Jill A. Fisher, PhD
Assistant Professor of Social Medicine
Center for Bioethics
University of North Carolina at Chapel Hill
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Brian Zikmund-Fisher, PhD, is the senior author on a study led by Donna M. Zulman, MD, that reveals about a third of doctors and their patients with diabetes do not agree on which of the patient's health conditions is most important. In the study, 38% of physicians (compared to 18% of patients) ranked hypertension as the most important condition. Patients were more likely to prioritize symptoms such as pain and depression. Read the article, in the Journal of General Internal Medicine, here. Read a press release about the article here.
The article, "The DECISIONS Study: A Nationwide Survey of United States Adults Regarding 9 Common Medical Decisions," authored by Brian Zikmund-Fisher et al. in Medical Decision Making (September-October 2010) was recently identified as the most downloaded article in the journal of all articles published in 2009 and 2010.
Jill A. Fisher, PhD
Funded by National Science Foundation.
Funding Years: 2015-2017.
When thinking about infectious diseases and making decisions about how to protect themselves, people often overreact to infectious diseases with low risk of infection, such as Ebola, and at other times fail to respond to infectious diseases with higher risk of infection, such as the flu. Both types of responses can lead to negative outcomes such as stress and anxiety, less productivity at work, and inefficient use of healthcare resources (either using too much or too little depending on the disease). We think that one reason that people may exhibit these responses to infectious diseases is that there may be a conflict between their beliefs about their risk and their feelings about their risk. This research will examine areas of misinformation and emotional responses to three infectious diseases: Ebola, the flu, and MERS. After identifying key areas of misinformation and excessive or subdued emotional responses to these three diseases, the research team develops and tests a number of communication strategies that best correct misinformation and resolve conflicts between beliefs and feelings of risk to motivate more appropriate responses to infectious diseases. After determining which strategies are better at doing those things than others, the research team creates a website to display "best-practices" in communicating about infectious diseases.
This research involves conducting a number of web studies to investigate when and for whom cognitive- and affective-based communication strategies work best at modifying cognitions, affect, and behavioral intentions towards pandemic risks. The research uses the theory of "risk-as-feelings". These studies will advance our understanding of risk-as-feelings in a number of ways. First, the research team examines the frequency of simultaneous contradictory responses (SCRs) - when beliefs and feelings of risk conflict - at least with these three infectious diseases. Second, the research team tests for the existence of simultaneous contradictory affective responses. Third, the team then assesses the relative influence of cognitive and affective sources of information on cognitions, affective reactions, and behavioral intentions, as well as in the possible resolution of SCRs. Fourth, the application of risk-as-feelings to determine optimal communication strategies about these infectious diseases should serve as a test-case for the utility of incorporating risk-as-feelings into public health theories of health behavior and communication. Fifth, due to its foundation in the theory of risk-as-feelings, insights gleaned from the current studies should help shape the way information is communicated about other public health issues beyond these disease. And finally, the research tests whether resolving SCRs is key to inducing appropriate responses to pandemic risks or whether improving knowledge, acknowledging fears, and/or improving feelings of efficacy, is sufficient to improve responses, as would be predicted by standard health behavior theories from public health.
PI(s): Brian Zikmund-Fisher
The Michigan Medicine Committee advisory groups are appointed by the Hospital's Office of Clinical Affairs. They review ethical or moral questions that may come up during a pediatrics patient's care. The consultants facilitate communication among patients, their families and the treatment team to assist everyone in making appropriate choices when difficult decisions need to be made. The Committee's goal is to help everyone decide the right thing to do. The Michigan Medicine Ethics Committee is a sub-committee of the Executive Committee on Clinical Affairs as determined by the Medical Staff Bylaws.
The committee is available for consultation to family members, patients, staff, and health care providers. The committee may help you and your child’s medical team clarify facts, examine ethical issues, and assist in the resolution of disagreements about your child’s care. The committee includes people with additional training in medical ethics, doctors, nurses, social workers, a lawyer, a chaplain, an administrator, and members of the community
The University of Michigan has a Pediatric Ethics Committee because the best medical care requires not only medical skill but good moral judgment. The Committee’s main purpose is to offer help and guidance on moral and ethical questions, such as:
- Should treatment be started or stopped?
- How much should a child be told about his or her disease?
- Is the promise of treatment worth the suffering it may cause?
- What is the best thing to do when we must face the end of life?
- What happens when a meeting with the Ethics Committee is requested?
The consultants on call review the patient's medical situation and treatment options. In addition, concerns and feelings of the patient, family members, and the health care team are discussed. Members of the committee may visit with patients, families and medical personnel to discuss these concerns.
Ethics Committee members discuss the information which has been gathered. The Ethics Committee makes suggestions about the best course of action. Often there are a number of options available in the course of a patient's care. Final decisions are made by the patient, family and the health care team.
The Pediatric Ethics Committee meets on the first Tuesday of the month from 12-1:30pm at University Hospital in dining rooms C&D. If you would like to attend as a guest, please contact Amy Lynn @ email@example.com
Request a Consult
8:00 a.m. - 5:00 p.m. Call 734-615-1379
After normal business hours, please call 936-6267 and ask for the clinical ethicist on call to be paged.
For upcoming Bioethics Grand Rounds see Events
This National Institute of Environmental Health Sciences (NIEHS)-funded study seeks to explore the mental conceptualizations of risk of dioxin-like compounds (DLCs) among residents in Midland/Saginaw (M/S), Michigan, who live in areas that have been exposed to DLCs. The CPOD study is using a combination of in-depth qualitative "mental models" interviews (for comparison with an "expert" model) and a larger, population-based survey questionnaire to yield a rich base of knowledge and information about community members' beliefs and understandings about dioxins and dioxin-related health risks. This, in turn, will inform evidence-based recommendations for designing better, more appropriate risk communication messages for the community and for other dioxin exposure assessment studies. Specifically, we seek to distinguish between those dioxin-related concepts, facts, or beliefs that are already well understood by most community members (which therefore could be minimized in future communications) from those misconceptions or factual omissions that most directly inhibit effective risk management by community members. We are also contrasting models of people who know their personal exposure (through prior participation in the University of Michigan Dioxin Exposure Study) versus those who do not. Brian Zikmund-Fisher is the PI of this study.
Funded by the Alzheimer's Association
Active Year(s): 2008-2011
The goal of the MCI Risk Communication Study is to develop and evaluate a risk communication protocol to convey diagnostic and risk information to MCI patients and family members. A multi-step protocol will be created, taking into account principles of health risk communication, patient and provider preferences, and ethical issues involved in working with cognitively impaired populations. The protocol will be delivered by health care professionals with risk communication experience and tested on 10 patient/care-partner dyads recruited from Alzheimer’s Disease Centers at the University of Michigan and Boston University. The results of this pilot study will help inform the fourth trial of REVEAL.
PI: J. Scott Roberts, PhD
Autumn Fiester, PhD, Division of Medical Ethics, Department of Medical Ethics & Health Policy, Perelman School of Medicine University of Pennsylvania
Title – The “Difficult” Patient Reconceived: Learning the Skills of Mediators in Managing Challenging Clinical Encounters.
Abstract: Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses sourced in conflicts related to healthcare delivery and that the solution to the “difficult patient” is to teach better conflict management skills to clinical providers.
1. Apply the mediator's concepts of "positions" and "interests" to patient-provider conflicts
2. Identity the moral emotions and explain their significance in managing the "difficult" patient
3. Learn seven maxims for diffusing conflict in clinical encounters
Available via live stream at: https://connect.umms.med.umich.edu/bioethics_3_22_17