Background / Purpose / Objective(s) Advance care planning (ACP) is often positioned as a best-practice standard in hospice and palliative care.1 However, this framing assumes legal access, recognized relational legitimacy, and healthcare trust that many LGBTQI+ older adults do not experience.2 We examine how the current definition and application of ACP, emphasizing future-oriented decision-making and documentation, aligns with and falls short for adults who are multiply marginalized through structural discrimination, family exclusion, and limited access to affirming care.3 Our objective is to examine how ACP is often operationalized in ways that overlook the needs of LGBTQI+ older adults, particularly those in under-resourced, rural, or conservative settings, and to explore care approaches that emphasize relational trust, cultural humility, and lived experience. Approach This interprofessional panel brings together expertise in palliative medicine, clinical psychology, gerontology, geriatrics, and LGBTQI+ health equity. We explore how the institutional implementation of ACP can conflict with the lived experiences of LGBTQI+ older adults and their care partners, particularly in rural and conservative regions.4 Drawing on psychosocial research, clinical practice, and policy analysis, we examine themes such as disenfranchised grief, caregiver burden, healthcare mistrust, and chosen families.5 We consider how marriage equality has alleviated legal barriers but has not fully addressed ACP-relevant structural inequities.4 We offer strategies for cultivating care environments that support ACP as a relational and iterative process. Implications / Lessons Learned Participants will learn to recognize when ACP efforts may unintentionally reinforce structural inequities or exclude LGBTQI+ older adults. We offer practical strategies for shifting from a metrics-driven approach to one that prioritizes inclusive, trust-building communication, especially in under-resourced or politically hostile environments. This session encourages reflection on institutional assumptions and offers tools grounded in dignity, cultural humility, and LGBTQI+ lived experience to help clinicians better support patients and care partners facing serious illness.

CONTEXT:Globally, about 85% of palliative care need is unmet. Africa accounts for 20% and 52% of adult and pediatric palliative care burden worldwide, respectively. Nigeria has progressing palliative care provision but meets only an estimated 0.2% of national need. OBJECTIVES:To describe extant literature detailing palliative care knowledge, implementation, medicine availability, education, policy, vitality, and research in Nigeria, propose areas for future scientific inquiry, and inform interventional targets. METHODS:Arkey and O'Malley design for scoping reviews reported per the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. PubMed, Embase, Cochrane CENTRAL, Web of Science, Scopus, and African Index Medicus were searched in January 2024 and updated in December 2024. Full-text, peer-reviewed articles in English describing palliative care in Nigeria were included. RESULTS:Of the 6116 search results, 290 underwent full-text review and 59 satisfied inclusion criteria. Most studies examined palliative care knowledge, attitudes, and practices while few evaluated implementation practices or interventions. Palliative care awareness in Nigeria is low; however patients, family caregivers, and healthcare professionals have expressed interest in expanded education, infrastructure, and culturally-appropriate delivery models. Persistent challenges include opioid availability, delayed referral, inconsistent education, insufficient institutional and federal policy, and absent professional validation. CONCLUSIONS:This review identified gaps in palliative care in Nigeria that can inform interventional targets for national acceptance and equitable delivery. It is critical to prioritize multilevel policy changes to expand access to high-quality palliative care services and mitigate the growing burden of health-related suffering among the seriously ill.

LGBTQIA+ individuals make up an increasingly significant percentage of the US population and experience substantial health and healthcare disparities that impact palliative care needs. Nurses who provide palliative care must have the knowledge and skills to provide responsive, affirming, and inclusive care for the LGBTQIA+ community. This chapter provides an introduction to key considerations for nurses regarding LGBTQIA+ affirmative palliative care. First, the authors outline historical, structural, and cultural factors that have contributed to health disparities and limited access to adequate palliative care for LGBTQIA+ individuals. They discuss essential points concerning LGBTQIA+ responsive palliative care in the ethical, physical, psychosocial, and family domains, illustrated by a case study throughout the chapter. Finally, they provide guidance on terms, concepts, and suggested assessment prompts that may assist nurses. Ultimately, the chapter aims to empower nurses to provide responsive and affirming palliative care to LGBTQIA+ patients and families in the context of systemic barriers.

