Jeff DeWitt completed a PhD in Social Psychology in 2017 while working in Dr. Gretchen Chapman's Medical Decision Making Lab at Rutgers University. Broadly, Jeff's research is focused on the interplay between social cognition and behavioral decision making with an emphasis on healthcare applications. In particular, he has investigated how our representations and predictions of others' beliefs and goals can influence our own in altruistic medical contexts such as whether to donate blood or receive a flu shot.
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Jodyn Platt, MPH, PhD, Assistant Professor of Learning Health Sciences, has been named a University of Chicago MacLean Fellow.
As part of the one year Cancer Genomics and Ethics Big Data Science Fellowship she will receive clinical training in the Medical Ethics Summer Intensive Program and conduct a research project with Olufunmilayo Olopade, MD, FACP, Director of the Center for Clinical Cancer Genetics at University of Chicago Medicine.
Platt explains how her work as a fellow will begin: "I would like to systematically observe and interview individuals involved in shaping how data evolves and moves from the patient encounter to the big data enterprise and back to clinical care." Looking forward to expanding her network over the course of the year, she plans "to engage in, and lead, interdisciplinary scholarship that will ensure the revolution in healthcare delivery brought on by big data and cancer genomics is an ethical one."
Platt is also the organizer of the upcoming ELSI-LHS symposium on November 15th at U-M which explores the “Ethical, Legal and Social Implications of Learning Health Systems”.
Jennifer joined CBSSM in August 2017. She works with Dr. Susan Goold and community partners on grant funded research projects related to evaluating Medicaid expansion and its impact on beneficiaries through the Healthy Michigan Plan and ways in which to engage minority and underserved communities in setting priorities for community health.
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 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.
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.
Professionalism, Ethical Obligations, and the Moral Imperative of Self-Care
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.
Click to decide between death and living with a colostomy. Which would you choose? Are you sure?
Given the choice, would you choose immediate death,or living with a colostomy (where part of your bowel is removed and you have bowel movements into a plastic pouch attached to your belly)?
- Immediate Death
Think about what it would be like if you were diagnosed with colon cancer. You are given the option of choosing between two surgical treatments.The first is a surgery that could result in serious complications and the second has no chance of complications but has a higher mortality rate.
|Possible outcome||Surgery 1
|Cure without complication||80%||80%|
|Cure with colostomy||1%|
|Cure with chronic diarrhea||1%|
|Cure with intermittent bowel obstruction||1%|
|Cure with wound infection||1%|
|No cure (death)||16%||20%|
If you had the type of colon cancer described above, which surgery do you think you would choose?
- Surgery 1
- Surgery 2
How do your answers compare?
Are you saying what you really mean?
CBDSM investigators Brian Zikmund-Fisher, Angela Fagerlin, Peter Ubel, teamed up with Jennifer Amsterlaw, to see if they could reduce the number of people choosing the surgery with the higher rate of death and therefore reducing the discrepancy. A large body of past research has shown that people are notoriously averse to uncertainty. The investigators had a hunch that uncertainty could account for some of the discrepancy. Surgery 1 has a greater number of ambiguous outcomes, perhaps causing people to be averse to it. In an effort to minimize this uncertainty, the investigators laid out a series of scenarios outlining different circumstances and presentations of the two surgeries. For example the research presented some of the participants with a reframing of the surgery information, such as:
|Possible outcome||Surgery 1
|Cured without complication||80%||80%|
|Cured, but with one of the following complications: colostomy, chronic diarrhea, intermittent bowl obstruction, or wound infection||4%|
|No cure (death)||16%||20%|
The investigators believed by grouping all of the complications together that people would be more apt to chose the surgery with the lower mortality rate, because seeing a single group of undesirable outcomes, versus a list, may decrease some of the ambiguity from previous research.
Although none of the manipulations significantly reduced the percentage of participants selecting Surgery 2, the versions that yielded the lowest preference for this surgery all grouped the risk of the four possible complications into a single category, as in the example shown above.
Why these findings are important
Over the past several decades there has been a push to give patients more information so they can make decisions that are consistent with their personal preferences. On the other hand there is a growing psychological literature revealing people's tendency to make choices that are in fact inconsistent with their own preferences; this is a dilemma. Because the present research suggests that the discrepancy between value and surgery choice is extremely resilient, much research still needs to be done in order to understand what underlies the discrepancy, with the goal of eliminating it.
The research reported in this decision of the month is currently in press. Please come back to this page in the near future for a link to the article.
Read the article:
Can avoidance of complications lead to biased healthcare decisions?
Amsterlaw J, Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Judgment and Decision Making 2006;1(1):64-75.
CBSSM is soliciting applications from qualified individuals for 1-2 postdoctoral research fellow positions for the 2018-2019 academic year.
The mission of CBSSM is to be the premier intellectual gathering place of clinicians, social scientists, bioethicists, and all others interested in improving individual and societal health through scholarship and service.
Bioethics Post-Doctoral Research Fellow
Active projects in bioethics at CBSSM currently include the ethical, legal, and social implications of genomic medicine, human subjects research ethics, empirical research with relevance to clinical ethics, global bioethics, gender equity, reproductive justice, deliberative democratic methods in bioethics, resource allocation, ethical issues associated with learning health systems, and the sociology of medical ethics/bioethics, among others. Candidates' area of focus must be in bioethics, although their backgrounds may be in social or natural sciences, humanities, medicine, or law.
Decision Sciences Post-Doctoral Research Fellow
This fellowship focuses on understanding and improving the health care communication and decisions made by both patients and providers. Past postdoctoral fellows have included scholars whose research in health care communication and decision making has been approached using theories drawn from social cognition, motivation and emotion, risk communication, human factors, ethics, and economics.
Postdoctoral fellows are expected to collaborate on established projects and are encouraged to conduct independent research with an emphasis on study inception, manuscript writing, and applying for grants. CBSSM’s resources and collaborative support enable fellows to build their own research programs.
Please see: http://cbssm.med.umich.edu/training-mentoring/post-doctoral-fellowship for more details about these fellowship opportunities.