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Bioethics Grand Rounds with Jeffrey Punch, MD

Wed, September 24, 2014, 12:00pm to 1:00pm
Location: 
Ford Auditorium

Grand Rounds

Box Lunches will be provided courtesy of the Center For Bioethics and Social Sciences in Medicine.

This month's grand rounds features Jeffrey Punch, MD.

Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is sponsored by the UMHS Adult Medical Ethics Committee and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME and CEU credit is available.

 

Bioethics Grand Rounds with Aisha Langford, PhD

Wed, December 10, 2014, 12:00pm to 1:00pm
Location: 
Ford Auditorium

Grand Rounds for December

Box Lunches will be provided courtesy of the Center For Bioethics and Social Sciences in Medicine.

This month's grand rounds features Aisha Langford, PhD.

Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is sponsored by the UMHS Adult Medical Ethics Committee and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME and CEU credit is available.

 

Mon, April 16, 2012

When women at high risk of breast cancer viewed a customized web-based decision guide about prevention options, they were more likely to make a choice about prevention and to feel comfortable with their choice.  CBSSM co-director and study senior author Angela Fagerlin is quoted in the press release.  Click here to view a press release about the study, whose authors included current CBSSM faculty member Brian Zikmund-Fisher and CBSSM alumni Peter Ubel and Dylan Smith.

CBSSM Colloquium 2016-- call for abstracts

2016 CBSSM Research Colloquium – University of Michigan

 

Call for Abstracts

 

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium will be held Wednesday, April 27, 2016 at the Founders Room, Alumni Center, 200 Fletcher Street, Ann Arbor, MI 48109.

The CBSSM Research Colloquium will feature the Bishop Lecture in Bioethics as the keynote address.  This year CBSSM is delighted to announce that William Dale, MD, PhD will present the Bishop Lecture with a talk entitled: "Why Do We So Often Overtreat, Undertreat, and Mistreat Older Adults with Cancer?"

William Dale, MD, PhD is Associate Professor of Medicine and Chief, Section of Geriatrics & Palliative Medicine & Director, SOCARE Clinic at the University of Chicago. A geriatrician with a doctorate in health policy and extensive experience in oncology, Dr. Dale has devoted his career to the care of older adults with cancer -- particularly prostate cancer. Dr. Dale has a special interest in the identification and treatment of vulnerable older patients who have complex medical conditions, including cancer. He is actively researching the interactions of cancer therapies with changes associated with aging.
 

 

Abstract submissions are welcome from all disciplines both within UM, as well as other institutions. CBSSM is an interdisciplinary center focusing on bioethics and social sciences in medicine. Our research program areas of interest include:

  • Clinical and Research Ethics - committed to empirical research in ethics (what some have called empirical ethics) by providing an evidence base for informed policy and practice.
  • Health Communication and Decision Making – using techniques from basic and applied research, determines the best practices for communicating health information to patients.
  • Medicine and Society - examines the way health care and bioethics are influenced by social structures and cultural ideas.
  • Health, Justice, and Community - aims to improve knowledge, understanding and practice in resource allocation and distributive justice, ethics of health policy (public and private) and community engagement, with the overarching goal of improving health equity.
  • Genomics, Health, and Society - examines the ethical, social and behavioral implications of advances in genomics.

For more information about our program areas: http://cbssm.med.umich.edu/


Submission Details: (Form is below)

  • Abstracts should contain a title, followed by the names and designations of all contributing authors and the contact details of the corresponding author.
  • Abstracts are to be a maximum of 300 words in length (exclusive of title and author information).
  • Presentations should last no more than 20 minutes, with an additional 5 minutes for questions.  The total time allotted is therefore 25 minutes per presentation. 
  • Abstracts should be submitted on the attached Abstract Submission form.  Submit abstracts via email to Kerry Ryan, kryanz@med.umich.edu. If you have questions about the abstract, please contact CBSSM at 734-615-8377 or email Kerry Ryan.
  • Deadline for abstract submission is Friday, March 11, 2016.
  • Notification:  Applicants will be notified by Friday, March 25, 2016.


Tentative Schedule for the Colloquium:


9:00-10:30 Presentations
10:45-12:00 Bishop Lecture:  William Dale, MD, PhD
12:00-1:15 Lunch
1:15-4:30 Presentations

Click here for Abstract Submission Form.

