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Artificial intelligence for better goals of care documentation
  1. Gina Piscitello1,2,
  2. Jane O Schell1,2,
  3. Robert M Arnold3 and
  4. Yael Schenker1,2
  1. 1Section of Palliative Care and Medical Ethics, Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Gina Piscitello, University of Pittsburgh, Pittsburgh, USA; piscitellogm{at}


Objectives Lower rates of goals of care (GOC) conversations have been observed in non-white hospitalised patients, which may contribute to racial disparities in end-of-life care. We aimed to assess how a targeted initiative to increase GOC documentation rates is associated with GOC documentation by race.

Methods We retrospectively assessed GOC documentation during a targeted GOC initiative for adult patients with an artificial intelligence predicted elevated risk of mortality. Patients were admitted to an urban academic medical centre in Pittsburgh, Pennsylvania between July 2021 and 31 December 2022.

Results The 3643 studied patients had a median age of 72 (SD 13.0) and were predominantly white (87%) with 42% admitted to an intensive care unit and 15% dying during admission. GOC documentation was completed for 28% (n=1019/3643). By race, GOC was documented for 30% black (n=105/351), 28% white (n=883/3161) and 24% other (n=31/131) patients (p=0.3933). There was no statistical difference in the rate of documented GOC among races over time (p=0.5142).

Conclusions A targeted initiative to increase documented GOC conversations for hospitalised patients with an elevated risk of mortality is associated with similar documentation rates across racial groups. Further research is needed to assess whether this initiative may promote racial equity in GOC documentation in other settings.

  • Communication
  • Ethics
  • End of life care

Data availability statement

Data from this study can be obtained by contacting the corresponding author at

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Data availability statement

Data from this study can be obtained by contacting the corresponding author at

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  • Contributors GP, JOS, RMA and YS all met criteria for authorship including making a substantial contribution to the design of the work, drafting and revising the manuscript, approving the version to be published and taking public responsibility for appropriate portions of content.

  • Funding GP was supported by 5TL1TR001858-07. YS was supported by K24AG070285.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.