Mapping Nurses' Natural Language to Oncology Patients' Symptom ... Keywords: Nursing, Documentation, Terminology ... standardized nursing vocabularies.
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Consumer-Centered Computer-Supported Care for Healthy People H.-A. Park et al. (Eds.) IOS Press, 2006 © 2006 The authors and IOS Press. All rights reserved.
Mapping Nurses’ Natural Language to Oncology Patients’ Symptom Expressions Ann Kristin Rotegårda, Laura Slaughtera, Cornelia M. Rulanda,b a
Center for Shared Decision Making and Nursing Research, Rikshospitalet-Radiumhospitalet HF, Oslo, Norway b Department of Biomedical Informatics, Columbia University, NY, USA
Abstract Systems that integrate information from both the patients and health professionals require bi-directional term translation. We manually extracted nursing terms from 25 randomly selected cancer patients’ charts that expressed symptoms and mapped these to a set of patient-oriented symptoms from a cancer support system. We found that 40% of the nursing terms were synonyms of patient expressions that could be mapped directly; however 38% of the nursing terms required a map to more than one patient expression. In this study, we gained an understanding of the link between nursing and patient language that is needed for future system development. Keywords: Nursing, Documentation, Terminology
Introduction The development of systems that facilitate shared decision making between patients and nurses require mechanisms that translate between nursing language documented in the electronic health records and patientoriented expressions. The literature has shown that there is often a mismatch between health personnel and patients’ language and ways of thinking about symptoms and problems [1]. This can be a hindrance to the exchange of and access to information which can influence the quality of care and treatment. Recent work is focused on building mechanisms to connect patient or consumer-level health vocabulary with structured nursing vocabularies. The specific aim in this study was to extract terms nurses used when describing cancer patients’ symptoms in the patients’ charts and explore how close these map to patient-oriented symptoms from a symptom assessment/management tool used by cancer patients.
Methods We used text analysis to manually extract nursing terms from nurses' natural language entries in 25 randomly selected cancer patients’ charts from a Norwegian university hospital. Two MSc nurses with expert domain knowledge identified all nursing terms that corresponded to cancer patients’ symptoms. Nursing terms were then
mapped to 145 validated patient-oriented cancer symptoms within a symptom assessment/management application [2]. Oncology nurses, terminology experts, and health informaticians discussed the term extraction, synonym identification and mappings during 7 focus group sessions.
Results We identified 493 unique terms (807 total) within the 25 charts which expressed cancer-related symptoms. The nurses’ terms mapped to the patient-oriented expressions as follows: • 3% (15/493) had exactly the same expression as the patient term, e.g. “ubehag” (discomfort) • 35% (173/493) were synonyms of the patients’ symptom expression. Many expressions are “informal language”, however, formal health terminology was also found, e.g. “abdominal smerte” (abdominal pain) compared to the patient-oriented symptom “vondt i magen” (belly ache). • 16% (79/493) were narrower terms than the patient symptom expression e.g. “residiv smerte” (recidive pain). • 38% (189/493) of the nurses’ expressions could be mapped to several patients’ symptoms, of which some were broader terms e.g. “ikke sovet noe særlig” (didn’t sleep well) vs. patient symptom “vanskelig a sove gjennom naten” (difficulty sleeping through the night) and some were related expressions e.g. “pasienten har mye å tenke på” (the patient has a lot to think about) • 8% (37/493) could not be mapped to a patient symptom; some of these might be added to the system as new symptoms e.g. “hyppig vannlating” (frequent urination)
Discussion We are working towards building tools for connecting patient expressions to language used in the electronic health record. Forty percent of the nursing terms from the chart directly map to patient-oriented expressions, although they are mostly synonyms rather than exact terms. This informs us that in many cases, we can expect a 1:1 translation that links patient-oriented terms with nursing language. However, a large number of nursing terms (38%) can be mapped to more than one patientoriented expression. The majority of these are psycho-
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social symptoms (e.g. the nurse wrote “psychological strain” and this can be linked to any of the patientoriented symptoms related to worries and feelings). Nurses document these with less precision than the physical symptoms and this may require multiple mappings. Our next step is to connect the terms from the nurses’ natural language documentation with the standardized nursing vocabularies.
References [1] Zielstorff RD. Controlled vocabularies for consumer health. Journal of Biomedical Informatics, 2003; 36(4-5):326-33. [2] Ruland CM, White T, Stevens M, Fanciullo G, Khilani SM. Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results. Journal of the American Medical Informatics Association, 2003; 10(6):573-9.
