{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:38:37Z","timestamp":1792777117432,"version":"4.5.0"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Transcult Nurs"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Language barriers perpetuate health care disparities, yet traditional data sources overlook inequities in relationship\u2011based care. This study uses artificial intelligence to examine language\u2011related disparities in spiritual care, a domain largely documented in unstructured clinical notes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed electronic health records of 7,360 deceased adults aged \u226565 years from a tertiary hospital (2010\u20132023). Natural language processing identified spiritual care documentation, and structured flowsheets captured formal chaplain visits. Logistic regression assessed associations between patient language and spiritual care access and timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Non\u2011English speakers had 59% lower odds of receiving formal spiritual care (odds ratio = 0.41,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.003) and received support nearly 10 months later (median 136 vs. 432 days,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.020). Among non\u2011English speakers, non-chaplain providers more often first documented spiritual needs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Artificial intelligence\u2013supported analysis of unstructured documentation revealed language\u2011related disparities missed by structured data, offering a culturally grounded approach to identifying inequities in relationship\u2011based care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10436596261491239","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T05:34:06Z","timestamp":1792560846000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Detecting Language-Related Disparities in Spiritual Care Using Artificial Intelligence"],"prefix":"10.1177","author":[{"given":"Claire","family":"Stephenson","sequence":"first","affiliation":[{"name":"The University of Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6170-6380","authenticated-orcid":false,"given":"Yuwen","family":"Ji","sequence":"additional","affiliation":[{"name":"The University of Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1546-9972","authenticated-orcid":false,"given":"Nahid","family":"Zeinali","sequence":"additional","affiliation":[{"name":"The University of Iowa, USA"},{"name":"California Medical Innovations Institute, San Diego, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-1260","authenticated-orcid":false,"given":"Katherine Carroll","family":"Britt","sequence":"additional","affiliation":[{"name":"The University of Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2471-9082","authenticated-orcid":false,"given":"Alaa","family":"Albashayreh","sequence":"additional","affiliation":[{"name":"The University of Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"crossref","unstructured":"Abedini N. C. Downey L. Engelberg R. A. Curtis J. R. Sharma R. K. (2022). End-of-life healthcare utilization and palliative care use among older adults with limited English proficiency. Journal of the American Geriatrics Society 70(10) 2847\u20132857. https:\/\/doi.org\/10.1111\/jgs.17913","DOI":"10.1111\/jgs.17913"},{"key":"e_1_3_4_3_1","doi-asserted-by":"crossref","unstructured":"Albashayreh A. Zeinali N. Gusen N. J. Ji Y. Gilbertson-White S. (2025). An informatics approach to characterizing rarely documented clinical information in electronic health records: Spiritual care as an exemplar. Applied Clinical Informatics 16(04) 1146\u20131156. https:\/\/doi.org\/10.1055\/a-2599-6300","DOI":"10.1055\/a-2599-6300"},{"key":"e_1_3_4_4_1","doi-asserted-by":"crossref","unstructured":"Ali P. A. Watson R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses\u2019 perspectives. Journal of Clinical Nursing 27(5\u20136) e1152\u2013e1160. https:\/\/doi.org\/10.1111\/jocn.14204","DOI":"10.1111\/jocn.14204"},{"issue":"1","key":"e_1_3_4_5_1","first-page":"81","article-title":"Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment","volume":"63","author":"Anandarajah G.","year":"2001","unstructured":"Anandarajah G., Hight E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63(1), 81\u201389.","journal-title":"American Family Physician"},{"key":"e_1_3_4_6_1","doi-asserted-by":"crossref","unstructured":"Bakken S. Dreisbach C. (2022). Informatics and data science perspective on Future of Nursing 