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Janice Firn, PhD, MSW

Faculty

Dr. Firn has a BS from Michigan State University, MSW from the University of Michigan, and PhD from Lancaster University (UK). Before CBSSM, Janice worked in oncology and palliative care at Michigan Medicine. In her role as Clinical Ethicist for the Clinical Ethics Service, Janice responds to ethics consultation requests, and participates in preventative ethics rounds and education and research initiatives.  Her academic interests include bioethics; self-care, burnout, and resilience; palliative and end of life care; and interprofessional education and collaboration.

Last Name: 
Firn
Mon, October 19, 2015

Beth Tarini is lead author on study published in the Journal of Pediatrics that found that few primary care physicians say they would order genetic testing or refer a child to a genetics specialist as a first step when they see children with two or more developmental delays, despite the higher risk of genetic disorders in these children.

Brian Zikmund-Fisher and Wendy Uhlmann are also co-authors.

Citation:

Tarini, Beth A., Brian J. Zikmund-Fisher, Howard M. Saal, Laurie Edmondson, and Wendy R. Uhlmann. "Primary Care Providers' Initial Evaluation of Children with Global Developmental Delay: A Clinical Vignette Study." The Journal of Pediatrics.

Research Topics: 

Funded by the National Institutes of Health/Brigham and Women's Hospital/Boston University

Funding years: 2010-2013

The rapid identifcation of genetic risk factors for common, complex diseases poses great opportunities and challenges for public health. Genetic information is increasingly being utilized as part of commercial effors, including direct-to-consumer (DTC) genetic testing to provide risk information on common diseases to consumers. Very few empirical data have been gathered to understand the characteristics of DTC test consumers, the psychological, behavioral and health impact (clinical utility), and the ethical, legal and social issues associated with DTC services.

In the proposed research, we will survey users of the two leading US companies providing DTC genetic testing (23andMe and Navigenics) regarding their response to genetic test s for common diseases of interest, including heart disease, diabetes, Alzheimer's disease (AD), arthritis, and breast, colon, lung and prostate cancers. Each company now has thousands of customers and each anticipates extensive sales in coming years. Each has agreed to allow our group to survey consumers using third-party data collection and analysis procedures that will enable an independent consideration of the benefits and risks of DTC testing in this format. The companies have also agreed to provide genetic test information (with respondents' permission) for analyses. A total of 1000 consumers (500 from each company) website will be surveyed via the Internet at three time points: 1) before receipt of genetic test results; 2) approximately two weeks following receipt of test results; and 3) six months following receipt of results.

More information: http://www.psc.isr.umich.edu/research/project-detail/35031

PI: Scott Roberts

Co-I: Mick Couper

Program in Clinical Ethics

The Program in Clinical Ethics within the Center for Bioethics and Social Sciences in Medicine (CBSSM) represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities.  The aims of this program are to: liaise with and provide support to the adult and pediatrics ethics committees; streamline clinical ethics consultation; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.

Background
The Program in Clinical Ethics within CBSSM represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities.  The aims of this program are to: liaise with and provide support to the adult and pediatrics ethics committees; streamline clinical ethics consultation; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.

Program Organization
The Program in Clinical Ethics is co-directed by the chairs of the adult and pediatric ethics committees and consultation services, Christian J. Vercler, MD, MA and Andrew G. Shuman, MD. A dedicated clinician ethicist manages the program on a daily basis.  A cadre of eight faculty ethicists rotate on service throughout the year and work closely with the clinician ethicist.  Trainees and students rotate as well.  Dedicated administrative support will be organized through CBSSM.

Clinical Ethics Consultation Service
The Clinical Ethics Program offers adult and pediatric ethics consultation services across UMHS, and are available 24/7/365.  More information about the adult and pediatric ethics committees and consultation services can be found on the Adult Ethics Committee and Pediatrics Ethics Committee web pages.

