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CBSSM Seminar: Timothy R. B. Johnson, M.D.

Tue, October 03, 2017, 3:00pm
Location: 
NCRC, Building 10, G065

Timothy R. B. Johnson, M.D.
Arthur F. Thurnau Professor and Chair, Department of Obstetrics and Gynecology
Bates Professor of the Diseases of Women and Children
Professor of Obstetrics and Gynecology and Women’s Studies
Research Professor, CHGD

Title: Global Health Ethics and Reproductive Justice: Breadth and Depth in CBSSM

Global Health Ethics and Reproductive Justice (in this instance sexual rights and gender equity, specifically gender and sexual harassment/assault in Academic Medical Centers) appear to be areas where a number of CBSSM members have interest, expertise and are working inter-disciplinarily in domains that will differentiate CBSSM nationally and internationally. Could and should these develop into CBSSM thematic interests? Whatever the case, they will remain topics of significant interest across CBSSM and are worthy of broad discussion and  understanding.

CBSSM Seminar: Peter Jacobson, J.D., M.P.H.

Tue, October 10, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Peter Jacobson, J.D., M.P.H.
Professor of Health Law and Policy
Director, Center for Law, Ethics, and Health

Title:  Addressing Health Equity Through Health in All Policies Initiatives.

Scholars and public health advocates have expressed optimism about the potential for Health in All Policies (HiAP) initiatives to improve both health equity and population health. HiAP is a collaborative approach across multiple sectors. In a qualitative study to assess these concepts, we found considerable variation across the sites on: how HiAP and equity initiatives are defined and governed; the integration of equity as a core goal; institutional capacity; and the determination of actual policy changes. We found a general migration from a HiAP-centered strategy to one based more on health equity. Regardless of the specific nomenclature, the implementation focus was directed more toward changing practices than policies.

 

CBSSM was well-represented at the annual American Society for Bioethics & Humanities (ASBH) in Kansas City, MO (Oct 19-22) and the Society for Medical Decision Making (SMDM) in Pittsburgh, PA (Oct 22-25).

At ASBH, Andrew Shuman, Susan Goold, Kayte Spector-Bagdady, Janice Firn, Kerry Ryan, Michele Gornick, Stephanie Kukora, Naomi Laventhal, and Christian Vercler presented.

At SMDM, Michele Gornick, Sarah Hawley, and Dean Shumway presented. Several CBSSM alumni also presented.
 

CBSSM Seminar: Roi Livne, PhD

Wed, November 08, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Roi Livne, PhD
Assistant Professor, Sociology

Title: “The New Economy of Dying: Palliative Care, Morality, and Finance in the Age of Excess”

Abstract: This talk argues that over the past 40 years, a new economy has emerged around end-of-life care: one seeking to control, cap, and limit both spending and treatment near the end of life. Built around the expertise of Hospice and Palliative Care, this economy draws on the moral conviction that near the end of life, less treatment (and consequently, less spending) is better. Based on a historical analysis and ethnographic fieldwork in three California hospitals, Livne examines the interactive work that palliative care clinicians do with severely ill patients and their families, trying to facilitate their voluntary consent to pursue less life-sustaining and life-prolonging treatments.

 

Joseph Colbert, BA

Research Associate

Joseph joined CBSSM as a Research Area Specialist in November 2017. As a project manager, he coordinates the daily operations of Dr. Jeffrey Kullgren’s project “Provider, Patient, and Health System Effects of Provider Commitments to Choose Wisely,” a grant funded research project using novel approaches to reduce the overuse of low-value services in healthcare.

Last Name: 
Colbert

Woll Family Speaker Series: Debate on Conscience Protection

Fri, March 09, 2018, 12:00pm to 1:00pm
Location: 
Med Sci II, West Lecture Hall

The Woll Family Speaker Series on Health, Spirituality and Religion

We are excited to be hosting a debate on Conscience Protection on Friday March 9th from 12-1 as part of the UMMS Program on Health, Spirituality and Religion. Please save the date! CME Credit provided (see below).

Point: Healthcare professionals are "obligated to provide, perform, and refer patients for interventions according to the standards of the profession.” NEJM, 2017

Counterpoint: Healthcare professionals have the right to opt out of performing or referring for procedures they view as objectionable in accord with their religious or personal values.

Join Dr. Naomi Laventhal and Dr. Ashley Fernandes in this academic discussion as part of the University of Michigan Program on Health, Spirituality and Religion.

Bioethics Grand Rounds- Janice Firn, PhD & Tom O'Neil, MD

Wed, December 20, 2017, 12:00pm
Location: 
Univerisity Hospital Ford Auditorium

Professionalism, Ethical Obligations, and the Moral Imperative of Self-Care

Abstract:
Healthcare providers are inevitably called to participate in and bear witness to emotionally challenging cases. Combined with time constraints, competing responsibilities, the urgent nature of these cases, healthcare providers risk burnout.  The consequences of burnout have been shown to be increased staff turnover, substandard patient outcomes and increased likelihood for errors.  As part of competent clinical practice, healthcare providers must not only attend to the needs of the patient and family but also themselves. However, a tension exists between making enough time for patients and taking enough time for oneself. But, engaging in self-care activities can help address clinician distress; this practice is essential for remaining compassionate, providing competent patient care services, and avoiding harm. Healthcare providers, therefore, have an ethical duty to engage in personal self-care.  This presentation makes a case for why self-care is a key component of competent clinical practice.  Several ways in which a lack of self-care can undermine professional competence, thus risking burnout and poor patient outcomes, are discussed. Strategies for recognizing and addressing burnout are also reviewed.