Although eating disorders (EDs) affect individuals of all races and ethnicities, racially/ethnically minoritized individuals are less likely to receive ED treatment than White individuals. The present study aimed to compare ED treatment experiences in a sample of racially/ethnically minoritized individuals vs. White participants. As a secondary aim, we explored how acculturation and mental health stigma factors were associated with treatment experiences. We recruited 41 White and 27 racially/ethnically minoritized individuals with a history of EDs (with all racially/ethnically minoritized individuals having to be categorized into one group due to limited power to conduct analyses across groups). Participants completed an assessment of their treatment experiences, ratings of the helpfulness of each treatment, self-reported barriers to treatments, their level of acculturation, and their tolerance towards stigma. We found that racially/ethnically minoritized participants reported receiving a significantly lower total number of ED treatments than White participants. Second, racially/ethnically minoritized participants were significantly less likely to seek out inpatient and day treatment/partial hospitalization than White participants. Third, racially/ethnically minoritized rated nutritionists and residential treatment as significantly less helpful than White participants. Fourth, racially/ethnically minoritized participants identified the lack of cultural competence among providers as a significantly more substantial barrier to treatment than White participants. Finally, among racially/ethnically minoritized participants, higher immersion in dominant society correlated positively with perceived helpfulness of ED treatment. These insights can guide the development of targeted interventions aimed at mitigating treatment barriers and enhancing treatment outcomes for racially/ethnically minoritized individuals affected by EDs.

INTRODUCTION:The appropriate assessment and treatment of depression in older adults is critical to promoting the quality of life as well as reducing the risk for physical conditions such as frailty. Medical and mental health care clinicians working in integrated care settings are distinctly positioned to provide depression care for older adults; yet, there is a lack of sufficient training at the intersection of depression and frailty among older adults. METHOD:To address this gap in training, we developed a four-module, 60-min multidisciplinary, web-based training entitled, "Assessing and Treating Depressed and Frail Older Adults in Integrated Primary Care." The feasibility, participant reaction (acceptability and utility), and learning outcomes of the training were assessed with a sample (N = 25 completers) of clinical psychology graduate students and medical residents during the 2022-2023 academic year. RESULTS:Overall, participants were receptive to the training, and the training resulted in improved knowledge as measured by pre- and postcontent questions. DISCUSSION:The findings suggest that, despite certain barriers to implementation, cross-disciplinary training on geriatric mental health has promising feasibility and can result in enhanced learning for medical and clinical psychology trainees. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Healthcare providers (HCPs) face high rates of distress, experienced as burnout, moral distress, compassion fatigue, and grief. HCPs are also experiencing a crisis in meaning whereby distress is associated with disconnection from meaning in work and, in turn, a lack of meaning in work can further perpetuate distress for HCPs. Although scalable systems-level solutions are needed to tackle multidimensional HCP distress, it is also necessary to address HCP suffering at individual, team, and institutional levels. Targeted interventions to alleviate HCP distress are limited. Meaning-centered psychotherapy (MCP), a brief, evidence-based, intervention first developed for persons with advanced cancer, holds promise to mitigate HCP distress. This study adapted MCP for HCPs through feedback from a multidisciplinary sample of clinicians trained in MCP and working in healthcare settings. A survey was distributed electronically between November and December 2023 to HCPs previously trained in MCP assessing quantitative and qualitative feedback on the appropriateness of MCP for HCPs, the relevance of MCP session topics and exercises, and implementation barriers and facilitators. Descriptive statistics on relevant participant ratings were calculated; a matrix analysis approach was used for qualitative data. Forty participants, primarily mental health providers, expressed that MCP principles were highly relevant for HCPs and offered key insights on appropriate intervention modifications, including the need for a primary focus on meaning in professional life, reduced intervention length, and delivery in group format. Feedback informed critical adjustments to promote appropriateness and acceptability of MCP-HCP which is poised for pilot testing to determine its feasibility and preliminary efficacy for HCPs.

