Stigmatizing Terminology and Patient-Centered Language in Perinatal Substance Use Chart Notes

Stigmatizing language used in the care of people with substance use disorder is prevalent despite efforts to establish preferred, patient-centered language alternatives for providers. Open notes policies and increased portal usage are expected to lead to patients reading chart notes written about them with potential impact on their care. Building on the research that demonstrates that stigmatizing language is present in patient chart notes, our study employs an exploratory sequential mixed methods design to describe and analyze the chart notes from a perinatal substance use disorder clinic. We analyzed 161 patient chart notes meeting our study criteria from a random sample of 300 notes, and those patients are 88% White, 91% use Medicaid insurance, and their median age was 29 years at delivery. Chart notes were found to comprise stigmatizing terms, patient-centered and non-patient-centered language. Language type varied by patient age, prior C-section, prenatal care quality, and time since conception. Our team developed an assessment tool for chart notes in response to our findings.