Maria Silveira, MD, MPH, is the lead author on an article in the New England Journal of Medicine (April 1, 2010) on end-of-life decision making. Silveira and her colleagues found in a large-scale study that more than a quarter of the elderly lacked decision-making capacity as they approached death. Those who had advance directives were very likely to get the care that they wanted. Co-authors on the study are Kenneth Langa, MD, PhD, and Scott Y.H. Kim, MD, PhD. Read a press release about the article here.

Ian Wall, CBDSM Research Associate, has been awarded a prestigious National Science Foundation Graduate Research Fellowship for his upcoming doctoral work in sociology at the University of Wisconsin, Madison. The three-year award includes an annual stipend, tuition allowance, and travel allowance. Ian, who works with Scott Kim, MD, PhD, and Ray DeVries, PhD, will be starting his program at Madison in fall 2010.

Reshma Jagsi, MD, DPhil, is the lead author on a new study showing that breast cancer patients who have had mastectomies and need radiation are less likely to receive these treatments than patients who have had lumpectomies. The article appears in the Journal of Clinical Oncology (online March 29, 2010). Additional authors are Paul Abrahamse, Sarah T. Hawley, Jennifer J. Griggs, Steven J. Katz, Monica Morrow, John J. Graff, and Ann S. Hamilton. Read a press release about the research here.

Holly Witteman, Research Fellow at CBDSM, has been awarded a $25,000 Robert Derzon Post-Doctoral Grant from the Foundation for Informed Medical Decision Making for her project entitled "Development and Evaluation of Interactive Interfaces for Values Exploration and Clarification." Pending IRB approval, the project is slated to commence in April 2010. Witteman has been working since fall 2009 under the mentorship of Angela Fagerlin. CBDSM extends its congratulations!

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 vast majority of oncologists (84%) say that they consider costs to the patient when recommending cancer treatments. But fewer than half of oncologists frequently discuss cost issues with their patients. These are some of the results of a national survey conducted by Peter Neuman, ScD (Tufts Medical Center) and CBDSM's Peter A. Ubel, MD, funded by the California HealthCare Foundation. Results were published in the January 2010 Health Affairs. Ubel comments: "Oncologists understand, from up close, that cancer diagnoses and treatment leave many people bankrupt. They want to do what is medically right for their patients, but they are struggling to figure out what, at the same time, is economically right for them." Read the article here.

Oxford University Press has published Evaluation of Capacity to Consent to Treatment and Research, by CBDSM's Scott Kim, MD, PhD. The book is part of the series Best Practices in Forensic Mental Health Assessment. For further information about this volume, click here.

CBDSM's Reshma Jagsi, MD, DPhil, is the lead author on a study published in the Annals of Internal Medicine showing that women are less likely than men to receive major funding for scientific research. The study also found that only a quarter of all researchers (men and women) who received major early-career awards received further federal funding within five years. Additional authors are Amy Motomura, Kent Griffith, and Soumya Rangarajan. Read a press release about the article here.

Brian Zikmund-Fisher, PhD, is one of three speakers in a recent public health webcast on strategies for conveying the health risks of the H1N1 virus. Zikmund-Fisher is an assistant professor at the University of Michigan School of Public Health and CBDSM. To view the webcast, click here.

Several CBDSM faculty contributed to an article by lead author Monica Morrow, MD, that appeared recently in the Journal of the American Medical Association. The authors investigated the concern that mastectomy is overused in the US. In surveying 1,984 patients, they found that 75% had breast-conserving surgery as their initial surgical therapy. Of these, 38% required additional surgery. Although breast-conserving surgery was recommended by surgeons and attempted in the majority of patients evaluated, the mastectomy rate was affected by surgeon recommendation, patient decision, and failure of breast-conserving surgery. CBDSM faculty contributing to this article were Reshma Jagsi, MD, DPhil; Amy K. Alderman, MD; Jennifer J. Griggs, MD, MPH; and Sarah T. Hawley, PhD. Other authors included Ann A. Hamilton, PhD; John J. Graff, PhD; and Steven J. Katz, MD, MPH. Read the article at http://jama.ama-assn.org/content/vol302/issue14/index.dtl.

CBDSM's Ray DeVries, PhD, along with Mark Pearlman, MD (UM professor of obstetrics and gynecology), and UM doctoral student Ann V. Bell recently published an op-ed column in the New York Times. They discuss the delayed diagnosis of breast cancer and how it is the most common and the second most costly medical claim against American doctors. Read the full article: NY Times

Angela Fagerlin, PhD, has received the American Psychological Association's 2009 Award for Outstanding Contributions to Health Psychology (Division 38, Junior Category). The award was presented at the APA convention in Toronto in early August. CBDSM sends congratulations on this exceptional achievement by one of our faculty members!

