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.
Page not found
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.
Haoyang Yan, graduate student in psychology, will be seeking feedback on three experiments (with a decision quality scale construction), which aim to examine pediatric tracheotomy decision effectiveness resulting from various decision making techniques.
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
Funded by American Medical Sleep Foundation
Funding Years: 2015-2018
Obstructive sleep apnea (OSA) is a well-recognized risk factor for serious health consequences and increased health care expenditures, but the impact of OSA under-recognition and under-treatment on outcomes and healthcare utilization patterns on a national level remains largely unstudied, particularly among the elderly. Research that characterizes the scope and impact of OSA under-recognition across the U.S. - and barriers to its diagnosis and treatment - is needed to develop strategies that will optimize medical outcomes for Americans with OSA. This proposal aims to identify critical gaps in the identification and treatment of OSA in the U.S., and determine the extent to which such gaps influence outcomes and healthcare utilization. This study will be facilitated though analysis of Medicare 5% datasets, and the National Health and Aging Trends Study - a newly available survey of Medicare beneficiaries that focuses on health outcomes in adults age 65 and older, linked to Medicare claims data. This approach will allow us to characterize national trends in OSA recognition and treatment, clarify relationships between OSA and health outcomes; and identify barriers to improving OSA-related consequences. Ultimately, this project will inform future research directed at improving cost-effective strategies to ameliorate medical and economic consequences of OSA.
PI(s): Tiffany Braley, James Burke
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