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Funded by the Agency for Healthcare Research and Quality

Funding Years: 2015-2019

The theme of the University of Michigan Patient Safety Learning Laboratory ("M-Safety Lab") is to improve the delivery of inpatient care by cross-linking investigators from diverse disciplines - including engineering, medicine, nursing, architecture and design and computer science - who share a common interest in patient safety. Our overarching goal is to implement novel methods to enhance cognition and communication among care providers in order to reduce hospital-acquired complications. The M-Safety Lab will include a robust infrastructure that will support two projects, each of which has the potential to transform the delivery of inpatient care. Both projects - Project 1 will develop a new monitoring system for hospitalized patients and Project 2 will address the common, but understudied area of diagnostic and therapeutic error - will be based on two major interrelated themes: Preventing hospital-acquired complications and improving medical decision-making through enhanced cognition and communication. We have assembled an extremely broad and productive group of investigators from a large number of synergistic disciplines. The Laboratory-Wide Aim is to establish a cohesive M-Safety Lab comprised of multidisciplinary, collaborating teams of investigators supported by a robust infrastructure including an Innovation, Development, Evaluation and Administration (IDEA) Core that will help oversee the development and successful completion of both projects from problem analysis to evaluation, and will provide methodological, technical, and administrative support for the M-Safety Lab.

PI(s): Sanjay Saint

Co-I(s): Amy Ellen Cohn, Frank Jacob Seagull, Jan Stegemann, Jennifer Meddings, Laurence McMahon, Mary Rogers, Michael Greene, Milisa Manojlovich, Rachael Schmedlen, Richard Lewis, Robert Adams, Sarah Krein, Satinder Baveja, Scott Flanders, Timothy Hofer, Vineet Chopra

2011 CBSSM Research Colloquium

Fri, May 20, 2011 (All day)

The second annual Bioethics Research Colloquium was held Friday, May 20, 2011, at the Alumni Center.  The Colloquium was jointly sponsored by the Center for Bioethics and Social Sciences in Medicine and the Center for Ethics in Public Life. 

The majority of the colloquium was devoted to presentations of research in or about bioethics conducted by University of Michigan faculty, fellows and students.  Presentations focused on theoretical, empirical, and critical approaches to understanding and resolving ethical issues in health care and the life sciences.

Presenters:

  • Apurba Chakrabarti, Department of Cellular, Molecular, and Developmental Biology: A bureaucratic framework of IRBs: Understanding how cultural forces influence the contemporary IRB bureaucracy.
  • Nathaniel Adam Tobias Coleman, Department of Philosophy: Online sexual racism and the prevalence of HIV among black MSM. 
  • Susan Dorr Goold, MD, MHSA, MA, Department of Internal Medicine: Market failures, moral failures, and health reform (keynote).
  • Henry Greenspan, PhD, Residential College, LSA: Temptation and trespass in the pharmaceutical industry: Incentivizing ethical self-regulation. 
  • Lisa H. Harris, MD, Department of Obstetrics and Gynecology: Obstetrician-gynecologists' objections to and willingness to help patients obtain abortion in various clinical scenarios: A national survey. 
  • Aisha T. Langford, MPH, Comprehensive Cancer Center: The misdiagnosis of the minority problem in cancer clinical trials: Is our focus on medical mistrust causing harm? 
  • Naomi Laventhal, MD, Department of Pediatrics and Communicable Diseases: Innovative therapies in the newborn intensive care unit: The ethics of off-label use of therapeutic hypothermia.
  • Erika Manu, MD, Department of Internal Medicine: Resident attitudes and experience with palliative care in patients with advanced dementia.
  • Karen M. Meagher, Department of Philosophy (MSU): Considering virtue: Public health and clinical ethics.
  • Andrew Shuman, MD, Department of Otolaryngology: The right not to hear: The ethics of parental refusal of hearing rehabilitation.
  • Lauren Smith, MD, Department of Pathology: Pathology review of outside material: When does it help and when can it hurt? 

