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Mon, July 31, 2017

Sarah Hawley and co-authors, David Miller and Megan Haymart, recently discussed their New England Journal of Medicine perspective piece, "Active Surveillance for Low-Risk Cancers — A Viable Solution to Overtreatment?" in an MHealth Lab interview. They discuss whether active surveillance — close monitoring without immediate treatment — could reduce overtreatment for some thyroid, prostate and breast cancer patients.

Tue, August 22, 2017

A new study finds that more than half of women with early stage breast cancer consider an aggressive surgery to remove both breasts. The way women generally approach big decisions, combined with their values, affects which breast cancer treatment they think about, the study also found.

CBSSM members, Sarah Hawley and Reshma Jagsi, were authors on this study.

 

Panel Discussion: Ethical, Legal, and Social Implications of Genetics and Newborn Screening

Mon, September 25, 2017, 6:00pm
Location: 
Vandenberg Room, Michigan League

Join Joselin Linder, author of “The Family Gene”, and Jodyn Platt, assistant professor in the U-M Medical School in a panel discussion about the ethical, legal, and social implications of genetics and newborn screening. The conversation will be moderated by Kayte Spector-Bagdady, assistant professor in the U-M Medical School and chief of the research ethics service in the Center for Bioethics and Social Sciences in Medicine.

Tue, September 26, 2017

Dean Shumway, Rochelle Jones, Sarah Hawley, and Reshma Jagsi are co-authors of a study, published in the Annals of Surgical Oncology, which found that clinician attitudes and patient expectations are driving overtreatment of radiotherapy in older breast cancer patients.

Mon, October 02, 2017

Sarah Hawley, Brian Zikmund-Fisher, and Reshma Jagsi are co-authors of a recent study published in Medical Decision Making, which was highlighted in MHealth Lab. Their study found that talking to clinicians is the best way for breast cancer patients to understand their recurrence risk. They also found that clinician discussions about recurrence risk should address uncertainty and the relevance of family and personal history. Kamaria Lee is first author of the article.

Wed, October 11, 2017

In an editorial in Nature Human Behaviour, Brian Zikmund-Fisher discusses the findings of a recent study about the unintended consequences of argument dilution in direct-to-consumer drug advertising. In a series of experiments, study authors, Niro Sivanathan and Hemant Kakker found that long lists of serious and minor side effects found in drug advertisements actually "dilute" consumers' judgments of the overall risk from side effects.

Thu, October 26, 2017

In a new analysis in Health Affairs, CBSSM's Jeffrey Kullgren and fellow researchers found that while the "Choosing Wisely" campaign to reduce overtesting and overtreatment is off to a strong start, more work is still needed to cut back on low-value care.

CBSSM Seminar: Jan Van den Bulck, PhD

Tue, November 28, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Jan Van den Bulck, PhD
Professor, Communication Studies

Topic:
"Are the media (re-)defining how we interact with each other and with the world?

We know everything there is to know about people we have never even met. Through social media, we follow their every move. We even know their pets. Our media use interferes with healthy sleep, family meals, or even our work. Our children need levels of self-control to manage distractions that threaten their schoolwork. Or do they?"

Tue, November 28, 2017

In a study published in JAMA Internal Medicine, Jeff Kullgren and co-authors found that few individuals enrolled in High-Deductible Health Plans (HDHPs) in the United States are engaging in consumer behaviors.

The Privileged Choices (Jan-08)

What's the difference between opting in and opting out of an activity? Who decides if people will be put automatically into one category or another? Click this interactive decision to learn how default options work.

Scenario 1

Imagine that you're a US Senator and that you serve on the Senate's Committee on Health, Education, Labor, and Pensions. The Infectious Diseases Society of America has come before your committee because they believe that too many health care workers are getting sick with influenza ("flu") each year and infecting others. As a result, your Senate committee is now considering a new bill that would require that all health care workers get annual influenza vaccinations ("flu shots") unless the worker specifically refuses this vaccination in writing.

Do you think you would support this bill for mandatory flu shots for health care workers?

  • Yes
  • No

Scenario 2

Imagine that you're the human resources director at a mid-sized company that's initiating an employee retirement plan. Management is concerned that many employees are not saving enough for retirement. They're considering a policy that would automatically deduct retirement contributions from all employees' wages unless the employee fills out and submits a form requesting exemption from the automatic deductions.

Do you think a policy of automatic retirement deductions is reasonable for your company to follow?

  • Yes 
  • No

Scenario 3

Organ transplants save many lives each year, but there are always too many deserving patients and too few organs available. To try to improve the number of organs available for donation, the state legislature in your state is considering a new policy that all people who die under certain well-defined circumstances will have their organs donated to others. The system would start in three years, after an information campaign. People who do not want to have their organs donated would be given the opportunity to sign a refusal of organ donation when they renewed their drivers' licenses or state ID cards, which expire every three years. Citizens without either of these cards could also sign the refusal at any drivers' license office in the state. This is a policy similar to ones already in place in some European countries.

Does this seem like an appropriate policy to you?

  • Yes 
  • No

How do your answers compare?

For many decisions in life, people encounter default options-that is, events or conditions that will be set in place if they don't actively choose an alternative. Some default options have clear benefits and are relatively straightforward to implement, such as having drug prescriptions default to "generic" unless the physician checks the "brand necessary" box. Others are more controversial, such as the automatic organ donation issue that you made a decision about.

Default options can strongly influence human behavior. For example, employees are much more likely to participate in a retirement plan if they're automatically enrolled (and must ask to be removed, or opt out) than if they must actively opt in to the plan. Researchers have found a number of reasons for this influence of default options, including people's aversion to change.

But default options can seem coercive also. So, an Institute of Medicine committee recently recommended against making organ donation automatic in the US. One reason was the committee's concern that Americans might not fully understand that they could opt out of donation or exactly how they could do so.

The policy scenarios presented to you here have been excerpted from a 2007 article in the New England Journal of Medicine titled "Harnessing the Power of Default Options to Improve Health Care," by Scott D. Halpern, MD, PhD, Peter A. Ubel, MD, and David A. Asch, MD, MBA. Dr. Ubel is the Director of the Center for Behavioral and Decision Sciences in Medicine.

This article provides guidance for policy-makers in setting default options, specifically in health care. Generally, default options in health care are intended to promote the use of interventions that improve care, reduce the use of interventions that put patients at risk, or serve broader societal agendas, such as cost containment.

In this NEJM article, the researchers argue that default options are often unavoidable-otherwise, how would an emergency-room physician decide on care for an uninsured patient? Many default options already exist but are hidden. Without either returning to an era of paternalism in medicine or adopting a laissez-faire approach, the authors present ways to use default options wisely but actively, based on clear findings in the medical literature.

Some examples of default policies that may improve health care quality:

  • routine HIV testing of all patients unless they opt out.
  • removal of urinary catheters in hospital patients after 72 hours unless a nurse or doctor documents why the catheter should be retained.
  • routine ventilation of all newly intubated patients with lung-protective settings unless or until other settings are ordered.

Drs. Halpern, Ubel, and Asch conclude, "Enacting policy changes by manipulating default options carries no more risk than ignoring such options that were previously set passively, and it offers far greater opportunities for benefit."

Read the article:

Harnessing the power of default options to improve health care.
Halpern SD, Ubel PA, Asch DA. New England Journal of Medicine 2007;357:1340-1344.

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