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CBSSM Seminar: Stephen Molldrem, PhD Candidate

Thu, July 07, 2016, 3:00pm
Location: 
NCRC Building 16, Conference Rm 266C

Stephen Molldrem, PhD Candidate, American Culture

Title: Collecting and Managing Sexual Orientation and Gender Identity Data in Health Contexts: Bioethical Dilemmas from a Queer Historical Perspective

Abstract: This talk, drawn from dissertation research, historicizes a number of regulatory changes governing the collection and management of sexual orientation and gender identity data in health contexts in the United States that have taken place since 2009. It focuses on a range of less-considered bioethical dilemmas that stem from the introduction of questions about sexual orientation and gender identity into the battery of demographic information collected in certified Electronic Health Record technologies.

Bioethics Grand Rounds

Wed, July 27, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Kunal Bailoor, MD Candidate Class of 2018, Ethics Path of Excellence

"Advance Care Planning: Beyond Durable Power of Attorney (DPOA)"

Abstract: Advance care planning is a crucial part of end of life medical care. It can take many forms, including designation of a surrogate decision maker via a DPOA document. However it can also involve living wills, physicians orders for life sustaining treatment (POLSTs), or even simply clinician patient conversation. The newly revised hospital policy on advance directives reflects this broader approach. The talk will include a brief review of the philosophical and ethical basis of advance care planning before diving into a discussion of the new hospital policy and it's impact on practice.

 

Suzanne Young, who is the granddaughter of Ronald and Nancy Bishop, was recently featured on the American Society for Microbiology podcast "This Week in Microbiology" (TWiM #135 ~ min 50:28).  Suzanne Young is a doctoral student at the University of South Florida and was the lead author of a research article looking at the release of antibiotic-resistant bacteria following a sewage spill in Florida.

In addition to a discussion of Ms. Young's great research, her Ann Arbor roots, including her grandparents' social activism and the Bishop Lecture in Bioethics are also mentioned.

 

 

CBSSM Seminar: Susan Goold & Zachary Rowe (DECIDERS Project)

Thu, December 15, 2016, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Susan Goold, MD, MHSA, MA
Professor of Internal Medicine, Medical School
Professor of Health Management and Policy, School of Public Health

Zachary Rowe
Executive Director of Friends of Parkside (FOP)

Title:  Evaluation of CHAT as a tool for engaging communities in priority setting

Abstract:  Engaging minority and underserved communities in setting research priorities could make the scientific research agenda more equitable and more responsive to their needs.  This presentation evaluates CHAT, a serious game, to prioritize health research based on feedback from 47 focus groups (N=519) across Michigan.

Fri, December 09, 2016

Kenneth Langa's national study, published in JAMA Internal Medicine, was cited in a New York Times article discussing US dementia trends. Despite concern that dementia rates were increasing, Langa found that it is actually decreasing. He found that population brain health seemed to improve between 2000 and 2012 and that increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement. However, the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain.

Research Topics: 

Brian Zikmund-Fisher, Sarah Hawley, Reshma Jagsi and others were recently published in a JAMA Oncology research letter on breast cancer patient risk communication. They found that medical oncologists were found to be far more likely than surgeons to quantify risk estimates for patients and that patients who do not see a medical oncologist may make treatment decisions, including surgery, without all relevant risk information.

For the full article: http://oncology.jamanetwork.com/article.aspx?articleid=2491464

 

The new, enhanced UMHS Ethics committee was featured in the Office of Clinical Affairs "Chief Brief." According to the article, "ECCA members complimented the committee’s improved access to ethics consultation services, focus on proactive and preventative ethics education, and unification of adult and pediatric efforts. Since the programmatic rollout, there has been a 45 percent increase in clinical ethics consultation volume from the prior year, and an 82 percent increase from average of the prior five years." Dr. Andrew Shuman and Dr. Christian Vercler are the co-directors of CBSSM's Program in Clinical Ethics. Dr. Janice Firn is the clinical ethicist who manages the program on a daily basis.

Kathryn Moseley, MD, MPH

MD vs. WebMD: The Internet in Medical Decisions (Dec-10)

With just a simple search term and a click of the mouse, a person can find a large amount of health information on the Internet. What role does the Internet play in how patients make medical decisions? Does using the Internet as a source for information to help patients make informed decisions vary by health condition? Does the Internet substitute for detailed discussions with a health care provider?

Consider the following:

Imagine that you recently visited your health care provider for an annual physical examination. During the exam your doctor told you that you are at the age where you should start thinking about getting a screening test for colon cancer. In this conversation your health care provider explained some of the reasons why you should get screened. At the end of the visit, you had more information about screening tests for colon cancer but had not yet decided whether or not you wanted to get tested.

As you think about how you would make a decision about whether or not to get screened for colon cancer:
 
How important is your health care provider as a source of information about screening tests for colon cancer?
Not at all important (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Extremely important
 
Would you use, or have someone else use for you, the Internet to find information on screening tests for colon cancer?
 
  • Yes
  • No
  • Don't know
How important is the Internet as a source of information screening tests for colon cancer?
Not at all important (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Extremely important
 
 
 

How do your answers compare?

In a recent study published in the journal Medical Decision Making, CBSSM investigators Brian Zikmund-FisherMick Couper, and Angela Fagerlin examined Internet use and perceived importance of different sources of information by patients making specific medical decisions.