2014 CBSSM Research Colloquium and Bishop Lecture (Myra Christopher)

Thu, May 15, 2014 (All day)
Location: 
Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University, Ann Arbor, MI

2014 CBSSM Colloquium and Bishop Lecture featuring Myra Christopher

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium was held Thursday, May 15, 2014 at the Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University Ave, Ann Arbor, MI 48109.
 

The CBSSM Research Colloquium featured the Bishop Lecture in Bioethics as the keynote address.  Myra Christopher presented the Bishop Lecture with a talk entitled: "The Moral Imperative to Transform the Way Pain is Perceived, Judged and Treated." Myra Christopher holds the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics.

The 2014 Research Colloquium presenters:

  • Andrew G. Shuman, MD, Assistant Professor, Department of Otolaryngology, University of Michigan: "When Not to Operate: The Dilemma of Surgical Unresectability"
  • Phoebe Danziger, MD, University of Michigan Medical School: "Beliefs, Biases, and Ethical Dilemmas in the Perinatal Counseling and Treatment of Severe Kidney Anomalies"
  • Kathryn L. Moseley, MD, MPH, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan: "Electronic Medical Records: Challenges for Clinical Ethics Consultation"
  • Helen Morgan, MD,  Department of Obstetrics and Gynecology, University of Michigan: "Academic Integrity in the Pre-Health Undergraduate Experience"
  • Tanner Caverly, MD, MPH, Health Services Research Fellow, Ann Arbor VA Medical Center and Clinical Lecturer, University of Michigan: "How Transparent are Cancer Screening & Prevention Guidelines about the Benefits and Harms of What They Recommend?"
  • Susan D. Goold, MD, MHSA, MA , Professor of Internal Medicine and Health Management and Policy, School of Public Health, University of Michigan: "Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care"
 

 

CBSSM recently hosted the 2014 Research Colloquium held Thursday, May 15, 2014 at the Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University Ave, Ann Arbor, MI 48109.

The CBSSM Research Colloquium featured the Bishop Lecture in Bioethics as the keynote address.  Myra Christopher presented the Bishop Lecture with a talk entitled: "The Moral Imperative to Transform the Way Pain is Perceived, Judged and Treated." Myra Christopher holds the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics. The Bishop Lecture is made possible by a generous gift from the estate of Ronald C. and Nancy V. Bishop.

The 2014 Research Colloquium presenters included:

  • Andrew G. Shuman, MD, Assistant Professor, Department of Otolaryngology, University of Michigan: "When Not to Operate: The Dilemma of Surgical Unresectability"
  • Phoebe Danziger, MD, University of Michigan Medical School: "Beliefs, Biases, and Ethical Dilemmas in the Perinatal Counseling and Treatment of Severe Kidney Anomalies"
  • Kathryn L. Moseley, MD, MPH, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan: "Electronic Medical Records: Challenges for Clinical Ethics Consultation"
  • Helen Morgan, MD,  Department of Obstetrics and Gynecology, University of Michigan: "Academic Integrity in the Pre-Health Undergraduate Experience"
  • Tanner Caverly, MD, MPH, Health Services Research Fellow, Ann Arbor VA Medical Center and Clinical Lecturer, University of Michigan: "How Transparent are Cancer Screening & Prevention Guidelines about the Benefits and Harms of What They Recommend?"
  • Susan D. Goold, MD, MHSA, MA , Professor of Internal Medicine and Health Management and Policy, School of Public Health, University of Michigan: "Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care"

