The case for frugal default options in patient–doctor communication

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79400/1/j.1365-2753.2010.01404.x.pd

Enough: The Failure of the Living Will

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90575/1/3527683.pd

Barriers to organizational learning: a case study of a change project

An attempt is made in this article to identify the success and failure factors in organizational change and learning process. The empirical study was made by following an organization-wide project that aims at changing pricing practices in highly decentralized sub-units through the efforts of corporate head office. The results show that the highly decentralized organizational structure and the independent financial status of the sub-units have proved to be the barriers to learning and change. In this paper we outline those barriers of organizational learning that occurred in the case of study

The Death of the Living Will

Enough. The living will has failed, and it is time to say so. We should have known it would fail: A notable but neglected psychological literature always provided arresting reasons to expect the policy of living wills to misfire. Given their alluring potential, perhaps they were worth trying. But a crescendoing empirical literature and persistent clinical disappointments reveal that the rewards of the campaign to promote living wills do not justify its costs

Patient decision making about organ quality in liver transplantation

It is challenging to discuss the use of high‐risk organs with patients, in part because of the lack of information about how patients view this topic. This study was designed to determine how patients think about organ quality and to test formats for risk communication. Semistructured interviews of 10 patients on the waiting list revealed limited understanding about the spectrum of organ quality and a reluctance to consider anything but the best organs. A computerized quantitative survey was then conducted with an interactive graph to elicit the risk of graft failure that patients would accept. Fifty‐eight percent of the 95 wait‐listed patients who completed the survey would accept only organs with a risk of graft failure of 25% or less at 3 years, whereas 18% would accept only organs with the lowest risk possible (19% at 3 years). Risk tolerance was increased when the organ quality was presented relative to average organs rather than the best organs and when feedback was provided about the implications for organ availability. More than three‐quarters of the patients reported that they wanted an equal or dominant role in organ acceptance decisions. Men tended to prefer lower risk organs (mean acceptable risk = 29%) in comparison with women (mean acceptable risk = 35%, P = 0.04), but risk tolerance was not associated with other demographic or clinical characteristics (eg, the severity of liver disease). In summary, patients want to be involved in decisions about organ quality. Patients' risk tolerance varies widely, and their acceptance of high‐risk organs can be facilitated if we present the risks of graft failure with respect to average organs and provide feedback about the implications for organ availability. Liver Transpl, 2011. © 2011 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88081/1/22437_ftp.pd

Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?

To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits. Data Sources/Data Collection . Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses ( N =1,132 patients, 277 surgeons). Study Design . Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation. Principal Findings . Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts ( p <.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient–physician communication was significantly ( p <.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge. Conclusions . Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71991/1/j.1475-6773.2008.00843.x.pd

A Matter of Perspective: Choosing for Others Differs from Choosing for Yourself in Making Treatment Decisions

Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk. OBJECTIVE : Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves. RESEARCH DESIGN : Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer. PARTICIPANTS : Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample. MEASURES : Chosen or recommended treatments. We also measured participants' emotional response to our task. RESULTS : Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], P s<.001; chemotherapy: 68% & 68% vs 60%, P s<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P =.003; chemotherapy: 72% vs 60%, P <.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, P s<.01). CONCLUSIONS : Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce “big picture” thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72417/1/j.1525-1497.2006.00410.x.pd

Patient understanding of liver cirrhosis and improvement using multimedia education

Objective For patients to engage with the long-term management of liver cirrhosis, sufficient understanding of their condition is essential. The aim of this study was to assess baseline patient knowledge and to test whether a condition-specific multimedia screencast could improve this. Design Service quality improvement study. Setting A UK tertiary liver centre. Patients were recruited during 12 general hepatology outpatient clinics. Patients Fifty-two patients with liver cirrhosis were included. Sixty-two per cent were male; their median age was 56 years and their median clinic attendance period was 3 years. Interventions Participants completed a baseline questionnaire assessing their knowledge of the management and complications of cirrhosis. They then watched a tailored screencast discussing this condition, which had been developed by expert hepatologists in collaboration with patient representatives. Knowledge was reassessed using a new copy of the original questionnaire after an interval of at least one month. Main outcome measures Patient scores on knowledge questionnaires at baseline and follow-up. Results Fifty-two patients achieved a median score of 25.0% before viewing the screencast. Thirty-five patients then completed a follow-up questionnaire after an interval period. The median questionnaire score in this group improved from 25.0% to 66.7%; an increase of 41.7% compared with baseline (p<0.001). Conclusions Despite regular review at a specialist clinic, participants had poor baseline knowledge of liver cirrhosis. Delivering information by screencast led to a significant improvement. We therefore present an effective way to empower patients with accurate, up-to-date and retainable information that can easily be translated to many other conditions

Anxiety symptoms prior to a prostate cancer diagnosis: Associations with knowledge and openness to treatment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135536/1/bjhp12222.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135536/2/bjhp12222_am.pd