Medical Decision Making

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

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]

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...

Selective Hearing: Physician Ownership and Physicians’ Response to New Evidence

Jun. 4, 2016

David H. Howard, Guy David, and Jason Hockenberry

In the Journal of Economics & Management Strategy, Guy David and colleagues examine whether physicians who own their surgical practices respond to new medical evidence differently from physicians who work in hospital-owned practices. In 2002, a clinical trial demonstrated that knee surgery did not benefit patients with osteoarthritis, which led to an overall decrease in knee surgeries. The authors took advantage of this “information shock” in 2002 to whether assess the impact of physician vs. hospital ownership status on these surgical practice patterns. They identified all...

Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

May. 25, 2016

Craig D Newgard, Zhuo Yang, Daniel Nishijima, K John McConnell, Stacy A Trent, James F Holmes, Mohamud Daya, N Clay Mann, Renee Y Hsia, Tom D Rea, N Ewen Wang, Kristan Staudenmayer, M. Kit Delgado

In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of...

"Chasing a Ghost": Factors that Influence Primary Care Physicians to Follow Up on Incidental Imaging Findings

May. 23, 2016

Hanna M. Zafar, Eva K. Bugos, Curtis P. Langlotz, Rosemary Frasso

In Radiology, Hanna Zafar and colleagues, including Rosemary Frasso, explore factors that influence how primary care providers (PCPs) communicate and manage incidental imaging findings. Through semistructured interviews, researchers explored concerns and perspectives of 30 PCPs on receiving and acting on incidental imaging findings. Many providers expressed frustration stemming from the “quagmire” of follow-up for incidental findings producing a large financial burden on the health care system. Although these PCPs believed that the majority of incidental findings were of limited...