Preventative Ethics
The concept of preventative ethics is critical in anticipating, navigating and mitigating potential conflicts and tensions before they become true ethical dilemmas or crises, and necessitate formal consults.   This model facilitates awareness and proactive decision-making on the part of patients, families, trainees and staff, and creates a more visible presence for ethics in the health system.  The Program in Clinical Ethics offers regular preventative ethics rounds in a variety of care settings across UMHS.

Educational Program
Medical ethics is an integral component of contemporary education for all clinicians. There is a vibrant program for longitudinal ethics education within the medical school, and a more intensive curriculum as part of its path of excellence program.  The Program in Clinical Ethics provides a robust program for longitudinal education and awareness of clinical ethics for UMHS staff and trainees. 


People
Christian J. Vercler, MD MA
Andrew G. Shuman, MD
[more to be named soon!]

Contacts
Co-Directors of the Program in Clinical Ethics: Christian J. Vercler, MD, MA & Andrew G. Shuman, MD
Administrative contact: Valerie Kahn – valkahn@med.umich.edu  734-615-5371

CBSSM Seminar: Kayte Spector-Bagdady, JD

Wed, December 09, 2015, 3:00pm to 4:00pm
Location: 
NCRC, Building 16, Room B004E

Kayte Spector-Bagdady, JD


CBSSM Postdoctoral Fellow

From the Guatemala STD Experiments to the NPRM for Revisions to the Common Rule: Why We Still Don’t Have Human Subjects Research Ethics Right

While much has been made of scandals, and academics zealously deliberate nuances, we still find ourselves revisiting the most basic of human subjects research ethics questions: What is a research subject? What is informed consent? This talk will address this ongoing debate but also the less often asked question of why—what are the structural pressures that bring us time and again to step one and is human subjects research ethics a zero sum game?

The new, enhanced UMHS Ethics committee was featured in the Office of Clinical Affairs "Chief Brief." According to the article, "ECCA members complimented the committee’s improved access to ethics consultation services, focus on proactive and preventative ethics education, and unification of adult and pediatric efforts. Since the programmatic rollout, there has been a 45 percent increase in clinical ethics consultation volume from the prior year, and an 82 percent increase from average of the prior five years." Dr. Andrew Shuman and Dr. Christian Vercler are the co-directors of CBSSM's Program in Clinical Ethics. Dr. Janice Firn is the clinical ethicist who manages the program on a daily basis.

Raymond G. De Vries, Ph.D., together with M. Nieuwenhuijze, gave a talk at the 7th International Conference on Clinical Ethics and Consultation in Amsterdam, Netherlands, in May 2011.

2012 CBSSM Research Colloquium

Fri, May 18, 2012 (All day)

The 2012 Research Colloquium presentations by U-M faculty, fellows and students highlighted research on medical decision making.  The colloquium presenters and their topics were as follows:

  • Melissa Constantine, PhD: Making a baby in the 21st century: An updated user manual
  • Vida Henderson, PharmD, MPH, MFA, and Deliana Ilarraza: Using community-based participatory research and user-centered design approaches in developing an interactive diabetes decision aid
  • Naomi Laventhal, MD, MA, and Stephanie Kukora, MD: Resident attitudes toward ethical and medical decision-making for neonates born at the limit of viability
  • Kathryn Moseley, MD, MPH: Distrust of pediatricians' sleep advice: Focus group results from the Project for African American Infant Safety
  • Laura Scherer, PhD: What's in a name? The effect of a disease label on parents' decision to medicate a colicky infant
  • Lauren Smith, MD: Cracking the code: Ethical issues involved in the decision to undergo genetic testing
  • Ralph Stern, MD: The myth of individual risk
  • Wendy Uhlmann, MS, CGC: The swinging gate: Genetic testing and ethical issues

Leaving the Emergency Room in a Fog (Sep-09)

Consider this scenario:

Alfred made a visit to his local Emergency Room. What was his diagnosis? What did the medical team do for his problem? What was he supposed to do to continue care at home? And what symptoms was he supposed to watch for to alert him to return to the ER?

