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Is it disgusting? (May-08)

People vary in their attitudes toward physical disabilities. Give us your reactions, and we'll tell you the results of surveys of the general public--and of actual patients.

 

Strongly

disagree

Mildly

disagree

Mildly

agree

Strongly

agree

I try to avoid letting any part of my body touch the toilet seat in a public restroom, even when it appears clean.

1

2

3

4

It would make me uncomfortable to hear a couple making love in the next room of a hotel.

1

2

3

4

It would bother me tremendously to touch a dead body.

1

2

3

4

Even if I were hungry, I would not eat a bowl of my favorite soup if it had been stirred by a used-but thoroughly washed- fly-swatter

1

2

3

4

I am bothered by the odor caused by passing gas.

1

2

3

4

The smell of other persons' bowel movements disgusts me.

1

2

3

4

Consider the following

Now we'd like you to think about a specific health condition. Please read this scenario carefully so that you can answer some questions. Imagine you have a colostomy. A colostomy is an operation involving the surgical redirection of your bowels through a hole created in your gut. This hole is called a stoma. Waste passes through your intestines and out the stoma into a bag, which you must empty several times a day. If you wear relatively loose clothing, this bag won't be visible underneath your garments. Occasionally, you'll experience odors and noises caused by gas and waste passing through the stoma into the bag. There's also the chance that the colostomy bag may leak if it's allowed to fill past capacity. Although you'll be restricted from lifting very heavy objects, your daily activities won't otherwise be greatly affected by the colostomy.

To what extent does your colostomy make you feel embarrassed or socially uncomfortable?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 
To what extent does your colostomy make you feel stigmatized?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 

How do your answers compare?

Do your responses to the six questions on the disgust scale correlate with the stigmatization you expressed related to your imaginary colostomy?

In their national survey of the general public (people without colostomies), CBDSM researchers found that people who reported a higher level of disgust sensitivity responded more negatively to colostomy.

Current and former colostomy patients were also surveyed. In these groups, patients with higher disgust sensitivity had more difficulty adjusting to life with a colostomy. Specifically,colostomy patients with higher disgust sensitivity felt more stigmatized in society by their colostomy and felt more bothered by colostomy symptoms, such as leakage. Dr. Dylan Smith and his colleagues postulate that people who have a pre-existing high sensitivity to disgusting stimuli will be less likely to adjust well to life with a colostomy. Alternatively, it could be that people who adjust successfully to a colostomy do so in part by reducing their sensitivity to certain kinds of disgusting stimuli.

If future studies show that we can predict that patients with high disgust sensitivity are likely to have more difficulty adjusting to a colostomy, health-care teams can then seek ways to de-sensitize responses to bowel functioning, in order to aid patients in their adaptation to life with a colostomy. Further, many people with inflammatory bowel syndrome can choose whether or not to have a colostomy for relief of their symptoms. For these patients, a clear understanding of disgust sensitivity could be a factor in helping to make an informed choice about elective colostomy.

Certainly this research suggests that disgust plays a role in perceived and actual stigmatization of disabled patients. Previous studies of patients' adjustment to disability have focused on general responses to adversity, taking into account their social support, their coping style, or their optimism, for example. The uniqueness of this recent CBDSM study is that it considers how the specific challenges of a disability interact with a personality trait relevant to that disability: disgust sensitivity. This personality trait might also be linked to other health conditions, such as amputation or incontinence. In addition, personality traits other than disgust might affect patients' adaptation to other disabilities.

Read the article:

Sensitivity to disgust, stigma, and adjustment to life with a colostomy
Smith DM, Loewenstein G, Rozin P, Sherriff RL, Ubel PA. Journal of Research in Personality 2007;41(4):787–803.

The Disgust Scale used here is adapted from the work of Haidt J, McCauley C, Rozin P. Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences. 1994; 16(5): 701-713.

 

Bioethics Grand Rounds: Musical Event "When Death Comes Callin"

Wed, October 26, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

When Death Comes Callin': Songs and Reflections About Death

Charlotte DeVries, Jeanne Mackey, Merilynne Rush, and friends offer a program of songs and brief readings reflecting various perspectives on death - humorous, sad, thoughtful, and quirky.

Lunch is provided on a first-come, first-served basis.

