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CBSSM Seminar: Laura Scherer, PhD

Tue, February 06, 2018, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Laura Scherer, PhD

Assistant Professor, Psychological Sciences
University of Missouri

 

Title: Exploring the psychology of overuse and underuse: Understanding the reasons for healthcare seeking and avoidance

Abstract: Overuse and underuse of healthcare resources are two major problems that stand in the way of maximizing patient outcomes and delivering optimal care. Both problems can stem from structural factors (e.g. healthcare access, defensive medicine, direct-to-consumer advertising), but the psychological aspects of overuse and underuse are often overlooked. This talk will discuss some of the psychological processes that can cause patients to seek healthcare that may cause more harm than benefit, and avoid or refuse healthcare that is beneficial.

 

CBSSM Seminar: Jeff Kullgren, MD, MS, MPH

Wed, October 19, 2016, 3:00pm to 4:00pm
Location: 
NCRC Building 16, Conference Rm 266C

Jeff Kullgren, MD, MS, MPH
Assistant Professor, Internal Medicine

Consumer Behaviors among Americans in High-Deductible Health Plans 
More than 1 in 3 Americans with private health insurance now face high out-of-pocket expenditures for their care because they are enrolled in high-deductible health plans (HDHPs), which have annual deductibles of at least $1,300 for an individual or $2,600 for a family before most services are covered.  Though it is well known that HDHPs lead patients to use fewer health services, what is less known is the extent to which Americans who are enrolled in HDHPs are currently using strategies to optimize the value of their out-of-pocket health care spending such as (1) budgeting for necessary care, (2) accessing tools to select providers and facilities based on their prices and quality, (3) engaging clinicians in shared decision making which considers cost of care, and (4) negotiating prices for services.  Such strategies could be particularly helpful for people living with chronic conditions, who are even more likely to delay or forego necessary care when enrolled in an HDHP.  In this seminar we will examine these issues and review preliminary results from a recent national survey of US adults enrolled in HDHPs that aimed to determine how often these strategies are being utilized and how helpful patients have found them to be, which patients choose to use or not use these strategies and why, and identify opportunities for policymakers, health plans, and employers to better support the growing number of Americans enrolled in HDHPs.

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

CBSSM Seminar: Timothy R. B. Johnson, M.D.

Tue, October 03, 2017, 3:00pm
Location: 
NCRC, Building 10, G065

Timothy R. B. Johnson, M.D.
Arthur F. Thurnau Professor and Chair, Department of Obstetrics and Gynecology
Bates Professor of the Diseases of Women and Children
Professor of Obstetrics and Gynecology and Women’s Studies
Research Professor, CHGD

Title: Global Health Ethics and Reproductive Justice: Breadth and Depth in CBSSM

Global Health Ethics and Reproductive Justice (in this instance sexual rights and gender equity, specifically gender and sexual harassment/assault in Academic Medical Centers) appear to be areas where a number of CBSSM members have interest, expertise and are working inter-disciplinarily in domains that will differentiate CBSSM nationally and internationally. Could and should these develop into CBSSM thematic interests? Whatever the case, they will remain topics of significant interest across CBSSM and are worthy of broad discussion and  understanding.

CBSSM Seminar: Michele Gornick, PhD

Thu, January 15, 2015, 3:00pm to 4:00pm
Location: 
NCRC 16-266C

Michele Gornick, PhD

VA HSRD Fellow & CBSSM Research Investigator

Title: The public’s preferences for the return of secondary findings identified through genome sequencing: Information and deliberation make a difference

Summary: Genomic sequencing is becoming a part of clinical practice. Existing studies are limited and conclude that people would like unrestricted access to all of their genetic information. However, we do not know the extent to which respondents in these studies took into account the complex scientific and ethical issues that attend genome sequencing. In order to address this gap, we organized a deliberative democracy (DD) session to educate members of the public on genome sequencing, to engage them in dialogue about the benefits and risks of the clinical implementation of this technology, and to elicit their informed perspectives about policies governing the return of secondary findings.

J. Scott Roberts, PhD, received an R01 award from NHGRI for a multi-site, randomized controlled clinical trial to examine the impact and efficacy of a genetic risk assessment program that educates people with mild cognitive impairment about their chances of developing Alzheimer's disease.

The Center for Ethics and Humanities in the Life Sciences at Michigan State University has posted information about its 2011-12 Brown Bag/Webinar Series.  All sessions take place 12-1 pm in C-102 East Fee Hall on the East Lansing campus.  Sessions for the fall include:
September 7: Helen Veit, PhD, "The ethics of aging in an age of youth: Rising life expectancy in the early twentieth century United States"
October 19: Scott Kim, MD, PhD, "Democratic deliberation about surrogate consent for dementia research"
November 10: Stuart J. Youngner, MD, "Regulated euthanasia in the Netherlands: Is it working?"
December 7: Karen Meagher, PhD candidate, "Trustworthiness in public health practice"
See www.bioethics.msu.edu/ for more information.

