Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors

Jan. 27, 2017

Christopher P. Bonafide,  David T. Jamison,  Elizabeth E. Foglia, 

In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...

A Trial of Financial and Social Incentives to Increase Older Adults’ Walking

Jan. 20, 2017


Kristin A. Harkins, Jeffrey T. Kullgren, Scarlett L. Bellamy, Jason Karlawish, Karen Glanz
 

In the American Journal of Preventive Medicine, Kristin Harkins and colleagues, including LDI Senior Fellows Jason Karlawish and Karen Glanz, investigate the effects of financial incentives and donations to charity separately and combined on older adults’ uptake and retention of increased levels of walking. Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults’ motivation to become active. Ninety-four participants aged ≥65 years participated in this...

Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Research Brief
Dec. 8, 2016

An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Nov. 20, 2016

Stephen E. Kimmel, Andrea B. Troxel, Benjamin French, George Loewenstein, Jalpa A. Doshi, Todd E. H. Hecht, Mitchell Laskin, Colleen M. Brensinger, Chris Meussner, Kevin Volpp

In Pharmacoepidemiology and Drug Safety, Stephen Kimmel and colleagues, including Jalpa Doshi, Benjamin French and Kevin Volpp, investigate the comparative effectiveness of reminders alone versus daily lottery incentives in improving medication adherence. This study was a four-arm multi-center...

Pennsylvania Launches its Prescription Drug Monitoring Program

Aug. 25, 2016

Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.

Attitudes and Practices of Euthanasia and Physician Assisted Suicide in the US, Canada and Europe

Aug. 19, 2016

Ezekiel J. Emanuel; Bregje D. Onwuteaka-Philipsen; John W. Urwin; Joachim Cohen

In JAMA, Ezekiel Emanuel and colleagues review the legal status as well as the available data and practices of euthanasia and physician assisted suicide. This study gathers data from polling, published surveys of the public and physicians, official state and country databases, interview studies with physicians and death certificate studies from 1947 to 2016 to paint a thorough picture. The findings show that euthanasia and physician-assisted suicide can be practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada. Physician assisted suicide, excluding euthanasia, is...

Shared Decision Making and Treatment Decisions for Young Children with Autism Spectrum Disorder

Aug. 19, 2016

Susan E. Levy, Rosemary Frasso, Stephanie Colantonio, Hayley Reed, Gail Stein, Frances K. Barg, David S. Mandell, Alexander G. Fiks

In Academic Pediatrics, Susan Levy and colleagues including Rosemary Frasso, David Mandell and Alexander Fiks, examine the barriers to communication and shared decision-making between pediatricians and parents of young children with autism spectrum disorder (ASD). Lack of shared decision-making and communication about management decisions often results in parents’ perception of unmet needs for coordination of care and referral for specialized care. This authors interviewed 20 pediatricians from 10 primary care practices in urban and suburban areas, and 20 English-speaking parents...

What Do Hospitalized Patients Say Would Be Worse Than Death?

Aug. 16, 2016

[cross-posted with the Health Cents blog on philly.com]

In caring for hospitalized patients with serious illnesses, and in evaluating interventions designed to help them, clinicians and researchers often focus on death as the primary outcome to be avoided. We tend to pay less attention to avoiding other outcomes that may be equally or more unacceptable to some patients.

States Worse Than Death Among Hospitalized Patients with Serious Illnesses

Aug. 15, 2016

Emily B. Rubin, Anna E. Buehler, Scott D. Halpern

In JAMA Internal Medicine, Emily Rubin and colleagues, including Scott Halpern, investigate how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death. The authors conducted structured interviews with 180 patients, 60 years and older, who were hospitalized between July 2015 and March 2016 at an academic medical center in Philadelphia. All patients were asked to evaluate health states with specific physical and cognitive debilities, dependencies on forms of life support and dependencies on others to perform various...

Non-surgical management of ovarian cancer: Prevalence and implications

Jun. 9, 2016

David I. Shalowitz, Andrew J. Epstein, Emily M. Ko, Robert L. Giuntoli

In Gynecologic Oncology, David Shalowitz and colleagues, including Andrew Epstein, analyze the prevalence of non-surgical treatment for ovarian cancer, the reasons behind this in cases where surgery would have been clinically appropriate, and implications for survival rates. The authors find that one in five patients with ovarian cancer do not undergo surgery, which goes against best-practice guidelines. Surgery has been shown to significantly improve survival rates for ovarian cancer compared with non-surgical treatment. The largest determinant of whether a patient had surgical...

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