Funded by the NIH

The overarching goal of our research is to improve opioid analgesic safety and efficacy by optimizing opioid risk recognition, informed analgesic decision-making, and drug storage/disposal behaviors among parents of youth who are prescribed these agents for home use. With this proposal, we aim to demonstrate that our Scenario-Tailored Opioid Messaging Program (STOMP?) will: 1) Improve parents' opioid risk understanding and their analgesic decision-making; 2) Enhance parents' analgesic self-efficacy, analgesic use, storage behaviors and their children's pain outcomes, and 3) To demonstrate that the STOMP? plus provision of a method to get rid of left-over medications will effectively nudge parents to safely dispose of left-over opioid analgesics. For more info: http://grantome.com/grant/NIH/R01-DA044245-01A1

PI: Terri Lewis-Voepel

CBSSM Co-Is: Brian Zikmund-Fisher & Alan Tait

Mon, June 23, 2014

Brian Zikmund-Fisher was interviewed by Reuters Health for the article "Shared decision making still lacking for cancer screening." He discusses his research and trade-offs in cancer screenings. "What this study does is it shows that despite all of the initiatives and the discussion of shared decision making that has been going on, we don't seem to be moving the needle very much," he states. 

His interview also received press in the Chicago Tribune and New York Daily News.

Angela Fagerlin was listed as one of the top 1% of most-cited researchers worldwide.

More than 3,200 researchers worldwide were included in the Thompson Reuters list, which ranks an individual’s impact based on a survey of Highly Cited Papers (defined as being in the top 1 percent by citations in the Web of Science database) between 2002-2012.

The University of Michigan ranks No. 11 in a new list of most-cited researchers produced by Thompson Reuters, with 27 U-M scientists determined by the company to be in the top 1 percent of their fields.

Link: http://research.umich.edu/blog/2014/07/31/u-m-ranks-no-11-in-new-list-of-most-cited-researchers/

Link: https://www.umhsheadlines.org/2014/08/angela-fagerlin-ph-d-listed-as-one-of-the-top-1-of-most-cited-researchers-worldwide/

 

Get it out of me! (Dec-05)

A 5% chance of death or a 10% chance of death:  which would you choose?

Imagine that you have been diagnosed with a slow growing cancer. Right now, the cancer is not causing you to feel sick. For most people, the cancer will grow so slowly it will never cause them any trouble. For others, the cancer will grow to the point that it makes them sick. Untreated, five percent (5 out of 100) will die of the cancer. Your doctor tells you that you have two treatment options: watchful waiting or surgery. Watchful waiting means you will not do any treatment right away, but your doctor will follow your cancer closely and treat any symptoms that you have if it begins to spread. Although it would be too late to be cured, you would be comfortable and free of pain. There are no side effects to watchful waiting, but five percent (5 out of 100) of the people who choose this treatment will develop symptoms and die from their cancer within five years. On the other hand, the surgery would cure your cancer permanently. Following surgery you will feel more tired than usual and will experience stomach upset occasionally for the three months following your surgery. However, surgery has a ten percent (10 out of 100) risk of death during the surgery.

Imagine that both of these treatments are completely covered by your health insurance. Which would you choose?

  •  I would not take the surgery and accept the 5% chance of dying from this cancer.
  •  I would take the surgery and accept the 10% chance of dying from the surgery.

How do your answers compare?

In the real world, cancer patients sometimes choose treatments that may have devastating side effects over less invasive, yet equally or more effective, approaches. One explanation for this is that people may feel a strong need to "get the cancer out" of their bodies. Surgical removal of all potentially cancerous tissues may satisfy this desire so thoroughly that people end up ignoring important statistical information about adverse outcomes.

Making a choice not in their best interest

CBDSM investigators Angela Fagerlin, Brian Zikmund-Fisher, and Peter Ubel hypothesized that people perceive cancer diagnoses as a call to action, and more specifically, a call to get rid of the cancer through surgery, regardless of what statistical information might say to the contrary. Consequently, they predicted that when presented with hypothetical cancer diagnoses, many people would say they would pursue surgery even if such an action would decrease their chance of survival.