Funded by Health and Human Services, Department of-Agency for Health Care Research and Quality

Funding Years: 2013 - 2016.

Both patient-centered care approaches and health information technology advances (e.g. patient portals to electronic health records) are increasing how often patients are directly presented with medical test results that identify health concerns, monitor health status, or predict future health risk. In principle, such data enable patients to actively mange health conditions and participate in care decisions. In practice, availability of data may not result in understanding, as test results are often presented in confusing formats with little context. Many patients, especially those with lower numeracy skills (i.e., poor ability to draw meaning from numbers), may be unable to interpret test outcome data and use it in decision making. For these patients, knowing test results or risk estimates does not ensure that they understand what those numbers imply or what actions they need to consider. Such data can be, quite literally, meaning-less, and patients are likely ignore such information in decision making even when they are fully informed.
We propose to draw on research methodologies from design science, decision psychology, human-computer interaction, and health communication and integrate them into a single, highly innovative research process that will tackle the problem of how best to present Hemoglobin A1c values and similar test results to patients with diabetes as an exemplar of the larger problem of meaningless medical test data. We will (a) define the problem space from multiple perspectives, (b) clarify what we can hope to achieve when we present diabetic patients with their test results, and (c) and identify possible approaches for improving data meaningfulness. Our iterative research approach involves three phases. In Phase 1, we will use intensive deep dive design sessions (a methodology borrowed from design science) with a multidisciplinary team combining experts in health communication and human-computer interaction with both practicing clinicians and expert patients. These sessions will identify discrepancies between patient needs for test result data and the formats in which such data are provided to patients, identify when low numeracy skills will be a barrier to patient interpretation and use of such data, and brainstorm potential solution concepts. In Phase 2, we will conduct rigorous comparative evaluations of proposed designs using (a) user-experience design sessions, and (b) an iterative sequence of large-sample, multi-factorial, randomized-controlled experiments in order to identify what formats make test data most meaningful and useful for facilitating informed patient decisions about medical care. In Phase 3, we will take our identified test results communication best practices and develop, program, and disseminate a test results display generator application that will be able to be integrated with existing electronic health record systems and other applications and will be made available to patients via a freely available website.

PI(s): Brian Zikmund-Fisher

Co-I(s): Angela Fagerlin, Reshma Jagsi, Predrag Klasnja, Kenneth M. Langa, Beth A. Tarini,, Sandeep Vijan

Fri, November 04, 2011

Angela Fagerlin's research was featured in a November 2, 2011, article in the Chicago Tribune, on improving the communication of information about cancer treatment risks to patients.  Tips for improving communication include using plain language, focusing on absolute risk, considering risk as a frequency rather than as a percentage, and so on.

Sorry, Doc, that doesn't fit my schedule (Feb-04)

Patients sometimes skip treatments because they just feel too busy. What should physicians do when their patients ignore their recommendations?

Imagine you are a businessperson who works long hours and you are on your way up to having a successful and lucrative career. You have a major business deal that will consume nearly all of your time over the upcoming month and your boss is relying on you to make sure the deal goes through. This is your chance to really make your mark and show your corporation that you are the kind of person that can handle deals as big as this one. Also suppose you have been smoking on and off for 25 years. You know it's a bad habit that could destroy your lungs, but you just can't quite kick it. Lately, you have been feeling tired, you have been experiencing chest pains when you are really busy at work and when you exercise, and you have had trouble breathing when climbing a flight of stairs. The chest pains are usually relieved by a little rest, but you decide it's time to get this examined by a doctor.

One day after work, you go to see Dr. Coral, who gives you a stress test and determines that you'll need an appointment for an angiogram to better evaluate your coronary arteries. Fortunately, you find one free day right before things get hectic at work, so you schedule the angiogram. Now imagine you have just had the angiogram and you are recovering in a paper gown waiting for Dr. Coral to come back with the results. Dr. Coral enters the room to speak with you and he has a serious look on his face. He says,

"I have both good and bad news for you. The angiogram shows that your 3 main coronary arteries are all severely blocked. The good news is that we caught this before you had a major heart attack."

"The bad news is that I am recommending you have triple bypass surgery as soon as possible. Your heart is working overtime, and it is just a matter of time until it gives out."