Funded by National Institutes of Health; National Institute of Mental Health

Funding Years: 2012-2017

This project will test a practical intervention that uses low cost technologies to activate depressed patients' existing social networks for self-management support. The intervention links patients with a "CarePartner" (CP), i.e., a non-household family member or close friend who is willing to support the patient in coordination with the clinician and any existing in-home caregiver (ICG). Through weekly automated telemonitoring, patients report their mood and self-management status, and receive tailored guidance on self-management. The CP receives a corresponding update along with guidance on how to best support the patient's self-management efforts, and the primary care team is notified about clinically urgent situations. The intervention will be tested among depressed primary care patients from clinics serving low-income and underinsured patients, whom the intervention was especially designed to benefit. Specific Aim 1 is to conduct a randomized controlled trial to compare the effectiveness of one year of telemonitoring-supported CP for depression versus usual care (control) on depression severity. Specific Aim 2 is to examine key secondary outcomes (response and remission, impairment, well-being, caregiving burden, healthcare costs) and potential moderators. Specific Aim 3 is to use a mixed-methods approach to enrich our interpretation of the statistical associations, and to discover strategies to enhance the intervention's acceptability, effectiveness, and sustainability. If the intervention proves effective without increasing clinician burden or marginal costs, then its subsequent implementation could yield major public health benefits, especially in medically underserved populations.

PI(s): James Aikens

Co-I(s): Michael Fetters, John Piette, Ananda Sen, Marcia Valenstein, Daniel Eisenberg, Daphne Watkins

Wendy Uhlmann, MS, CGC

Faculty

Wendy R. Uhlmann, MS, CGC is the genetic counselor/clinic coordinator of the Medical Genetics Clinic at the University of Michigan. She is a Clinical Professor in the Departments of Internal Medicine and Human Genetics and an executive faculty member of the genetic counseling training program. Wendy Uhlmann is a Past President of the National Society of Genetic Counselors and previously served on the Board of Directors of the Genetic Alliance and as NSGC’s liaison to the National Advisory Council for Human Genome Research.

Last Name: 
Uhlmann
Fri, September 07, 2018

The almost 5 million people who paid to get their DNA analyzed by the company 23andMe recently found out that their genetic data and related health information might have been sold to a major drug company. That's because 23andMe made a $300 million deal with pharmaceutical giant Glaxo SmithKline, to let it tap that genetic goldmine to help it develop new medicines. If 23andMe customers consented to allow their DNA samples to be used for research when they sent them in, their data can be sold in this way. Millions more people have samples sitting in very different kinds of biobanks: at universities and major teaching hospitals. When patients have surgery, biopsies, or blood draws at hospitals, those specimens may be kept for future research.

A new University of Michigan survey documents public attitudes toward potential commercial use of these samples. The survey reveals what members of the public think about such deals, and what they would want to know if their specimen were part of one, even if it didn't have their name attached. The results are published in a new paper in the August issue of the journal Health Affairs, by a team of U-M bioethics researchers from the Medical School and School of Public Health. Only one in four of the 886 people surveyed nationally said they'd be comfortable with companies getting access to their leftover specimens from a university or hospital biobank.

Kayte Spector-Bagdady, Raymond De Vries, Michele Gornick, Andrew Shuman, Sharon KArdia, and Jodyn Platt are authors on the study.

Research Topics: 

The Importance of First Impressions (Jun-05)

How do your risk estimate and your actual level of risk impact your anxiety? Please answer the following question to the best of your ability:

What is the chance that the average woman will develop breast cancer in her lifetime?

The average lifetime chance of developing breast cancer is actually 13%.

How does this risk of breast cancer (13% or 13 out of 100 women) strike you?
 
As an extremely low risk 1       2       3       4       5        6        7        8       9       10 As an extremely high risk
 

How do your answers compare?

Making a risk estimate can change the feel of the actual risk

CBDSM investigators Angela Fagerlin, Brian Zikmund-Fisher, and Peter Ubel designed a study to test whether people react differently to risk information after they have been asked to estimate the risks. In this study, half the sample first estimated the average woman's risk of breast cancer (just as you did previously), while the other half made no such estimate. All subjects were then shown the actual risk information and indicated how the risk made them feel and gave their impression of the size of the risk. The graph below shows what they found:

 

As shown in the graph above, subjects who first made an estimated risk reported significantly more relief than those in the no estimate group. In contrast, subjects in the no estimate group showed significantly greater anxiety. Also, women in the estimate group tended to view the risk as low, whereas those in the no estimate group tended to view the risk as high.

So what's responsible for these findings? On average, those in the estimate group guessed that 46% of women will develop breast cancer at some point in their lives, which is a fairly large overestimate of the actual risk. It appears, then, that this overestimate makes the 13% figure feel relatively low, leading to a sense of relief when subjects find the risk isn't as bad as they had previously thought.