Meaning-Centered Psychotherapy (MCP) is a manualized, evidence-based intervention designed to help cancer patients to find meaning and alleviate distress. Meaning-Centered Psychotherapy Training (MCPT) is a multicomponent program for cancer care clinicians that consists of didactics, group experiential learning, and role-plays with simulated patients to learn MCP and acquire skills to deliver it in real-world oncology settings. The efficacy and impact of MCPT for multidisciplinary cancer care clinicians to learn and disseminate MCP is described and evaluated. A multilevel evaluation based on the RE-AIM framework was utilized to assess the efficacy of the MCPT program over the initial 5 years of the program. The outcomes of the evaluation supported MCPT goals. Three hundred forty-two participants attended MCPT. Overall satisfaction measured in the post-training assessment was high. Significant increases in MCP skills were demonstrated by participants over the course of the role-play sessions, and participants showed significant improvements in pre/post-training MCP knowledge assessment scores, as well as significant increases in self-reported overall MCP skills and core competencies. Follow-up survey responses indicate that MCP trainees were utilizing MCP, had made changes to their clinical practice, and progressed on individual implementation goals. During the first 5 years, the MCPT program was successfully developed, established, implemented, and shown to be effective in the dissemination of MCP across the RE-AIM domains. Future directions for training and implementation research include increasing diversity of providers and investigating the impact of the program on patient outcomes.

Objective. During the COVID-19 pandemic, the use of teletherapy became mandatory for most therapists. Many therapists who had previously felt reluctant to try teletherapy ultimately transitioned to teletherapy with little experience or training. We qualitatively examined therapists' subjective experiences of providing teletherapy, particularly regarding their future plans and advice for colleagues who will be using teletherapy.Methods. A total of 31 psychotherapists participated in semi-structured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. Results. Within the overarching domain Plans for after the pandemic, we identified five main categories: 1) For whom and when teletherapy is helpful; 2) Therapists' future practice plans; 3) Therapists' attitudes towards teletherapy; 4) Helpful professional support, and 5) Helpful to keep in mind when starting. Many therapists found teletherapy more acceptable than they expected and discovered that it was surprisingly useful for patients. Therapists highlighted the importance of professional peer support in tackling teletherapy's technical, legal, and therapeutic challenges. Conclusion. Overall, these results suggest great variability in therapists' subjective experiences with teletherapy during this time of forced transition. Although for some, teletherapy remains a second-best option, many now prefer hybrid treatment options for optimal flexibility.

Context LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions’ substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. Methods Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). Findings 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the “Executive Summary,” “Recommendations,” and/or “Key Messages” sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. Conclusions LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking.

ContextEfforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress.ObjectivesThe aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates.MethodsSurrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals. Participants completed an assessment of EMPOWER's acceptability, measures of psychological distress pre-intervention, immediately post-intervention, and at 1- and 3-month follow-up assessments.ResultsDelivery of EMPOWER appeared feasible, with 89% of participants completing all 6 modules, and acceptable, with high ratings of satisfaction (mean=4.5/5, SD=0.90). Compared to EUC, intent-to-treat analyses showed EMPOWER was superior at reducing peritraumatic distress (Cohen's d=–0.21, small effect) immediately post-intervention and grief intensity (d=–0.70, medium-large effect), posttraumatic stress (d=–0.74, medium-large effect), experiential avoidance (d=-0.46, medium effect), and depression (d=-0.34, small effect) 3 months post-intervention. Surrogate satisfaction with overall critical care (d=0.27, small effect) was higher among surrogates randomized to EMPOWER.ConclusionsEMPOWER appeared feasible and acceptable, increased surrogates’ satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.

Morbidity and mortality associated with bereavement is an important public health issue, yet economic and resource investments to effectively implement and sustain integrated bereavement services are sorely lacking at national and global levels. Although bereavement support is a component of palliative care provision, continuity of care for bereaved individuals is often not standard practice in palliative and end-of-life contexts. In addition to potentially provoking feelings of abandonment, failure to extend family-centred care after a patient's death can leave bereaved families without access to crucial psychosocial support and at risk for illnesses that exacerbate the already substantial public health toll of interpersonal loss. The effect of inadequate bereavement care disproportionately disadvantages vulnerable groups, including those living in resource-constrained settings. We build on available evidence and previous recommendations to propose a model for transitional care, firmly establishing bereavement care services within health-care institutions, while respecting their finite resources and the need to ultimately transition grieving families to supports within their communities. Key to the transitional bereavement care model is the bolstering of community-based supports through development of compassionate communities and upskilling of professional services for those with more substantial bereavement support needs. To achieve this goal, interprofessional health workers, institutions, and systems must shift bereavement care from an afterthought to a public health priority.

