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Thu, February 11, 2016

Raymond De Vries, PhD and Scott Kim, MD, PhD 's study of euthanasia and assisted suicide (EAS) for persons with psychiatric illnesses was recently written up in the New York Times. They found that persons receiving EAS for psychiatric disorders in the Netherlands were mostly women, of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. They also reported that in more than half of approved cases, people had declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. Dr. De Vries and Dr. Kim are current and former co-directors of the Center for Bioethics and Social Sciences in Medicine (CBSSM) .


Citation: Kim SYH, DeVries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016.

 

Holly Witteman, formerly a post doctoral fellow at CBSSM and currently an assistant professor in the Faculty of Medicine at Université Laval, and colleagues’ 2016 article “One-Sided Social Media Comments Influenced Opinions And Intentions About Home Birth: An Experimental Study” was featured on Eurekalert!  an online, global news service operated by AAAS, the American Association for the Advancement of Science. The article was published in the April edition of Health Affairs and the co-authors are Angela Fagerlin, Nicole Exe, Marie-Eve Trottier and Brian Zikmund-Fisher.

An online experiment revealed that one-sided comments after health articles could influence people’s opinion about the health topic. It raises questions about how to ensure health related comment sections remain balanced.

EurekAlert!

Research Topics: 
Mon, October 30, 2017

In a recent US Department of Health and Human Services symposium, Andrew Shuman discussed patient data privacy.

Give me colostomy or give me death! (Aug-06)

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
  •  Colostomy

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
(complicated)
Surgery 2 
(uncomplicated)
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?

In fact, past research has shown that 51% people choose the surgery with a higher death rate, even though most of them initially preferred each of the four surgical complications, including colostomy, over immediate death.

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
(complicated)
Surgery 2 
(uncomplicated)
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.

 

 

 

Thu, December 08, 2016

Reshma Jagsi, MD, discusses the risk of complications on patients receiving radiation therapy if they've had implant reconstruction. Radiation therapy may affect outcomes of breast construction, and more is needed to help patients make informed choices.

San Antonio Breast Cancer Symposium (SABCS) Presentation Title: Impact of radiotherapy on complications and patient-reported satisfaction with breast reconstruction: Findings from the prospective multicenter MROC study

Joel Howell, MD, PhD

Faculty

Joel D. Howell is a Professor at the University of Michigan in the departments of Internal Medicine (Medical School), Health Management and Policy (School of Public Health), and History (College of Literature, Science, and the Arts), as well as the Victor C. Vaughan Professor of the History of Medicine. He received his M.D. at the University of Chicago, and stayed at that institution for his internship and residency in internal medicine. At the University of Pennsylvania, he was a Robert Wood Johnson Clinical Scholar, and received his Ph.D. in the History and Sociology of Science.

Research Interests: 
Last Name: 
Howell

Lewis Morgenstern, MD

Wed, April 06, 2016

Raymond De Vries and colleagues’ 2006 article, “Normal Misbehavior: Scientists Talk about the Ethics of Research” was recently cited in New Scientist article and a Transhuman Tech blog about (dis)honesty in scientific research.

Research Topics: 
Thu, April 04, 2013

Babies cry and spit up … and too often those common symptoms are labeled as disease, according to a new study conducted by U-M researchers. Frequent use of the GERD label can lead to overuse of medication. The study was published online today in the journal Pediatrics.

Stories have already been published by Reuters,  Yahoo News!MedPage TodayNPRMSN Healthy Living,  CBS News, and the Chicago Tribune, among others. Laura Scherer, PHD, Brian Zikmund-Fisher, PhD, Angela Fagerlin, PhD and Beth Tarini, MD are authors on this study.

Mon, June 23, 2014

Brian Zikmund-Fisher was interviewed by Reuters Health for the article "Shared decision making still lacking for cancer screening." He discusses his research and trade-offs in cancer screenings. "What this study does is it shows that despite all of the initiatives and the discussion of shared decision making that has been going on, we don't seem to be moving the needle very much," he states. 

His interview also received press in the Chicago Tribune and New York Daily News.

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