Datasets:
GraSCCo Treatment-Status — Annotation Guideline (v1.2)
Status: frozen for release. Incorporates clinical review and the κ-adjudication pass (binary/safety definition in §2 unchanged). Once frozen, do not edit mid-labeling; log any change as a new version with a timestamp.
Changes from v1.0 (clinical review): (1) "given" redefined as current administration/ continuation at time of documentation, resolving the PAUSED/STOPPED inconsistency; (2) verb test split by tense (weiterführen/fortsetzen/eingenommen no longer auto-given); (3) WITHHELD vs PAUSED disambiguation for "zurückgehalten"; (4) STOPPED "ex" vs HISTORICAL disambiguation; (5) CONTINUED-active extended to pumps/patches + continuation-language overrides heading; (6) κ section: human clinician required as second annotator, sized to corpus.
0. What you are doing
For every treatment or medication mention in a GraSCCo letter, assign one leaf label (Section 1) and one or more phenomenon tags (Section 7).
- The safety question behind every decision: Does this note assert that the drug/treatment is currently being administered or performed — now, in this encounter/treatment episode at the time of writing? If yes → it collapses to given. If it was only planned, discussed, refused, withheld, paused, stopped, historical, or merely listed → not given.
- Unit of analysis = the mention (a drug or procedure), not the sentence. Your evidence window is the enclosing line/clause, plus the adjacent sentence when the status is only settled later (cross-sentence; Section 6c).
- You are correcting a pre-fill. The CSV already has a provisional leaf from a heuristic. It is a starting point, not truth — especially WITHHELD (Section 6b). Re-read every mention and fix it.
1. The label set (9 leaves) and how they collapse
You assign the leaf. The binary and the 6-class are derived automatically — you never assign them, but they are shown so you understand the consequence of a leaf.
| Leaf | Definition | Binary | 6-class |
|---|---|---|---|
| GIVEN | Administered/performed in this episode (explicit) | given | GIVEN |
| CONTINUED-active | Home/long-term med the note asserts is being taken/continued now | given | GIVEN |
| PLANNED | Intended/ordered, not yet executed (incl. discharge plan, PRN order) | not given | PLANNED |
| DISCUSSED | Talked about / counseled / recommended; no action taken | not given | DISCUSSED |
| REFUSED | Patient declined (after offer/recommendation) | not given | REFUSED |
| WITHHELD/CONTRAINDICATED | Clinician decided not to start (contraindication, allergy, "Cave", "kein X") | not given | WITHHELD |
| PAUSED | Temporarily held/suspended ("pausiert") | not given | WITHHELD |
| STOPPED | Previously given, now discontinued ("abgesetzt", "ex") | not given | WITHHELD |
| HISTORICAL | Prior-episode administration / "Z. n." / background-only list entry | not given | HISTORICAL |
Plus one non-label outcome:
| DROP / not-a-treatment | Not a treatment mention at all (lab value, radiology finding, exam, bare diagnosis) | — | — |
2. The binary collapse rule (the core definition)
- given = the note asserts the drug/treatment is currently being administered or performed in this encounter or treatment episode (at the time of documentation), or a home med is being actively continued/taken now in the current care context.
- not given = everything else: planned, discussed, refused, withheld, contraindicated, paused, stopped, historical ("Z. n."), or merely listed.
Important (resolves the PAUSED/STOPPED case): "given" means current administration status, not "ever given during the episode." A drug labeled PAUSED or STOPPED is not given in the binary, even if it was administered earlier in this episode — because the model error we are hunting is a current false administration (e.g. calling a discontinued drug "currently given").
Per CMO ruling: historical "Z. n." and background medication lists are NOT given.
3. Decision procedure (apply in this order)
- Is it actually a treatment/medication mention? No → DROP (Section 6b/6h). Yes → continue.
- Explicit status trigger present? (refused, pausiert, abgesetzt, Z. n., bei Bedarf, Cave/kein-+drug, geplant/besprochen, falls…, frustran) → assign that leaf. (Triggers override the heading.)
- Under a routed section heading? (Section 4) → apply the heading default.
- Verb test (Section 3a) → GIVEN vs not given.
- Still unclear? → use episode-scoping judgment; if genuinely undecidable, default not given and flag the row for adjudication.
3a. Verb test (fallback for prose and the ambiguous heading)
Tense and framing decide direction — bare "continuation" words are not automatically given.
- → given (current administration / active continuation): erhielt · bekam · appliziert · verabreicht · umgestellt auf · begonnen mit · wurde fortgeführt · nimmt (weiter) ein
- → not given (forward-looking / plan): soll · geplant · empfohlen · soll weitergeführt/fortgesetzt werden · für zuhause fortführen · bei Entlassung fortsetzen
- Watch: bare "eingenommen" alone can be a historical self-report — it triggers given only when anchored to current intake ("nimmt ein", "weiter eingenommen", "wurde fortgeführt"). Bare "weiterführen / fortsetzen" without "wurde/nimmt" leans PLANNED, not given.