Background: Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals experience discrimination throughout the care continuum, including during serious illness and at end of life. High-quality palliative care requires that health professionals deliver individualized services that reflect the needs, experiences, and preferences of LGBTQ+ persons. Aim: To identify and appraise existing evidence related to the needs, experiences, and preferences for palliative and end of life care among LGBTQ+ individuals with serious illness. Design: Data-based convergent synthesis design reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources: PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, and Scopus from January 1, 2010 to November 6, 2020. Results: Of 4875 results captured, 69 articles underwent full-text review and 13 were retained for analysis. Most studies were from North America with trans individuals represented in 10 of 13 studies. Needs (n = 6) included increased social support, institutional safety, economic and legal supports, and advocacy to mitigate health barriers.Experiences (n = 12) were driven by fear and worry associated with discrimination/stigma,providers' hetero-/cisnormative assumptions, homophobia and transphobia, social isolation, and an undignified death. Preferences (n = 6) pertained to inclusion of chosen families in decision-making, disclosure of LGBTQ+ identity based on safety of the clinical environment, and a desire to maintain autonomy. Conclusions: The robustness of the science has improved regarding the needs, experiences, and preferences of trans individuals. Actionable, inclusive policies coupled with sustained and integrated cultural sensitivity training for health workers are mandatory. Interventional research is critical to enhance tailored palliative care for LGBTQ+ people and their chosen families.

•We found differences between healthy controls and individuals with current or past major depressive disorder in emotional tone, total function words, auxiliary verbs, negative tone, negative emotion, anxiety, sadness, attention, and visual LIWC categories.•Individuals experiencing current major depressive disorder spoke more words that were characterized in the LIWC anxiety category, when compared to healthy controls.•Few linguistic differences emerged between individuals currently experiencing major depressive disorder and those who had a past history of major depressive disorder; however, individuals experiencing a current major depressive disorder utilized fewer auxiliary verbs in comparison to those with a past history of major depressive disorder.

CONTEXT:Provider grief, i.e., grief related to the death of patients, often forms an ongoing and profound stressor impacting healthcare providers' ability to maintain their sense of well-being, avoid feeling overwhelmed, and sustain quality and compassionate patient care over time. OBJECTIVES:This narrative review presents findings on the types of interventions hospitals have offered to physicians and nurses to address provider grief. METHODS:Searches of PubMed and PsycINFO were conducted for articles (e.g., research studies, program descriptions and evaluations) focused on hospital-based interventions to help physicians and nurses cope with their own grief. RESULTS:Twenty-nine articles met inclusion criteria. The most common adult clinical areas were oncology (n = 6), intensive care (n = 6), and internal medicine (n = 3), while eight articles focused on pediatric settings. Nine articles featured education interventions, including instructional education programs and critical incident debriefing sessions. Twenty articles discussed psychosocial support interventions, including emotional processing debriefing sessions, creative arts interventions, support groups, and retreats. A majority of participants reported that interventions were helpful in facilitating reflection, grieving, closure, stress relief, team cohesion, and improved end-of-life care, yet mixed results were found related to interventions' effects on reducing provider grief to a statistically significant degree. CONCLUSION:Providers largely reported benefits from grief-focused interventions, yet research was sparse and evaluation methodologies were heterogenous, making it difficult to generalize findings. Given the known impact provider grief can have on the individual and organizational levels, it is important to expand providers' access to grief-focused services and to increase evidence-based research in this field.

Bereavement is a common human experience that often involves significant impacts on psychological, emotional and even cognitive functioning. Though various psychological theories have been proposed to conceptualize the grief process, our current understanding of the underlying neurocognitive mechanisms of grief is limited. The present paper proposes a neurocognitive model to understand phenomena in typical grief, which links loss-related reactions to underlying learning and executive processes. We posit that the competitive relationship between the basal ganglia (BG) and circuitry involving the medial temporal lobe (MTL) underlies common cognitive experiences in grief such as a sense of “brain fog.” Due to the intense stressor of bereavement, we suggest that these two systems’ usually flexible interactive relationship become imbalanced. The resulting temporary dominance of either the BG or the MTL system is then manifested in perceived cognitive changes. Understanding the underlying neurocognitive mechanism in grief could inform ways to best support bereaved individuals.

