Melissa will speak about an internal grant to better understand provider practices, specific to involving pediatric patients in end of life planning, prognostication and involvement in difficult medical decision-making.
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Target specific oral anticoagulants (TSOAC)s including dabigatran, rivaroxaban, and apixaban represent novel alternatives to vitamin K antagonists. These medications provide an attractive choice for both physicians and patients alike due to their predictable pharmacokinetics, fixed-dose regimens, lack of routine monitoring, and fewer drug-drug interactions as compared to warfarin. However, these anticoagulants are not without their own unique features and risks, including required dose adjustments for patient specific factors such as renal function, weight, and age, and lack of a routine monitoring parameter to follow patient adherence with therapy. In addition, the cost of TSOACs and the growing number of indications they are currently approved for makes ensuring affordability as well as the correct dosage based on indication for therapy extremely important.
PI(s): Geoffrey Barnes
Co-I(s): Emily Ashjian
Jeff Kullgren's editorial "Injecting Facts Into the Heated Debates Over Medicaid Expansion" was recently published in the Annals of Internal Medicine. In this editorial, Dr. Kullgren reviews Wherry and Miller's study on the effects of ACA on coverage, access, utilization, and health.
Link to IHPI article.
Reshma Jagsi, M.D., D.Phil., is Professor and Deputy Chair in the Department of Radiation Oncology at Michigan Medicine and Director of the Center for Bioethics and Social Sciences in Medicine. In addition to her medical training at Harvard Medical School, she served as a fellow in the Center for Ethics at Harvard University and completed her doctorate in Social Policy at Oxford University as a Marshall Scholar. Dr. Jagsi is board-certified in Radiation Oncology by the American Board of Radiology.
This month's grand rounds features: Michael Jibson, MD, Psychiatry Department speaking about "Psychiatry, Law, and Society: Ethical and Legal Issues in Mental Health"
Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is co-sponsored by the Center for Bioethics and Social Sciences in Medicine, the UMHS Adult and Pediatric 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 credit is available.
To meet ACCME requirements for Faculty Planner disclosure and Presenter Disclosure to participants of CME activities at UM, please be advised that the following faculty planner(s)/co-planner(s) and presenter have no personal financial relationships relevant to the activity listed below:
- Andrew Shuman, MD
- Christian Vercler, MD
Funded by NIH: National Cancer Institute
Funding Years: 2008-2014
Prostate cancer is a leading cause of cancer death among men, and thousands of men must make treatment decisions every year. Decision making for localized prostate cancer is especially challenging as clinical trials have shown that the standard treatment options of active surveillance, surgery and radiation are comparable in terms of survival. Thus, treatment for prostate cancer is a preference-sensitive decision, with the best choice depending in part on patient attitudes towards the risks and benefits of treatment alternatives. Therefore, ideally the treatment decision will be made with full consideration of patient preferences. As such, it is recommended that patients and their physicians discuss any preferences patients have that might be relevant to the treatment decision. This dialogue is complicated by patients’ lack of experience with sharing in these types of decisions. Additionally, physicians often use medical jargon, making it more difficult for patients to understand their diagnosis and treatment options. Research is needed to determine the best methods for helping patients communicate their preferences to their physicians so that patient values hold considerable weight in treatment decisions.
The goals of this study are two-fold:
- To demonstrate to patients some of the issues that might arise during their diagnosis visit that may prevent them from communicating preferences to physicians.
- To provide solutions that would enable greater patient participation in medical decision making.
PI(s): Angela Fagerlin, PhD and Peter A. Ubel, MD
Co-I(s): John T. Wei, MD; Brian Zikmund-Fisher, PhD; Margaret Holmes-Rovner, PhD; James Tulsky, MD; Stewart Alexander, PhD
Parent grant: Michigan Center for Health Communication Research II
Funded by the Department of Veterans Affairs
Funding Years: 2007-2012
Prostate cancer is the second leading cause of cancer related death among men in the United States, and accounts for 29% of all cancers diagnosed in men. Furthermore, approximately one in six men will be diagnosed with prostate cancer in their lifetime. Thus, 17% of male Veterans will be asked to make a decision about the treatment of their prostate cancer. The burden of this disease is further magnified when one considers that most patients will live for years following their diagnosis and with any adverse effects of therapy. Given that there have been no clinical trials showing that any prostate cancer treatment produces an increased likelihood of survival; men are asked to actively participate in treatment decisions. Previous research has revealed that men are often uninformed about their prostate cancer, particularly African American men and men with lower educational attainment. Thus, it is critical to develop and test decision aids that can help all men (especially men with low literacy skills) make an informed decision. The goal of the study was to compare the impact of a plain language decision aid (DA) to a conventional DA on prostate cancer patients’ decision making experience and communication with their physician.
PI(s): Angela Fagerlin, PhD and Peter A. Ubel, MD
Co-I(s): Khaled Hafez, MD; Bruce Ling, MD; Jeffrey Gingrich, MD; Sara Knight, PhD; Phillip Walther, MD; Margaret Holmes-Rovner, PhD; James Tulsky, MD; Stewart Alexander, PhD