A study by Beth Tarini, MD, has found that more than three-quarters of parents would be willing to permit use of their newborn's blood screening sample for research if their permission were obtained in advance. However, more than half of the parents said they would be "very unwilling" to permit this use of blood samples unless they were given a chance to grant or deny permission. For a discussion of this important article, go to http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1217

is the title of a project assessing the impact of different features of a web-based decision aid to improve patient decision making for asymptomatic carotid disease. This project was recently funded by the Foundation for Informed Medical Decision Making. Ethan A. Halm, MD, MPH (Univerity of Texas Southwestern Medical Center) will be working with CBDSM's Brian Zikmund-Fisher, PhD, on this research that will compare two decision aids related to surgery to prevent stroke.  

Reshma Jagsi, MD, DPhil, has found that 29% of cancer research published in high-impact journals disclosed a conflict of interest, including industry funding of the study or a study author who was an industry employee. "Given the frequency we observed for conflicts of interest and the fact that conflicts were associated with study outcomes, I would suggest that merely disclosing conflicts is probably not enough. It's becoming increasingly clear that we need to look more at how we can disentangle cancer research from industry ties," comments Jagsi. The study, which has received wide media attention, was published in the journal Cancer, online at  http://www3.interscience.wiley.com/journal/122381054/abstract?CRETRY=1&SRETRY=0 

Additional authors are Nathan Sheets, Aleksandra Jankovic, Amy R. Motomura, Sudha Amarnath, and Peter A. Ubel.

Caitlin Weber has been presented the 2009 Laurie Kittl Luzynski Administrative Professional Award. This award honors a staff member in the Department of Internal Medicine who has particular commitment to continuing education and to wellness awareness, in addition to a positive attitude and team spirit. The Division of Hematology/Oncology at the University of Michigan presents the award annually in memory of a highly respected staff member in their unit. Weber, who is the Administrative Assistant for CBDSM, was nominated by CBDSM staff.

Be sure to post a comment at peterubel.com, the blog of CBDSM's director, Peter A. Ubel, MD. Dr. Ubel's commentaries range across science, policy, health, well-being, and ethics. Topics include bankruptcy, behavior, and building; nuances, nature, and neighborhoods; soccer, satire, and scientocracy.

During the winter term of 2009, CBDSM welcomes Yvette Peeters, a doctoral student in medical decision making at the University of Leiden Medical Center in the Netherlands. Yvette holds an MSc in clinical and health psychology plus psychometrics and research methodology. Her current interests include utility elicitation, quality of life, emotional adaptation, and survey methodology. During her stay at CBDSM, Yvette's academic mentor is Dylan Smith, PhD.

CBDSM's Scott Kim, MD, PhD, has recently been funded by the NIH for a project on therapeutic misconception and the ethics of sham surgery. Ethicists have raised concerns that elderly patients with a progressively debilitating disease such as Parkinson’s disease (PD) may be too vulnerable for research that involves novel, invasive interventions that use a controversial masking design, i.e., sham neurosurgical controls. Are these subjects laboring under a therapeutic misconception, erroneously believing that research, rather than being an experimental procedure for the sake of creating knowledge to help future patients, is actually a novel form of treatment intended to help them? Dr. Kim’s project will study four actual PD clinical trials that involve a sham surgery control. Collaborators include R. DeVries, K. Kieburtz, R. Wilson, S. Frank, and H.M. Kim. Pilot funding came from the Michael J. Fox Foundation.

19% of women who should receive radiation after mastectomy are not getting this treatment, according to new research results now online in the journal Cancer. CBDSM's Reshma Jagsi, MD, DPhil, is the lead author on this study, which found that the most common reason that women in this high-risk group cited for not considering the treatment was that their doctors did not recommend it. See more information at the University of Michigan Health System Newsroom.

For human-subjects research, maximum regulation does not mean maximum protection. Stop regulating minimal risk research, say Scott Kim, Peter Ubel and Raymond De Vries in their new commentary in Nature.

http://www.nature.com/nature/journal/v457/n7229/pdf/457534a.pdf

Free Market Madness: Why Human Nature Is at Odds with Economics--and Why It Matters is the third book by CBDSM's Peter Ubel, MD. Dr. Ubel explains that our free-market economy is based on the assumption that we always act in our own self-interest. But, using his understanding of psychology and behavior, he then shows that humans are not always rational, and he argues that in some cases government must regulate markets for our own health and well-being. Dr. Ubel's vivid stories bring his message home to anyone interested in improving the way American society works. This publication of Harvard Business Press can be ordered at amazon.com, borders.com, or barnesandnoble.com.

Caring for an ailing spouse may prolong your life. Stephanie Brown explains her research in a vodcast, featured on the University of Michigan website:  http://www.ns.umich.edu/podcast/vodcast.php. This vodcast was, appropriately, the university's home page lead for the week of Thanksgiving.