In this study, US adults aged 40 years and older were asked about how they got information about 9 common medical decisions, including decisions about common prescription medication (for high blood pressure, cholesterol, and depression), cancer-screening tests (for colorectal, breast, and prostate cancer), and elective surgeries (for lower back pain, cataracts, and knee/hip replacement). In addition, they study compared participants' ratings of the Internet as a source of information with their ratings of other sources, such as their health care provider.

So, how did your responses compare to the average adult in this study's population?

Results from this study showed that most patients did not use the Internet to make specific medical decisions like the ones you considered. On average, about 26% of participants made use of the Internet for information to make decisions about colon cancer screening tests and about 47% used it to inform a decision about lower back pain surgery.

Among participants who chose to use the Internet for finding information about specific medical decisions, data show that Internet use varies significantly across different types of medical decisions. Internet users were more likely to use the Internet for information related to elective surgery (36%), such as lower back pain surgery, and prescription medication (32%) than for cancer-screening decisions (22%), such as colon cancer screening.

Another element of this study looked at participants' ratings of different information sources. You are unlike other participants in this study in that you did not consistently rate health care providers as the most important source for information about colon cancer screening and lower back pain surgery. The CBSSM study found that, for both Internet users and nonusers, health care providers were rated highest as a source for information for all 9 decisions studied. Among Internet users, however, the Internet was rated as their 2nd-most important source of information.

The researchers found that Internet use to inform specific medical decisions varied by age ranging from 38% for those aged 40 to 49 years to 14% for those aged 70 years or older. Approximately 33% of 50 to 59 year olds used the Internet to make these medical decisions and 24% for those in the 60 to 69 year age category. This result is consistent with previous research on the demographics of Internet use.

The study authors concluded that the Internet has an impact on people's access to health care information; however, "the data suggest that access is not the same as use, and use for one medical decision does not imply use for all health decisions." In other words, people use the Internet differently depending on the context. The authors end by stating, "Clinicians, health educators, and health policy makers need to be aware that we remain a long way away from having Internet-based information sources universally used by patients to improve and support the process of medical decision making."

For the full text of this article:

Couper M, Singer E, Levin CA, Fowler F, Fagerlin A, Zikmund-Fisher BJ. Use of the internet and ratings of information sources for medical decisions: Results from the DECISIONS survey. Medical Decision Making 2010;30:106S-114S.

 

Give or take a few years (Feb-05)

A longer life may result from the amount of social support present in your life, but is the longevity due to giving or receiving that support?

Imagine that in your busy schedule each week, you typically at least have Wednesday and Saturday nights free as time to spend however you want. Recently, however, one of your close friends had her car break down and now she is wondering whether you would be willing to drive her to and from a yoga class on Wednesday nights for the next three weeks while the car is in the shop. She told you that the class is only about a 15 minute drive each way. She said that you shouldn't feel pressured, and she just thought she'd ask if you had the time to help her out.

Would you be willing to drive your friend to and from her yoga class for the next three weeks?
  • Yes, I'd take the time to help her out.
  • No, I'd keep my Wednesday nights free.
Do you think that helping out others could at all affect your health?
  • Yes
  • No

Giving vs. receiving: effects on mortality

A research team of investigators at the U of M Institute for Social Research teamed up with CBDSM investigator, Dylan Smith, to conduct a study investigating whether giving or receiving help affects longevity. The researchers noted that receiving social support is likely to be correlated with other aspects of close relationships, including the extent to which individuals give to one another. Based on this, they hypothesized that some of the benefits of social contact, sometimes attributed to receiving support from others, may instead be due to the act of giving support to others.

Using a sample of 423 married couples from the Detroit area, the investigators conducted face-to-face interviews over an 11-month period. The interviews assessed the amount of instrumental support respondents had given to and received from neighbors, friends, and relatives, as well as the amount of emotional support they had given to and received from their spouse. Instrumental support included things like helping with transportation, errands, and child care, whereas emotional support involved having open discussions with a spouse and feeling emotionally supported. Mortality was monitored over a 5-year period by checking daily obituaries and monthly death record tapes provided by the State of Michigan. To control for the possibility that any beneficial effects of giving support are due to a type of mental or physical robustness that underlies both giving and mortality risk, the investigators also measured a variety of demographic, health, and individual difference variables, including social contact and dependence on the spouse.

The investigators found that those who reported giving support to others had a reduced risk of mortality. This was true for both instrumental supoprt given to neighbors, friends, and relatives, and for emotional support given to a spouse. They also found that the relationship between receiving social support and mortality depended on other factors. Specifically, receiving emotional support appeared to reduce the risk of mortality when dependence on spouse, but not giving emotional support, was controlled. Receiving instrumental support from others actually increased the risk of mortality when giving support, but not dependence on spouse, was controlled.

What can we make of these findings?

It appears from these results that the benefits of social contact are mostly associated with giving rather than receiving. Measures that assess receiving alone may be imprecise, producing different results as a function of dependence and giving support.

Given the correlational nature of this study, it is not possible to determine conclusively that giving support accounts for the social benefit traditionally associated with receiving support. Nevertheless, the results of the present study should be considered a strong argument for the inclusion of measures of giving support in future studies of social support, and perhaps more importantly, researchers should be cautious of assuming that the benefits of social contact reside in receiving support.

It's true that when helping others out, you might have to give up some of your own time, but based on the above findings, it looks like in the long run you may end up ultimately gaining more time.

Read the article:

Providing social support may be more beneficial than receiving it: results from a prospective study of mortality.
Brown S, Nesse RM, Vinokur AD, Smith DM. Psychological Science 2003;14:320-327.

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