2020\u20132030: Charting a pathway to health equity. Nursing Outlook 70(6 Supplement 1) S77\u2013S87. https:\/\/doi.org\/10.1016\/j.outlook.2022.04.004","DOI":"10.1016\/j.outlook.2022.04.004"},{"key":"e_1_3_4_7_1","doi-asserted-by":"crossref","unstructured":"Bilotta I. Tonidandel S. Liaw W. R. King E. Carvajal D. N. Taylor A. Thamby J. Xiang Y. Tao C. Hansen M. (2024). Examining linguistic differences in electronic health records for diverse patients with diabetes: Natural language processing analysis. JMIR Medical Informatics 12 e50428. https:\/\/doi.org\/10.2196\/50428","DOI":"10.2196\/50428"},{"key":"e_1_3_4_8_1","doi-asserted-by":"crossref","unstructured":"Britt K. C. Acton G. (2022). Exploring the meaning of spirituality and spiritual care with help from Viktor Frankl. Journal of Holistic Nursing 40(1) 46\u201355. https:\/\/doi.org\/10.1177\/08980101211026776","DOI":"10.1177\/08980101211026776"},{"key":"e_1_3_4_9_1","doi-asserted-by":"crossref","unstructured":"Douglas M. K. Rosenkoetter M. Pacquiao D. F. Callister L. C. Hattar-Pollara M. Lauderdale J. Milstead J. Nardi D. Purnell L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing 25(2) 109\u2013121. https:\/\/doi.org\/10.1177\/1043659614520998","DOI":"10.1177\/1043659614520998"},{"key":"e_1_3_4_10_1","doi-asserted-by":"crossref","unstructured":"Dy S. M. Kiley K. B. Ast K. Lupu D. Norton S. A. McMillan S. C. Herr K. Rotella J. D. Casarett D. J. (2015). Measuring what matters: Top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. Journal of Pain and Symptom Management 49(4) 773\u2013781. https:\/\/doi.org\/10.1016\/j.jpainsymman.2015.01.012","DOI":"10.1016\/j.jpainsymman.2015.01.012"},{"key":"e_1_3_4_11_1","doi-asserted-by":"crossref","unstructured":"Gerchow L. Burka L. R. Miner S. Squires A. (2021). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling 104(3) 534\u2013553. https:\/\/doi.org\/10.1016\/j.pec.2020.09.017","DOI":"10.1016\/j.pec.2020.09.017"},{"key":"e_1_3_4_12_1","doi-asserted-by":"crossref","unstructured":"Griffin J. M. Riffin C. Bangerter L. R. Schaepe K. Havyer R. D. (2022). Provider perspectives on integrating family caregivers into patient care encounters. Health Services Research 57(4) 892\u2013904. https:\/\/doi.org\/10.1111\/1475-6773.13932","DOI":"10.1111\/1475-6773.13932"},{"key":"e_1_3_4_13_1","doi-asserted-by":"crossref","unstructured":"Hu Y. Jiao M. Li F. (2019). Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses. BMC Palliative Care 18(1) 104. https:\/\/doi.org\/10.1186\/s12904-019-0489-3","DOI":"10.1186\/s12904-019-0489-3"},{"key":"e_1_3_4_14_1","doi-asserted-by":"crossref","unstructured":"Kircher C. E. Hanna T. P. Tranmer J. Goldie C. E. Ross-White A. Moulton E. Flegal J. Goldie C. L. (2025). Defining \u201cearly palliative care\u201d for adults diagnosed with a life-limiting illness: A scoping review. BMC Palliative Care 24(1) 93. https:\/\/doi.org\/10.1186\/s12904-025-01712-7","DOI":"10.1186\/s12904-025-01712-7"},{"key":"e_1_3_4_15_1","doi-asserted-by":"crossref","unstructured":"Koper I. Pasman H. R. W. Schweitzer B. P. M. Kuin A. Onwuteaka-Philipsen B. D. (2019). Spiritual care at the end of life in the primary care setting: Experiences from spiritual caregivers\u2014A mixed methods study. BMC Palliative Care 18(1) 98. https:\/\/doi.org\/10.1186\/s12904-019-0484-8","DOI":"10.1186\/s12904-019-0484-8"},{"key":"e_1_3_4_16_1","doi-asserted-by":"crossref","unstructured":"Lerb\u00e6k B. Kusk K. H. J\u00f8rgensen L. Laugesen B. (2025). Navigating the complexities of nursing documentation when patients have access to the content: A qualitative study. Journal of Advanced Nursing 81(5) 2604\u20132616. https:\/\/doi.org\/10.1111\/jan.16502","DOI":"10.1111\/jan.16502"},{"key":"e_1_3_4_17_1","doi-asserted-by":"crossref","unstructured":"McFarland M. R. Wehbe-Alamah H. B. (2019). Leininger\u2019s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing 30(6) 540\u2013557. https:\/\/doi.org\/10.1177\/1043659619867134","DOI":"10.1177\/1043659619867134"},{"key":"e_1_3_4_18_1","doi-asserted-by":"crossref","unstructured":"Momeni G. Hashemi M. S. Hemati Z. (2022). Barriers to providing spiritual care from a nurses\u2019 perspective: A content analysis study. Iranian Journal of Nursing and Midwifery Research 27(6) 575\u2013580. https:\/\/doi.org\/10.4103\/ijnmr.ijnmr_422_21","DOI":"10.4103\/ijnmr.ijnmr_422_21"},{"key":"e_1_3_4_19_1","doi-asserted-by":"crossref","unstructured":"Prieto-Crespo V. Arevalo-Buitrago P. Olivares-Luque E. Garc\u00eda-Arcos A. L\u00f3pez-Soto