A study by CBDSM researchers Michael Volk, MD, and Peter Ubel, MD, has found that the Model for End-stage Liver Disease (MELD) organ allocation system has changed how high-risk organs are used--patients lower on the waiting list are receiving more high-risk or poor-quality organs, which has reduced post-transplant survival rates.  Dr. Volk and his colleagues are interested in finding ways to provide better decision making tools for patients who need organ transplants.
To read more about this study, please visit http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=807
Their findings are published in the November issue of Gastroenterology (Vol. 135, No. 5)

 The University of Michigan's Center of Excellence in Cancer Communications Research has been renewed for another five years, through August 2013, by the National Institutes of Health. The purpose of the $8.8 million award is to develop an efficient, theory-driven model for generating health behavior interventions that is generalizable across health behaviors and sociodemographic populations. The UM Center for Health Communicaitons Research, under principal investigator Victor Strecher, MPH, PhD, coordinates the core of this Center of Excellence. CBDSM Director Peter A. Ubel, MD, and CBDSM faculty member Angela Fagerlin, PhD, are leading Project 3, in which they will conduct Internet studies to test several movel ways of tailoring a prostate cancer decision aid, with the goal of identifying interventions that increase the perceived salience of patient preferences. After they have determined the best interventions, they will modify the current prostate cancer decision aid and then test it in men with newly diagnosed localized prostate cancer. Co-investigators on Project 3 are John T. Wei, MD, and Brian Zikmund-Fisher, PhD, at the University of Michigan and James Tulsky, MD, and Stewart Alexander, PhD, at Duke University.

Brian Zikmund-Fisher, PhD, a CBDSM investigator and Director of the CBDSM Internet Survey lab, is the principal investigator on an Investigator Initiated Research award from the Foundation for Informed Medical Decision Making that began in October 2008.  The grant, entitled "Learning by Doing: Improving Risk Communication Through Active Processing of Interactive Pictographs," will fund the development and testing of of Flash-based interactive risk graphics that research participants or patients can use to visually demonstrate how likely they believe some event is to occur. Dr. Zikmund-Fisher hopes that people who create risk graphics themselves will have a better intuitive understanding of risk than people who just view static images. Co-investigators on the award include Angela Fagerlin, Peter A. Ubel, and Amanda Dillard.

New medications offer promise to millions of Americans diagnosed with cancer each year. Yet many of these new drugs are expensive; a single medication regimen can cost upwards of $50,000 per person per year on top of other medical expenses. Our society is struggling to 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 the California Health Care Foundation to conduct a national survey of oncologists about new cancer therapies. Assisting with the project is CBDSM research staff member Julie Parow.

In early April 2008, CBDSM welcomed its first doctoral fellow, Teresa Gavaruzzi. Ms. Gavaruzzi holds degrees in cognitive psychology and experimental psychology and is currently a doctoral student in cognitive psychology at the University of Padua in Italy. Under the mentorship of Angela Fagerlin, PhD, Teresa is participating especially in CBDSM research groups related to patient decision making. For her doctoral dissertation, she’s examining factors affecting the perception and understanding of risks in medical choices and the implications for informed consent, especially in screening for colorectal cancer and prostate cancer. An important part of her work is studying the effects of message framing and format on behaviors.

CBDSM faculty member Dylan Smith, PhD, is the principal investigator on an NIH R-21 grant beginning in spring 2008. Dr. Smith will be measuring health-related quality of life in older adults with chronic illnesses, evaluating existing recall-based approaches against two new tools that are designed to be robust to memory biases. Co-investigators with Dr. Smith are Peter A. Ubel, Norbert Schwarz, and Susan Murphy.

The Regents of the University of Michigan have named Peter A. Ubel, MD, the George Dock Collegiate Professor of Internal Medicine, effective December 13, 2007, through August 31, 2012. Collegiate professorships recognize faculty members whose work is of the highest quality. The titles honor prominent faculty members—in this case, Dr. George Dock (1860-1951), a professor at the University of Michigan Medical School.

CBDSM researcher Brian J. Zikmund-Fisher, PhD, and collaborator Mick Couper, PhD, from the UM Institute for Social Research spoke to the Medical Editors’ Meeting of the Foundation for Informed Medical Decision Making in Jackson Hole, Wyoming. Drs. Couper and Zikmund-Fisher reported on "Methods and Early Results from the National Survey of Medical Decisions." This pioneering survey reveals surprising information about the epidemiology of ten common medical decisions that are made by older Americans. Discussion of the presentation was lively!

The Foundation for Informed Medical Decision Making, which funded this CBDSM research, is a nonprofit organization dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being.
Learn more at www.fimdm.org

Amanda Dillard, PhD, has been awarded a $25,000 George Bennett Postdoctoral Grant by the Foundation for Informed Medical Decision Making. With this funding, Dr. Dillard will conduct surveys to examine whether certain types of patient testimonials have a beneficial influence on knowledge, satisfaction, and interest in shared health care decision making, specifically in the context of a decision aid related to colon cancer screening. She will use social cognitive theory, social comparison theory, and risk processing perspectives to guide her hypotheses about testimonials.

Dr. Dillard’s postdoctoral position at CBDSM is funded by VA Health Services Research and Development, Ann Arbor, Michigan.