Abstract: Understanding Healthcare Provider Use of Language in Hospitalized Patients with Opioid Use Disorder (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)
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361P Understanding Healthcare Provider Use of Language in Hospitalized Patients with Opioid Use Disorder

Schedule:
Friday, January 12, 2024
Marquis BR Salon 6, ML 2 (Marriott Marquis Washington DC)
* noted as presenting author
Rachel Hirshman, BS, MSW Student, North Carolina State University, Raleigh, NC
Shavone Hamilton, PhD, Licensed Clinical Social Worker, Duke University, Durham, NC
Melissa Walker, MSW, Licensed Clinical Social Worker, Duke University, Durham, NC
Alan Ellis, PhD, Associate Professor, North Carolina State University, Raleigh, NC
Noel Ivey, MD, Assistant Professor of Medicine, Duke University, Durham, NC
Dana Clifton, MD, Assistant Professor of Medicine, Duke University, Durham, NC
Background and Purpose: Stigma within the healthcare environment limits access to treatment for opioid use disorder (OUD), even as OUD results in significant morbidity and mortality worldwide (Wakeman & Rich, 2018). Provider language in the electronic health record (EHR) can affect both patient experience and future care through the transmission of stigma or positive regard (P. Goddu et. al., 2018, Park et. al., 2021). Currently, language use by providers documenting patient encounters related to OUD is unknown.

Methods: We selected new patients of the Duke University Hospital OUD consult service who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013) criteria for OUD with a hospital stay ≥ 28 days. Two reviewers evaluated admission and discharge notes for presence of stigmatizing or affirming language using categories established through review of the current literature. ANOVA tests were utilized for comparison between provider group differences and independent t-tests for comparison between patient characteristic differences.

Results: 48 patients (96 notes) met inclusion criteria. We identified 434 instances of stigmatizing language (average 9 instances per patient) and 47 instances of positive/affirming language (average 1 instance per patient). 146 instances of stigmatizing language appeared in system generated language such as diagnostic codes and drop-down options. We observed no statistically significant differences in amount of language use based on patient characteristics or provider type. For provider service, there was a statistically significant difference in mean stigmatizing language use (p=0.02), with medicine service providers averaging 5.48 instances of stigmatizing language per note compared to 3.49 and 4.20 for providers on surgical and intensive care unit services, respectively.

Conclusion and Implications: Stigmatizing language was present in both provider and system generated language and was nine times more frequent than positive/affirming language per patient. While provider education may help to reduce stigmatizing language for patients with OUD, institutional level changes to the EHR and International Classification of Disease (ICD) codes are necessary to eliminate stigmatizing language within medical records. Our study highlights how social workers in interdisciplinary healthcare settings can help generate insights that inform future interventions to improve patient experience and care.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596

P. Goddu, A., O’Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., & Beach, M. C. (2018). Do words matter? Stigmatizing language and the transmission of bias in the medical record. Journal of General Internal Medicine, 33(5), 685–691. https://doi.org/10.1007/s11606-017-4289-2

Park, J., Saha, S., Chee, B., Taylor, J., & Beach, M. C. (2021). Physician use of stigmatizing language in patient medical records. JAMA Network Open, 4(7), e2117052. https://doi.org/10.1001/jamanetworkopen.2021.17052

Wakeman, S. E., & Rich, J. D. (2018). Barriers to medications for addiction treatment: How stigma kills. Substance Use & Misuse, 53(2), 330–333. https://doi.org/10.1080/10826084.2017.1363238

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