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.

Are you a numbers person? (Oct-07)

Many types of medical decisions involve making sense of numbers such as test results, risk statistics, or prognosis estimates. But people vary in their ability and confidence with numbers. How would you rate your own "numeracy"?

 

Not good at all

 

 

 

 

 

Extremely good

How good are you at working with fractions?

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How good are you at working with percentages?

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How good are you at calculating a 15% tip?

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How good are you at figuring out how much a shirt will cost if it is 25% off?

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Not at all helpful

 

 

 

 

Extremely helpful

When reading the newspaper, how helpful do you find tables and graphs that are parts of a story?

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Always prefer words

 

 

 

 

Always prefer numbers

When people tell you the chance of something happening, do you prefer that they use words ("it rarely happens") or numbers ("there's a 1% chance")?

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Always prefer percentages

 

 

 

 

Always prefer words

When you hear a weather forecast, do you prefer predictions using percentages (e.g., "there will be a 20% chance of rain today") or predictions using only words (e.g., "there is a small chance of rain today")

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Never

 

 

 

 

Very often

How often do you find numerical information to be useful?

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Why is it important for researchers to know how numerate you are?

When a doctor or health educator is trying to communicate complex statistical information to a patient, it's helpful to know how well the patient understands numbers. This is called numeracy-the ability to process basic probability and numerical concepts. People low in numeracy might want or need different types of explanations than people high in numeracy.

How is numeracy measured?

In the past, researchers have used surveys similar to math tests to evaluate the levels of numeracy of participants in research studies. These objective numeracy tests can be time-consuming to administer and are often seen by the participants as stressful and annoying. As an alternative, a CBDSM research team-including Angela Fagerlin, Brian Zikmund-Fisher, Dylan Smith, Aleksandra Jankovic, and Peter Ubel-recently designed and tested an eight-item self-assessment tool, called the Subjective Numeracy Scale (SNS), to measure numeracy. As you saw when you completed the tool, four of the questions on the SNS measure people's beliefs about their skill in performing various mathematical operations, and four measure people's preferences about the presentation of numerical information. When the CBDSM team tested the SNS, they found that it was moderately correlated with objective numeracy tests. In a variety of risk communication and preference elicitation tasks, the SNS also predicted people's behavior almost as well as an objective numeracy test did. The advantage of the SNS is that it is quick to administer and is less stressful to participants than objective tests. In addition, only the SNS is recommended for phone or Internet administration. The researchers also found that study participants who completed the SNS were much more likely to answer all the numeracy questions and were much more likely to say that they would be willing to participate in an additional research study.

Are their broader implications?

Research has shown that many Americans, including highly educated individuals, have low levels of numeracy. Low numeracy has significant implications for people's health care, especially when it comes to understanding the risks and benefits of treatments. Although we may not easily change people's numeric ability, it may be possible to create health education materials that help patients with low numeracy skills. Several CBDSM researchers are have been pursuing this subject.

Read the articles:

Measuring numeracy without a math test: development of the subjective numeracy scale (SNS).
Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM. Medical Decision Making 2007;27(5):672-680.

Validation of the subjective numeracy scale (SNS): Effects of low numeracy on comprehension of risk communications and utility elicitations.
Zikmund-Fisher BJ, Smith DM, Ubel PA, Fagerlin A. Medical Decision Making 2007;27(5):663-671.

Making numbers matter: Present and future research in risk communication.
Fagerlin A, Ubel PA, Smith DM, Zikmund-Fisher BJ. American Journal of Health Behavior 2007;31(Suppl. 1):S47-S56.

 

 

Bioethics Grand Rounds -Reshma Jagsi, MD, DPhil

Wed, October 25, 2017, 12:00pm
Location: 
UH Ford Auditorium

Reshma Jagsi, MD, DPhil

Title – "Ethical Issues Related to Fundraising from Grateful Patients"

Abstract: Health care institutions are becoming increasingly deliberate about philanthropic fundraising given the need to sustain their missions in the face of decreases in governmental research funds and lowering reimbursement for clinical care.  Donations from grateful patients constitute 20% of all philanthropic contributions to academic medical centers, totaling nearly $1 billion a year in recent years.  Institutions frequently employ development professionals to facilitate philanthropy. The development literature describes various approaches for identifying patients capable of contributing, cultivating potential donors, and engaging physicians in the solicitation of grateful patients, emphasizing that patients themselves may also benefit from exercising altruism in this way.  However, little evidence exists to guide the ethical practice of grateful patient fundraising, and concerns exist regarding privacy and confidentiality, patient vulnerability, and physicians' conflicts of obligations in this context.  Therefore, we will discuss how the process of philanthropic development should be structured in order to demonstrate respect for all persons involved, including patients who donate, those who might consider donation, those who do not wish to donate, and those who cannot afford to do so.

Lunch is provided. Please note: Lunch is first come, first served.

 

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