Why this finding is important

Clinical practice implications - The current research suggests that clinicians need to be very deliberate but very cautious in how they communicate risk information to their patients. These results argue that a physician should consider whether a person is likely to over-estimate their risk and whether they have an unreasonably high fear of cancer before having them make a risk estimation. For the average patient who would overestimate their risk, making a risk estimation may be harmful, leading them to be too relieved by the actual risk figure to take appropriate actions. On the other hand, if a patient has an unreasonably high fear of cancer, having them make such an estimate may actually be instrumental in decreasing their anxiety. Physicians may want to subtly inquire whether their patient is worried about her cancer risk or if she has any family history of cancer to address the latter type of patient.

Research implications - Many studies in cancer risk communication literature have asked participants at baseline about their perceived risk of developing specific cancers. Researchers then implement an intervention to "correct" baseline risk estimates. The current results suggest that measuring risk perceptions pre-intervention will influence people's subsequent reactions, making it difficult to discern whether it was the intervention that changed their attitudes or the pre-intervention risk estimate. Researchers testing out such interventions need to proceed with caution, and may need to add research arms of people who do not receive such pre-tests.

For more details: Fagerlin A, Zikmund-Fisher BJ, Ubel PA. How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey. Patient Educ Couns. 2005 Jun;57(3):294-9.

 

 

Does order matter when distributing resources? (Jun-03)

Should people with more severe health problems receive state funding for treatment before people with less severe health problems? See how your opinion compares with the opinions of others.

Imagine that you are a government official responsible for deciding how state money is spent on different medical treatments. Your budget is limited so you cannot afford to offer treatment to everyone who might benefit. Right now, you must choose to spend money on one of two treatments.

  • Treatment A treats a life threatening illness. It saves patients' lives and returns them to perfect health after treatment
  • Treatment B treats a different life threatening illness. It saves patients' lives but is not entirely effective and leaves them with paraplegia after treatment. These patients are entirely normal before their illness but after treatment will have paraplegia.

Suppose the state has enough money to offer Treatment A to 100 patients. How many patients would have to offered Treatment B so that you would have difficulty choosing which treatment to offer?

How do your answers compare?

The average person said that it would become difficult to decide which treatment to offer when 1000 people were offered Treatment B.

What if you had made another comparison before the one you just made?

In the study, some people were asked to make a comparison between saving the lives of otherwise-healthy people and saving the lives of people who already had paraplegia. After they made that comparison, they made the comparison you just completed. The average person in that group said it would take 126 people offered Treatment B to make the decision difficult. The differences are shown in the graph below

Why is this important?

The comparison you made is an example of a person tradeoff (PTO). The PTO is one method used to find out the utilities of different health conditions. These utilities are basically measures of the severities of the conditions. More severe conditions have a lower utility, and less severe conditions have a higher utility, on a scale of 0 to 1. Insurance companies, the government, and other organizations use these utilities as a way to decide which group to funnel money into for treatments.

On the surface, it seems like basing the money division on the severity of a condition is a good and fair method, since theoretically the people who are in the greatest need will be treated first. However, the PTO raises issues of fairness and equity that aren't accounted for in other utility elicitation methods like the time tradeoff (TTO) and rating scale (RS).

For example, when asked to decide how many people with paraplegia would have to be saved to equal saving 100 healthy people, many people say 100; that is, they think it is equally important to save the life of someone with paraplegia and a healthy person. Going by values obtained using the TTO or RS, an insurance company may conclude that 160 people with paraplegia (using a utility of .6) would have to be saved to make it equal to saving 100 healthy people. This would mean that less benefit would be gotten by saving someone with paraplegia, and thus they might not cover expenses for lifesaving treatments for people with paraplegia as much as they would for a healthy person. The PTO shows that many people would not agree with doing this, even though their own responses to other utility questions generated the policy in the first place.

For more information see:

Ubel PA, Richardson J, Baron J. Exploring the role of order effects in person trade-off elicitations. Health Policy, 61(2):189-199, 2002.

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