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Check out Brian Zikmund-Fisher's article in Risk Sense: “Do You Know What Messages Your Patient Stories Are Really Sending?" in which he discusses a purpose, content, and valence-based taxonomy of patient narratives in decision aids.

 More information can also be found in:  Victoria A. Shaffer and Brian J. Zikmund-Fisher (2013). All Stories Are Not Alike: A Purpose-, Content-, and Valence-Based Taxonomy of Patient Narratives in Decision Aids. Med Decis Making, 33: 4-13. doi:10.1177/0272989X12463266

 

Michael Poulin,PhD, has joined the faculty at the University at Buffalo, State University of New York (SUNY) as an AssistantProfessor of Psychology. Dr. Poulin was a post-doctoral fellow at CBSSM for twoyears, under the mentorship of StephanieBrown, PhD.  During this time he was anactive member of the CBSSM research community and a delightful colleague. Dr. Poulin's research focuses on the effects of stress on health and well-being, especiallythe ways people cope with stressful events. He examines how people's beliefsabout the world, including religious beliefs and beliefs about thetrustworthiness of others, influence adjustment to stress.  

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.

CBSSM Seminar: Aaron Scherer, PhD

Wed, February 03, 2016, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Aaron Scherer, PhD


CBSSM Postdoctoral Fellow

The Language of Medicine

Is the way we talk about health and medicine simply expressive or does the language we use actually change how we perceive and respond to health risks and medical interventions? Aaron Scherer will discuss a number of studies that explore how metaphors, labels, and explanations may shape our health-related perceptions and behavior.

CBSSM Seminar: Christian Vercler, MD

Thu, February 25, 2016, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Christian Vercler, MD

Clinical Assistant Professor, Plastic Surgery
Co-Chair, Pediatric Ethics Committee, C.S. Mott Children's Hospital
Co-Chair, Adult Ethics Committee, University of Michigan Hospital and Health Systems
Co-Director, Clinical Ethics Program, CBSSM (RESCHEDULED)

 

CBSSM Seminar: Peter A Ubel, MD

Tue, April 10, 2018, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Peter A Ubel, MD

Professor of Business Administration
Madge and Dennis T. McLawhorn University Professor
Professor in the Sanford School of Public Policy
Professor of Medicine
Affiliate of the Duke Initiative for Science & Society
Member of the Duke Cancer Institute

“The Ethics of Nudges: An Informal Discussion”

This will be an informal discussion with Dr. Ubel, CBSSM faculty, and others to discuss their research around the ethics of nudges.

 

CBSSM Seminar: Darin Zahuranec, MD

Wed, January 20, 2016, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room 266C

Darin Zahuranec, MD


Assistant Professor, Neurology

Title:  Improving decisions on life-sustaining treatments after stroke

Abstract:  Individuals with acute stroke face the sudden onset of new deficits, along with a need to make many decisions about medical treatments with impact on the potential for survival and long-term disability. This talk will review the challenges in decision-making after acute stroke and discuss possible solutions for the future.

 

CBSSM Seminar: Julie Wright Nunes, MD, MPH

Wed, May 17, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Julie Wright Nunes, MD, MPH
Assistant Professor, Internal Medicine

Title: Patient Education and Care: Challenges and Opportunities in Chronic Kidney Disease

Abstract: Twenty million people, or 20% of U.S. adults ages 60 and older, have chronic kidney disease (CKD). CKD is a significant public health threat carrying high risk of morbidity, mortality, and renal failure. Health behavior theory suggests that patient motivation and healthy behavior change require patients to have knowledge of their chronic condition, as well as the self-efficacy and skills to do what is needed to stay healthy. The chronic care model promotes early patient engagement in care. Yet, less than 20% of  patients with CKD are aware of their diagnosis. Even patients who are aware often do not understand the implications of their CKD diagnosis or what they need to do to optimize their health. Dr. Wright Nunes will discuss her research aimed to develop, test, and disseminate sustainable patient-centric education and coaching support interventions to improve quality of care and outcomes in patients who have CKD.

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.

Edward Goldman, JD, BA

Faculty

From 1978 to 2009, Ed was head of the U-M Health System Legal Office.  In 2009 he moved into the Medical School Department of ObGyn as an Associate Professor to work full-time on issues of sexual rights and reproductive justice.  He has teaching appointments in the Medical School, the School of Public Health, the Law School, and LSA Women's Studies.  He teaches courses on the legal and ethical aspects of medicine at the Medical School, the rules of human subjects research at the School of Public Health and reproductive justice in LSA and the Law School..  In 2011, Ed went to Ghana and helpe

Research Interests: 
Last Name: 
Goldman

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