The news is shocking, but in addition to your health concerns, you also have the business deal to worry about. This deal is an opportunity to make a name for yourself, and your boss has been very vocal that he was counting on you, trusting that you'd be the one for the job. You find yourself having to weigh your work ambitions against the recommendation from Dr. Coral because if you get surgery, there is no way you'd be able to take on your current work responsibility.
 
Which of the following decisions would you be most likely to make?
 
  • I would put aside Dr. Coral's recommendation and instead take responsibility at work for the current deal. I'll wait to have surgery in about a month.
  • I would follow Dr. Coral's recommendation by having surgery immediately, even though this forfeits the current opportunity at work.

A little feedback on what you chose.

It's not that physician's don't care about your other values, but they are primarily concerned about your health, and you might not even have lived long enough to finish the business deal if you didn't have this surgery immediately. This does, however, bring up an important fact: patient's do sometimes reject their physician's medical judgment, and it can be at a great cost to their health.
 
Why should a patient be part of the decision-making process?
 
Why shouldn't Dr. Coral just tell you that you need surgery and leave no alternative? Efforts to share decision-making with patients are important because they acknowledge patients' rights to hold views, to make choices, and to take actions based on personal values and beliefs. In addition to being ethically-sound, this shared decision-making process also leads to improved patient health outcomes.
 
What can a physician do to help the patient choose surgery?
 
To answer this question, first it needs to be emphasized that in order for a patient to be able to participate in the decision-making process, the patient must be able to soundly make decisions. This sounds abstract and subjective, but it can be broken down into something a little more concrete. Decision-making capacity (DMC) is based on four guidelines:
 
The patient is able to:
 
  • understand the information about the condition and the choices available;
  • make a judgment about the information in keeping with his or her personal values and beliefs;
  • understand the potential outcomes or consequences of different choices; and
  • freely communicate his or her wishes
Based on these four elements, it is possible to see what a physician can do to help facilitate a "good" health decision. In order to make sure a patient fully understands the situation, a physician can ask him or her to state their understanding of the problem and of the treatment options. Also, a physician should use clear and unambiguous language with the patient at all times. Although a report might be quite clear from a physician's perspective, a patient might not be as clear about all the details. In the situation you were asked to imagine, Dr. Coral should tell you that you will die without this surgery and that waiting is not a safe option.
Also, there might be other factors keeping a patient from following a physician's recommendation. Again, in your hypothetical situation, your boss was putting a lot of pressure on you not to let him down. Also, this decision would potentially have an effect on your advancement at work. You might not have felt free to elect surgery even if you knew it was the only good decision for your health. By directly acknowledging and addressing a patients' concerns, physicians may facilitate a decision for the surgery.
 
In conclusion, if a physician feels that a patient is not able to fulfill one or more of the elements of DMC then his or her ability to make that decision should be brought into question and surrogate decision makers should be sought. For more serious decisions, the standards for DMC should be higher than for less important decisions or those with less significant outcome differences among the choices.
 
For more information see:

 

Thu, February 04, 2010

Angela Fagerlin, PhD, talked with Financial Planning about how research on decision aids in healthcare might be used to help financial planners convey complex information to their clients. She discussed specifics: use of absolute vs relative risk data, frequencies vs. percentages, and graphical representations such as bar graphs and pictographs. 

Health Communication and Decision Making

A major theme of CBSSM involves using techniques from basic and applied research to determine the best practices for communicating health information to patients and the public more generally. This special interest group explores topics related to understanding and improving patient and public decision making about medical issues.

Research that falls within this programmatic area includes topics such as:

  • Risk communication and perception
  • Health communication and education
  • Development and testing of decision aids/patient education materials
  • Visualization and contextualization of health data
  • Communication of genomic information to patients and providers
  • Numeracy and literacy
  • Utility and survey methods
  • Patient decision making
  • Patient-physician communication

CBSSM Seminar: Jacob Solomon, PhD

Thu, November 19, 2015, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Jacob Solomon, PhD


CBSSM Postodoctoral Fellow

Title:

Designing the information cockpit: The impact of customizable algorithms on computer-supported decision making

Abstract:

Intelligent systems that provide decision support necessitate interaction between a human decision maker and powerful yet complex and often opaque algorithms. I will discuss my research on end-user control of these algorithms and show that designing highly customizable decision aids can make it difficult for decision makers to identify when the system is giving poor advice.

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