Brian Zikmund-Fisher, PhD, a CBSSM investigator and Director of the CBSSM Internet Survey lab, is the principal investigator on an Investigator Initiated Research award from the Foundation for Informed Medical Decision Making that began in October 2008.  The grant, entitled "Learning by Doing: Improving Risk Communication Through Active Processing of Interactive Pictographs," will fund the development and testing of of Flash-based interactive risk graphics that research participants or patients can use to visually demonstrate how likely they believe some event is to occur. Dr. Zikmund-Fisher hopes that people who create risk graphics themselves will have a better intuitive understanding of risk than people who just view static images. Co-investigators on the award include Angela Fagerlin, Peter A. Ubel, and Amanda Dillard.

How bad would it be? (May-05)

For certain diseases, receiving treatment can disrupt daily life considerably. How would this disruption affect your happiness?

Think about your average mood during a typical week. How would you rate your average mood?

  • very pleasant
  • slightly pleasant
  • neutral
  • slightly unpleasant
  • very unpleasant
Now imagine you have end-stage renal disease, a condition in which your kidneys fail to perform their normal function of cleaning and filtering the blood. Treatment consists of a procedure called hemodialysis, in which your blood is filtered through a machine. You require treatment three times per week for about three hours each time. Discomfort is minor, and you can read, write, talk, eat, sleep, or watch TV during the treatment. Your lifestyle includes most normal activities, including work, exercise, and leisure; however, you feel fatigued if you miss treatment for several days. Also, you must follow a strict diet that involves reducing salt intake, consuming relatively little meat, and drinking only small amounts of fluids. Imagine, you have been on hemodialysis for a year.
Now imagine your average mood during a typical week if you had end-stage renal disease as described above. If you had end-stage renal disease, how do you think you would rate your average mood?
  • very pleasant
  • slightly pleasant
  • neutral
  • slightly unpleasant
  • very unpleasant

How do your answers compare?

The discrepancy between Patients and Non-patients

Past research has shown that there are serious health conditions that do not seem to be as badly experienced by the people living with them as healthy people would expect. Although the existence of this discrepancy is well established at this point, its cause is not. One possibility is that patients are exaggerating their well-being. They may be focusing on periods of positive mood even though they actually experience lengthy periods of negative mood. On the other hand, patients might be as happy as they report and healthy people might very much be overestimating the negative impact of the illness. A related explanation comes from evidence that healthy people tend to underestimate their own past moods, recalling negative times more readily than positive times. This would then make them more likely to also understate the well-being of other people as well, and this could contribute to the discrepancy.

Which explanation is correct?

Jason Riis, a researcher at the University of Michigan, teamed up with investigators from CBDSM and the University of Pennsylvania to conduct a study with the goal of finding out which of the above explanations is accountable for the discrepancy. To accomplish this, they set out to measure mood in two ways. One way is to ask individuals to estimate their average mood. The other way is to measure mood on a momentary basis, asking individuals at frequent intervals to indicate their mood at the moment, and then taking the average of these responses. This latter way of assessing mood is less influenced by biased recall than just asking subjects to estimate overall mood.

The investigators recruited 49 end-stage renal patients receiving hemodialysis treatment three times per week and 49 healthy controls who were matched to the patients on age, race, sex, and education. Subjects were first given an entry interview during which they estimated their average mood. They were then asked to carry around Palm Pilots for a week that beeped at random intervals, prompting them to indicate their mood at the moment. After carrying the Palm Pilots around for a week, subjects completed an exit interview that asked them to recall their average mood in the last week and to again estimate their average mood in general. Healthy subjects also estimated what they thought their average mood would be if they were a hemodialysis patient.

The investigators found that patients' average momentary moods were no lower than their estimated average mood, thus finding no evidence that patients exaggerate their mood. In fact, they failed to find any evidence that patients experience lower moods than healthy controls. In appears, then, that hemodialysis patients do largely adapt to their condition. On the other hand, healthy controls did rate that their average mood would be lower if they were homodialysis patients. Thus, the previously observed tendency of healthy people to underestimate the reported quality of life of people with various health conditions does seem to be due, in large part, to their misperception of the extent to which people can adapt to such conditions. In this study, healthy people also underestimated their own average mood. This could also account for some of the discrepancy, but the effect was not very large.

Why this is important

Ignorance of adaptation can have negative consequences for decision making. It can cause individuals to opt for unnecessarily risky surgeries and policymakers to invest in programs that have a minimal impact on people's well-being. This is not to say that research and treatment of kidney disease should not continue to be priorities, but in making difficult policy decisions, consideration of the moods experienced by patients may influence priorities between serious conditions such as, for example, paraplegia and depression. The results of this study suggest that policy makers should proceed with caition because healthy people's apparent exaggeration of the influence of illness on mood can lead to incorrect perceptions of how illness will influence quality of life.

Read the article:

Ignorance of hedonic adaptation to hemo-dialysis: a study using ecological momentary assessment.
Riis J, Loewenstein G, Baron J, Jepson C, Fagerlin A, Ubel PA. Journal of Experimental Psychology: General 2005;134:3-9.

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