4. Section-heading routing (locked)
The heading often settles the label before you read the line.
| Heading (+ synonyms) | Default | Leaf |
|---|---|---|
| Vormedikation · Aufnahmemedikation · Medikation bei Aufnahme · Hausmedikation · Dauermedikation · Heimmedikation · Bisherige Medikation | not given | HISTORICAL/background |
| Entlassmedikation · Austrittsmedikation · Entlassrezept · Medikation zur/bei Entlassung · Therapieempfehlung · Medikationsempfehlung | not given | PLANNED (forward-looking) |
| Therapie während des Aufenthalts · Im Verlauf erhielt · Stationäre Medikation · Medikation auf Normalstation | given | GIVEN |
| Notfallmedikation · Intraoperative Medikation · Prämedikation | given | GIVEN |
| Abgesetzte Medikation | not given | STOPPED |
| Pausierte Medikation | not given | PAUSED |
| Bedarfsmedikation (PRN) | not given unless an administration is documented | PLANNED + PRN tag |
| Aktuelle Medikation · Aktueller Medikamentenplan · Medikation bei Verlegung | line-by-line (verb test) — do NOT auto-call given | by verb test |
The last row is the validated-ambiguous case: in this corpus these headings carried no administration verb in 48/48 occurrences, so they are decided by the line text, not the heading.
5. Per-leaf detail with German examples
GIVEN — "Die Patientin erhielt eine Therapie mit Kortikosteroiden i.v." · "… 2000 ml NaCl 0,9 % verabreicht." → administration carried out now.
CONTINUED-active — "Die Hausmedikation mit Ramipril 5 mg wurde unverändert fortgeführt." → continuation asserted → given. (Compare HISTORICAL below.) Also CONTINUED-active: continuous-delivery meds the patient arrived on and keeps receiving during the encounter (insulin pump, fentanyl/opioid patch, ongoing infusion), even without a "fortgeführt" verb — delivery is active now.
PLANNED — "Procedere: Eine Rektumamputation wäre vorgesehen." · "Entlassmedikation: Bisoprolol 2,5 mg (Fortführung empfohlen)." → intended, not done.
DISCUSSED — "Im Tumorboard besprochen, empfohlen wird …" → counseled, no action.
REFUSED — "Patient verweigert die Bluttransfusion (g. ä. R.)." → patient declined. Add the AMA modifier when "gegen ärztlichen Rat / Revers" (Section 8).
WITHHELD/CONTRAINDICATED — "Cave Penicillin." · "Auf eine Antibiose wurde verzichtet." · "ACE-Hemmer bei Niereninsuffizienz zurückgehalten." → clinician did not start it. ⚠ Only when a real drug is named (Section 6b). Disambiguation: "zurückgehalten" is ambiguous — if an ongoing med is temporarily held with expected resumption, use PAUSED; reserve WITHHELD for not-started / deliberately not given (contraindication, allergy, risk, decision to refrain). An allergy/known intolerance noted without a specific decision this episode still maps to WITHHELD/CONTRAINDICATED.
PAUSED — "Metformin präoperativ pausiert." · "Enalapril 2,5 mg dzt pausiert."
STOPPED — "Ramipril abgesetzt." · "Marcumar ex." Disambiguation: "ex"/abgesetzt = STOPPED when it's part of a current med-status statement (the drug was on the regimen and is now discontinued). If a prior therapy appears only as distant background exposure, label HISTORICAL instead.
HISTORICAL — "Z. n. Cortison-Stoßtherapie." · "14 Zyklen Raltritrexed 01/97–10/18" (dated past therapy in a Diagnosen block). → prior episode, not now.
6. Special rules and traps
6a. Continued / home medication (Dauer-/Hausmedikation)
Test: does the note assert current intake or continuation in this episode? Yes → CONTINUED-active (given). No (merely listed) → HISTORICAL/background (not given). Default / tie-breaker: if no word asserts current intake or continuation → not given. Heading override: explicit current-intake language beats the section heading — "Patient nimmt zu Hause Marcumar ein" is CONTINUED-active (given) even under a "Vormedikation" heading.
| German | Decider | Leaf | Binary |
|---|---|---|---|
| "Hausmedikation mit Ramipril 5 mg fortgeführt." | continuation verb | CONTINUED-active | given |
| "Vormedikation bei Aufnahme: Ramipril 5 mg 1-0-0, Metformin 1000 mg 1-0-1." | bare admission list | HISTORICAL | not given |
| "Hausmedikation: L-Thyroxin 75 µg." | no marker → default | HISTORICAL | not given |
| "Patient nimmt zu Hause Marcumar ein; im Verlauf pausiert, Bridging mit Enoxaparin." | later clause flips it | Marcumar → PAUSED; Enoxaparin → GIVEN | not given / given |
6b. The "kein = finding negation" trap (WITHHELD) ⚠ most common error
"kein/keine" and "Cave" only mean WITHHELD when they negate a drug/treatment. When they negate a finding (radiology, lab, exam), the line is not a treatment mention at all → DROP.
| German | Label |
|---|---|
| "Keine freie intraperitoneale Luft." | DROP (radiology finding) |
| "Kein Nachweis path. Lymphknoten." | DROP (radiology finding) |
| "keine Nebenwirkungen der Chemo." | DROP (this is a result, not a withheld drug) |
| "Auf eine Antibiose wurde verzichtet." | WITHHELD (real — a drug is withheld) |
| "Kein ASS bei Allergie." | WITHHELD (real — a drug is withheld) |
Rule of thumb: if removing the negation leaves no actual drug/therapy, it's a finding → DROP.