OBJECTIVE In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process. METHODS Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. RESULTS Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process. CONCLUSION Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.

Objectives. Diagnosing mental health challenges in bereavement is controversial; however, regardless of one's position on this matter, assessments of bereaved individuals continue to occur in clinical and research contexts. It is critical for evaluations to account for contextual factors that are unique to bereavement. This paper summarizes considerations for diagnosing depression in bereaved individuals, focusing on use of the six-item Hamilton Depression Rating Scale (HAM-D6). Methods. Following a literature review of the Hamilton Depression Rating Scale (HAM-D) and various versions, we summarized decision rules we used in scoring the HAM-D6 in a study of parents bereaved by cancer. We expanded on existing scoring guidelines for each of the HAM-D6 items, including depressed mood, work and activities, general somatic symptoms, guilt, psychic anxiety, and psychomotor retardation, and illustrated clinical distinctions and probes for assessors to consider through case examples from our research with bereaved parents. Results. Considerations for assessing depressive symptoms and behavior changes in the context of bereavement were summarized. Symptoms that may be diagnostic of depression in some populations may reflect other factors in the bereaved, such as a change in priorities, social expectations surrounding grief, or avoidance of grief activators. Nuanced factors are important for assessors to consider when administering the HAM-D6 to bereaved individuals. Significance of results. Our sharing of these considerations is not intended to promote diagnosis of depression in bereavement but to highlight the unique contextual factors that distinguish symptoms of depression from common experiences of grievers when applying an assessment tool such as the HAM-D6. While validated measures can be constraining, they can have clinical utility; they may increase standardization in research, help clinicians communicate with each other, advance the field more generally to understand the varying struggles bereaved individuals experience, and systemically facilitate access to services via managed care.

ABSTRACT: Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care.

BACKGROUND:Automatic speech recognition (ASR) technology is increasingly being used for transcription in clinical contexts. Although there are numerous transcription services using ASR, few studies have compared the word error rate (WER) between different transcription services among different diagnostic groups in a mental health setting. There has also been little research into the types of words ASR transcriptions mistakenly generate or omit. OBJECTIVE:This study compared the WER of 3 ASR transcription services (Amazon Transcribe [Amazon.com, Inc], Zoom-Otter AI [Zoom Video Communications, Inc], and Whisper [OpenAI Inc]) in interviews across 2 different clinical categories (controls and participants experiencing a variety of mental health conditions). These ASR transcription services were also compared with a commercial human transcription service, Rev (Rev.Com, Inc). Words that were either included or excluded by the error in the transcripts were systematically analyzed by their Linguistic Inquiry and Word Count categories. METHODS:Participants completed a 1-time research psychiatric interview, which was recorded on a secure server. Transcriptions created by the research team were used as the gold standard from which WER was calculated. The interviewees were categorized into either the control group (n=18) or the mental health condition group (n=47) using the Mini-International Neuropsychiatric Interview. The total sample included 65 participants. Brunner-Munzel tests were used for comparing independent sets, such as the diagnostic groupings, and Wilcoxon signed rank tests were used for correlated samples when comparing the total sample between different transcription services. RESULTS:There were significant differences between each ASR transcription service's WER (P<.001). Amazon Transcribe's output exhibited significantly lower WERs compared with the Zoom-Otter AI's and Whisper's ASR. ASR performances did not significantly differ across the 2 different clinical categories within each service (P>.05). A comparison between the human transcription service output from Rev and the best-performing ASR (Amazon Transcribe) demonstrated a significant difference (P<.001), with Rev having a slightly lower median WER (7.6%, IQR 5.4%-11.35 vs 8.9%, IQR 6.9%-11.6%). Heat maps and spider plots were used to visualize the most common errors in Linguistic Inquiry and Word Count categories, which were found to be within 3 overarching categories: Conversation, Cognition, and Function. CONCLUSIONS:Overall, consistent with previous literature, our results suggest that the WER between manual and automated transcription services may be narrowing as ASR services advance. These advances, coupled with decreased cost and time in receiving transcriptions, may make ASR transcriptions a more viable option within health care settings. However, more research is required to determine if errors in specific types of words impact the analysis and usability of these transcriptions, particularly for specific applications and in a variety of populations in terms of clinical diagnosis, literacy level, accent, and cultural origin.