Imagine that for the last three months, you have had a very bad headache – the worst in your life – that won’t go away, even when you take aspirin. In addition to the headache you have also been feeling dizzy. Your doctor tells you that you need to get a brain scan to test whether the headache is being caused by something serious. There are two possible scans you can get: a Magnetic Resonance Imaging (MRI) or a Computerized Axial Tomography (CT) scan. The MRI provides a slightly more detailed picture and might find something that the CT misses, such as an extremely uncommon blood vessel problem, but nearly all problems serious enough to need treatment would be seen on either the MRI or the CT.
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Newmedications offer promise to millions of Americans diagnosed with cancer each year. Yet many of thesenew drugs are expensive; a single medication regimen can cost upwards of $50,000per person per year on top of other medical expenses. Our society is strugglingto find ways to target resources for such technologies. Peter A. Ubel,MD,and colleague Peter J. Neumann, MD (Tufts Medical Center) have been funded by theCalifornia Health Care Foundation to conduct a national survey of oncologistsabout new cancer therapies. Assisting with the project is CBSSM research staffmember Julie Tobi.
Dr. Jeff Kullgren is a Research Scientist in the Center for Clinical Management Research at the VA Ann Arbor Healthcare System and an Assistant Professor in the Department of Internal Medicine at the University of Michigan Medical School and Institute for Healthcare Policy and Innovation. Dr.
Research has been the focus and the strength of the faculty members affiliated with CBSSM. Researchers have pursued groundbreaking investigations topics such as:
- doctor-patient communication
- psychological adaptation to disability
- health care rationing
- social cognition
- decision aids to communicate risk
- informed consent
- deliberative democracy
An important mission of CBSSM is to extend the ethics education medical students receive at the University of Michigan. Our current curriculum efforts are focused on enriching the existing curriculum and on making instruction on medical ethics for undergraduate medical students at UM more systematic and focused. Our goal is to increase medical student interest in ethics and their competence in recognizing and resolving ethical issues. Our strategy is to weave ethics into the curriculum throughout the 4 years of training in a way that allows students to build upon what they know of ethical theory and to apply that knowledge to their clinical practice. Additionally, given CBSSM faculty expertise, our aim is to create novel ethics curriculum components that incorporate our empirical work in bioethics and our particular expertise in decision science.
CBSSM scholars perform the basic and applied scientific research that will improve health care policy and practice, to benefit patients and their families, health care providers, third-party payers, policy makers, and the general public. In our Decision of the Month web feature, we turn a recent research finding into an interactive decision that a patient or a policy maker might face.
PROGRAM IN CLINICAL ETHICS
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.
Sarah Alvarez, a fellow at Stanford and formerly of Michigan Radio, will present her work on creating a news product that can meet the information needs of low-income news consumers. Specifically her focus is on how to use data to discover which issues or systems information gaps exist for low-income news consumers and once the gaps are identified how the information should be presented to help people understand the information and use it to make decisions.
If you plan to attend this meeting please e-mail Nicole Exe at firstname.lastname@example.org by Monday November 2. If you decide to attend after that date you are still welcome and do not need to e-mail.
Masahito Jimbo is Professor of Family Medicine and Urology at the University of Michigan. Having worked as a family physician in both urban (Philadelphia) and rural (North Carolina) underserved areas, he has first-hand knowledge and experience of the challenges faced by clinicians and healthcare institutions to be successful in providing patient care that is personal, comprehensive, efficient and timely. Initially trained in basic laboratory research, having obtained his MD and PhD degrees at Keio University in Tokyo, Japan, Dr.
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
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