P. J. (2024). Impact of spiritual support interventions on the quality of life of patients who receive palliative care: A systematic review. Nursing Reports 14(3) 1906\u20131921. https:\/\/doi.org\/10.3390\/nursrep14030142","DOI":"10.3390\/nursrep14030142"},{"key":"e_1_3_4_20_1","doi-asserted-by":"crossref","unstructured":"Puchalski C. Romer A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine 3(1) 129\u2013137. https:\/\/doi.org\/10.1089\/jpm.2000.3.129","DOI":"10.1089\/jpm.2000.3.129"},{"key":"e_1_3_4_21_1","doi-asserted-by":"crossref","unstructured":"Robbins S. G. Hackstadt A. J. Martin S. Shinall M. C.Jr. (2019). Implications of palliative care consultation timing among a cohort of hospice decedents. Journal of Palliative Medicine 22(9) 1129\u20131132. https:\/\/doi.org\/10.1089\/jpm.2018.0514","DOI":"10.1089\/jpm.2018.0514"},{"key":"e_1_3_4_22_1","doi-asserted-by":"crossref","unstructured":"Ruiz A. Chen J. Brown T. T. Cai X. Hernandez Fernandez P. Rodriguez H. P. (2025). Comparing remote and in-person interpretation experiences for clinicians and Spanish-speaking patients with limited English proficiency: A mixed methods study. BMJ Open Quality 14(2) e003227. https:\/\/doi.org\/10.1136\/bmjoq-2024-003227","DOI":"10.1136\/bmjoq-2024-003227"},{"key":"e_1_3_4_23_1","doi-asserted-by":"crossref","unstructured":"Sauerbrei A. Kerasidou A. Lucivero F. Hallowell N. (2023). The impact of artificial intelligence on the person-centred doctor-patient relationship: Some problems and solutions. BMC Medical Informatics and Decision Making 23(1) 73. https:\/\/doi.org\/10.1186\/s12911-023-02162-y","DOI":"10.1186\/s12911-023-02162-y"},{"key":"e_1_3_4_24_1","doi-asserted-by":"crossref","unstructured":"Sj\u00f6berg M. Edberg A. K. Rasmussen B. H. Beck I. (2021). Documentation of older people\u2019s end-of-life care in the context of specialised palliative care: A retrospective review of patient records. BMC Palliative Care 20(1) 91. https:\/\/doi.org\/10.1186\/s12904-021-00771-w","DOI":"10.1186\/s12904-021-00771-w"},{"key":"e_1_3_4_25_1","doi-asserted-by":"crossref","unstructured":"Soto-Rubio A. Perez-Marin M. Rudilla D. Galiana L. Oliver A. Fombuena M. Barreto P. (2020). Responding to the spiritual needs of palliative care patients: A randomized controlled trial to test the effectiveness of the Kibo Therapeutic Interview. Frontiers in Psychology 11 1979. https:\/\/doi.org\/10.3389\/fpsyg.2020.01979","DOI":"10.3389\/fpsyg.2020.01979"},{"key":"e_1_3_4_26_1","doi-asserted-by":"crossref","unstructured":"Sun X. H. Liu X. Zhang B. Wang Y. M. Fan L. (2021). Impact of spiritual care on the spiritual and mental health and quality of life of patients with advanced cancer. World Journal of Psychiatry 11(8) 449\u2013462. https:\/\/doi.org\/10.5498\/wjp.v11.i8.449","DOI":"10.5498\/wjp.v11.i8.449"},{"key":"e_1_3_4_27_1","unstructured":"U.S. Census Bureau. (2023). Most Americans speak only English at home or Speak English \u201cvery well.\u201d https:\/\/www.census.gov\/newsroom\/press-releases\/2023\/language-at-home-acs-5-year.html"},{"key":"e_1_3_4_28_1","unstructured":"U.S. Census Bureau. (2025). Detailed languages spoken at home and ability to Speak English for the population 5 years and over: 2017\u20132021. https:\/\/www.census.gov\/data\/tables\/time-series\/demo\/language-use\/2017-2021-lang-tables.html"},{"key":"e_1_3_4_29_1","doi-asserted-by":"crossref","unstructured":"Van Bulck L. Reading Turchioe M. Topaz M. Song J. (2025). Exploring the full potential of the electronic health record: The application of natural language processing for clinical practice. European Journal of Cardiovascular Nursing 24(2) 332\u2013337. https:\/\/doi.org\/10.1093\/eurjcn\/zvae091","DOI":"10.1093\/eurjcn\/zvae091"}],"container-title":["Journal of Transcultural Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10436596261491239","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10436596261491239","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10436596261491239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:52:00Z","timestamp":1792774320000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10436596261491239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":28,"alternative-id":["10.1177\/10436596261491239"],"URL":"https:\/\/doi.org\/10.1177\/10436596261491239","relation":{},"ISSN":["1043-6596","1552-7832"],"issn-type":[{"value":"1043-6596","type":"print"},{"value":"1552-7832","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"article-number":"10436596261491239"}}