Alfred woke up at 4 am on Sunday morning with pain in his left foot. That place where his new running shoes had rubbed a raw spot earlier in the week was getting worse. By 9 am, the foot was red and swollen, with a large oozing sore, and Alfred decided to go to the Emergency Room at his local hospital.

Late on Sunday afternoon, Alfred returned home from the ER. He crutched his way into the house and collapsed on the sofa. His teenage son quizzed him.

"What did they say was wrong?"
"Oh, an infection," replied Alfred.
"Well, what did they do for it?"
"I think they cut a chunk out of my foot," said Alfred.
"Whoa! Did they give you any medicine?"
"Yeah, a shot," said Alfred.
"And what’s with the crutches?"
"I’m supposed to use them for a while," said Alfred, looking annoyed.
"How long a while?"
"It’s written down," said Alfred, digging a crumpled sheet of paper out of his pocket.
"Says here you should take some prescription and elevate your left leg for two days."
"Two days? I have to go to work tomorrow," groaned Alfred.
"And you’re supposed to go back to the ER if you have a fever or pain in your leg. Where’s the prescription?"
"Here, look through my wallet. Maybe I stuck it in there," said Alfred.
The good news is that Alfred recovered completely, with some assistance and cajoling from his son. But how common is it for people who go to the Emergency Room to be foggy about what happened and what they should do once they leave the ER?
What do you think is the percentage of ER patients who do not understand at least one of the following: their diagnosis, the emergency care they received, their discharge care, or their return instructions?
 
  • 38%
  • 48%
  • 78%
  • 88%

How do your answers compare?

A recent study in the Annals of Emergency Medicine found that 78% of emergency room patients showed deficient comprehension in at least one of these areas:
 
  • Diagnosis
  • Emergency care that was given
  • Post-ER care needs
  • Symptoms that would require a return to the ER
51% of patients showed deficient comprehension in two or more areas. Only 22% of reports from patients were in complete harmony with what their care teams reported in all four areas. The biggest area of misunderstanding was in patients' post-ER care needs, such as medications, self-care steps, follow-up from their regular doctors, or follow-up with specialists.
 
Even more alarming is that, according to the study, "most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall." The patients were quite sure of what they knew 80% of the time—even when what they knew was not right.
 
These results suggest that Emergency Room teams need to do a better job of making sure that patients go home with clear information and instructions—and that patients and their loved ones shouldn't leave until they fully comprehend their situation.
 
Lead author Kirsten G. Engel, MD, conducted this study, "Patient Comprehension of Emergency Department Care and Instructions," with Michele Heisler, MD, Dylan M. Smith, PhD , Claire H. Robinson, MPH, Jane H.Forman, ScD, MHS, and Peter A. Ubel, MD, most of whom are affiliated with CBDSM.
 
The researchers carried out detailed interviews with 140 English-speaking patients who visited one of two Emergency Departments in southeast Michigan and were released to go home. These interviews were compared with the patients' medical records, and the comparisons revealed serious mismatches between what the medical teams found or advised and what the patients comprehended.
 
"It is critical that emergency patients understand their diagnosis, their care, and, perhaps most important, their discharge instructions," says Kirsten Engel, a former UM Robert Wood Johnson Clinical Scholar who is now at Northwestern University. "It is disturbing that so many patients do not understand their post-Emergency-Department care, and that they do not even recognize where the gaps in understanding are. Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the Emergency Department."
 
Peter A. Ubel, the study's senior author, agrees: "Doctors need to not only ask patients if they have questions, but ask them to explain, in their own words, what they think is wrong with their health and what they can do about it. And patients need to ask their doctors more questions, and even need to explain to their doctors what they think is going on."
 
Read the article:

 

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.

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