6c. Cross-sentence / propose-then-cancel
Label by the final asserted status, reading the next sentence/clause. Tag cross-sentence.
"Beginn einer Antikoagulation geplant; hiervon jedoch abgesehen bei Blutungsrisiko." → WITHHELD.
6d. Dated past therapies in Diagnosen / Anamnese blocks
A treatment with a date under a history heading (Diagnosen, Anamnese, Zwischenanamnese, Verlauf der Tumorerkrankung) and no present-administration verb → HISTORICAL. These are the bulk of GraSCCo's oncology content.
6e. PRN / "bei Bedarf" / b. B.
A standing PRN order is not given (leaf PLANNED, tag prn) unless an actual
administration is documented ("… b. B., erhielt 1×"). Then GIVEN.
6f. "frustran"
Attempted but failed (e.g. "PVK-Anlage frustran") → the intended drug was not
delivered → not given (leaf PLANNED, tag frustran).
6g. Over-split chemo regimens
The pre-fill splits multi-line protocols into fragments ("5-FU (2000 mg/m²)", "Tag 1–14, Pause Tag 15–21"). Merge fragments back to the parent regimen and label once. Do not label schedule fragments separately.
6h. DROP / not-a-treatment
Drop lab values, radiology/sono/CT/MR findings, exam descriptions, vital signs, and
bare diagnoses with no associated treatment. Mark the row DROP; it leaves the eval set.
7. Phenomenon tagging (for the "where it breaks" breakdown)
In addition to the leaf, tag each mention with every phenomenon that applies (multi-tag):
negation · refusal · discussion-only · cross-sentence · prn · paused ·
stopped · contraindication · historical · conditional (falls…dann) · frustran
These drive the per-phenomenon accuracy and false-administration breakdown, so tag generously.
8. Modifiers
- AMA (against medical advice): set on REFUSED when "gegen ärztlichen Rat / g. ä. R. / Revers" appears. The leaf stays REFUSED; the modifier is recorded separately.
9. Quality process (κ)
- Primary annotator labels the full set following this guideline.
- An independent, German-speaking human clinician (not the primary annotator)
labels 20–30% of the items. An AI/model cannot serve as this rater — the
benchmark exists to test AI on clinical text, so validating the gold with AI is circular
and not defensible. (An AI pass may be reported separately as an exploratory third signal,
never as the κ rater.)
- Suitable rater: internist or oncologist, senior internal-medicine/oncology resident, or an oncology-savvy clinical pharmacist / documentation specialist.
- Sample size (this corpus):
500–600 labelable items → 20–30% ≈ **120–180 mentions** double-labeled (a few hours of clinician time). Stratify to include the hard phenomena (home-med, WITHHELD, PAUSED, STOPPED, PRN, "kein" negation, cross-sentence) — oversample them, since rare leaves otherwise yield too few items for a stable κ. - Report Cohen's κ per leaf and for the binary. Targets: binary κ ≥ 0.8 (good); per-leaf 0.6–0.8 acceptable; a leaf < 0.6 signals the guideline is unclear there → issue a v1.x clarification before relying on that category. Expect home-med and WITHHELD to be weakest.
- Adjudicate disagreements; record resolutions; then freeze the eval set. No further edits.
10. Quick-reference card
| If the mention says… | Leaf | Binary |
|---|---|---|
| erhielt / verabreicht / appliziert (this stay) | GIVEN | given |
| fortgeführt / weiter eingenommen (home med, now) | CONTINUED-active | given |
| geplant / vorgesehen / soll / Entlassmedikation | PLANNED | not given |
| besprochen / empfohlen / Tumorboard | DISCUSSED | not given |
| verweigert / abgelehnt / Revers | REFUSED | not given |
| Cave / kein + drug / verzichtet auf / zurückgehalten | WITHHELD | not given |
| pausiert / ausgesetzt | PAUSED | not given |
| abgesetzt / ex | STOPPED | not given |
| Z. n. / dated past therapy / background list | HISTORICAL | not given |
| bei Bedarf / b. B. (no admin documented) | PLANNED (tag prn) | not given |
| frustran (attempt failed) | PLANNED (tag frustran) | not given |
| kein + finding / lab / radiology / exam | DROP | — |