment scores than tweets about ACP (LSIs, 0.3; ACP, –0.2; P < .001). Among tweets about ACP, most contained personal experiences related to the death of loved ones (27%) or discussed discrimination through do-not-resuscitate orders directed at the elderly and disabled (19%). Personal experiences had the greatest retweet-to-tweet-ratio (4.7), indicating high levels of user engagement. Tweets about discrimination contained the most negative net sentiment score (–0.5).
Interpretation
The observed increase in tweets regarding LSIs and ACP suggests that Twitter was consistently used to discuss treatment modalities and preferences related to intensive care during the pandemic. Future interventions to increase online engagement with ACP may consider leveraging influencers and personal stories. Finally, we identified do-not-resuscitate-related discrimination as a commonly held public fear, which should be further explored as a barrier to ACP completion and can be proactively addressed by clinicians during bedside goals-of-care discussions.
中文翻译：
在 COVID-19 大流行期间对生命支持和预先护理计划的看法
背景
COVID-19 大流行对临终计划提出了新的挑战，并与有关生命支持的在线讨论增加有关。
研究问题
在大流行期间，有关预先护理计划 (ACP) 和特定生命维持干预措施 (LSI) 的在线交流有何变化？
研究设计和方法
在 2019 年 1 月至 2021 年 5 月期间收集了 Twitter 上包含对 LSI（例如“ECMO”）或 ACP（例如“DNR/DNI”）的引用的对话。用户帐户元数据用于预测用户人口统计信息并将用户分类为组织、个人、临床医生或影响者。比较这些用户类别的印象数，并使用自然语言处理模型分析推文的内容，以确定讨论的主题和相关的情感情绪。
结果
有 202,585 条关于 LSI 的独特推文和 67,162 条关于 ACP 的独特推文。年轻、男性或有影响力的用户更有可能在线讨论 LSI。与关于 ACP 的推文相比，关于 LSI 的推文与更积极的情绪情绪得分相关（LSI，0.3；ACP，–0.2；P < .001）。在关于 ACP 的推文中，大多数包含与亲人死亡有关的个人经历 (27%) 或讨论了针对老年人和残疾人的不复苏命令的歧视 (19%)。个人体验的转推比最高（4.7），表明用户参与度很高。关于歧视的推文包含最负面的净情绪得分（–0.5）。
解释
观察到的关于 LSI 和 ACP 的推文增加表明，Twitter 一直被用来讨论大流行期间与重症监护相关的治疗方式和偏好。未来增加 ACP 在线参与的干预措施可能会考虑利用影响者和个人故事。最后，我们将与不复苏相关的歧视确定为公众普遍存在的恐惧，应将其作为 ACP 完成的障碍进一步探索，临床医生可以在床边护理目标讨论中主动解决。
京公网安备 11010802027423号