IMAGE: Robert Gramling is the Holly and Bob Miller Chair in Palliative Medicine at the University of Vermont Larner College of Medicine. In a new paper, Gramling and his colleagues show... view more Some of the most important, and difficult, conversations in healthcare are the ones that happen amid serious and life-threatening illnesses. Discussions of the treatment options and prognoses in these settings are a delicate balance for doctors and nurses who are dealing with people at their most vulnerable point and may not fully understand what the future holds. Now researchers at the University of Vermont's Vermont Conversation Lab have used machine learning and natural language processing to better understand what those conversations look like, which could eventually help healthcare providers improve their end-of-life communication. "We want to understand this complex thing called a conversation," says Robert Gramling, director of the lab in UVM's Larner College of Medicine who led the study, published December 9 in the journal Patient Education and Counselling.

New York, Researchers at University of Vermont have used machine learning and natural language processing (NLP) to better understand conversations about death, which could eventually help doctors improve their end-of-life communication. Some of the most important, and difficult, conversations in healthcare are the ones that happen amid serious and life-threatening illnesses. Discussions of the treatment options and prognoses in these settings are a delicate balance for doctors and nurses who are dealing with people at their most vulnerable point and may not fully understand what the future holds. "We want to understand this complex thing called a conversation. Our major goal is to scale up the measurement of conversations so we can re-engineer the healthcare system to communicate better," said Robert Gramling, director of the Vermont Conversation Lab in the study published in the journal Patient Education and Counselling.

One afternoon in the summer of 2018, Bob Gramling dropped by the small suite that serves as his lab in the basement of the University of Vermont's medical school. There, in a grey lounge chair, an undergrad research assistant named Brigitte Durieux was doing her summer job, earphones plugged into a laptop. Then he saw her tears. Bob doesn't balk at tears. As a palliative care doctor, he has been at thousands of bedsides and had thousands of conversations, often wrenchingly difficult ones, about dying. But in 2007, when his father was dying of Alzheimer's, Bob was struck by his own sensitivity to every word choice of the doctors and nurses, even though he was medically trained. "If we [doctors] are feeling that vulnerable, and we theoretically have access to all the information we would want, it was a reminder to me of how vulnerable people without those types of resources are," he says. He began to do research into how dying patients, family members, and doctors talk in these moments about end of treatment, pain management, and imminent death. Six years later, he received over $1 million from the American Cancer Society to undertake what became the most extensive study of palliative care conversations in the US.