To explore the relative frequency of people's willingness to choose surgery when it wasn't in their best interest, the investigators designed a cancer scenario similar to the one you read on the previous page. Participants were presented either a surgery or a medication treatment that would either increase or decrease their chance of survival.

The investigators found that participants who were presented with the opportunity to rid themselves of their cancer through surgery were significantly more inclined to take action than those who were presented with the medication treatment. For example, when the treatment reduced their overall chance of survival, 65% chose the surgery, whereas only 38% chose the medication treatment. This suggests that people's treatment decisions may be based not on the effectiveness of the treatments, but rather on their beliefs about how cancer should be treated. Specifically, cancer diagnoses seem to conjure up a strong desire for active treatment. And people seem to have an intuitive belief that action should not just involve treatment, but surgical removal of the cancer.

Why these findings are important

The results of this study may resonate with many clinicians who have encountered cancer patients who seem to desire treatment for treatment's sake, or who have a preference for surgical intervention even before they learn about the pros and cons of their treatment alternatives. This study should serve to remind clinicians that patients' preference for action can be strong enough, at times, to be a bias. At a minimum, it is important for health care professionals to be aware of the potential for such biases, so they can decide whether to accept patients' preferences at face value, or try to convince patients that aggressively treating a tumor may not be in their best interests.

Read the article:

Cure me even if it kills me: Preferences for invasive cancer treatment.
Fagerlin A, Zikmund-Fisher BJ, Ubel PA. Medical Decision Making 2005;25(6):614-619.

The Importance of First Impressions (Jun-05)

How do your risk estimate and your actual level of risk impact your anxiety? Please answer the following question to the best of your ability:

What is the chance that the average woman will develop breast cancer in her lifetime?

The average lifetime chance of developing breast cancer is actually 13%.

How does this risk of breast cancer (13% or 13 out of 100 women) strike you?
 
As an extremely low risk 1       2       3       4       5        6        7        8       9       10 As an extremely high risk
 

How do your answers compare?

Making a risk estimate can change the feel of the actual risk

CBDSM investigators Angela Fagerlin, Brian Zikmund-Fisher, and Peter Ubel designed a study to test whether people react differently to risk information after they have been asked to estimate the risks. In this study, half the sample first estimated the average woman's risk of breast cancer (just as you did previously), while the other half made no such estimate. All subjects were then shown the actual risk information and indicated how the risk made them feel and gave their impression of the size of the risk. The graph below shows what they found:

 

As shown in the graph above, subjects who first made an estimated risk reported significantly more relief than those in the no estimate group. In contrast, subjects in the no estimate group showed significantly greater anxiety. Also, women in the estimate group tended to view the risk as low, whereas those in the no estimate group tended to view the risk as high.

So what's responsible for these findings? On average, those in the estimate group guessed that 46% of women will develop breast cancer at some point in their lives, which is a fairly large overestimate of the actual risk. It appears, then, that this overestimate makes the 13% figure feel relatively low, leading to a sense of relief when subjects find the risk isn't as bad as they had previously thought.

Why this finding is important

Clinical practice implications - The current research suggests that clinicians need to be very deliberate but very cautious in how they communicate risk information to their patients. These results argue that a physician should consider whether a person is likely to over-estimate their risk and whether they have an unreasonably high fear of cancer before having them make a risk estimation. For the average patient who would overestimate their risk, making a risk estimation may be harmful, leading them to be too relieved by the actual risk figure to take appropriate actions. On the other hand, if a patient has an unreasonably high fear of cancer, having them make such an estimate may actually be instrumental in decreasing their anxiety. Physicians may want to subtly inquire whether their patient is worried about her cancer risk or if she has any family history of cancer to address the latter type of patient.

Research implications - Many studies in cancer risk communication literature have asked participants at baseline about their perceived risk of developing specific cancers. Researchers then implement an intervention to "correct" baseline risk estimates. The current results suggest that measuring risk perceptions pre-intervention will influence people's subsequent reactions, making it difficult to discern whether it was the intervention that changed their attitudes or the pre-intervention risk estimate. Researchers testing out such interventions need to proceed with caution, and may need to add research arms of people who do not receive such pre-tests.

For more details: Fagerlin A, Zikmund-Fisher BJ, Ubel PA. How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey. Patient Educ Couns. 2005 Jun;57(3):294-9.

 

 

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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