You are here

Ubel, Peter A

Overview:

I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?)

I am currently exploring controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care spending. My books include Pricing Life (MIT Press 2000) and Free Market Madness (Harvard Business Press, 2009). My newest book, Critical Decisions (HarperCollins), came out in September of 2012, and explores the challenges of shared decision making between doctors and patients.

Positions:

Madge and Dennis T. McLawhorn University Professor

Fuqua School of Business
Fuqua School of Business

Professor of Business Administration

Fuqua School of Business
Fuqua School of Business

Professor in the Sanford School of Public Policy

Sanford School of Public Policy
Sanford School of Public Policy

Professor of Medicine

Medicine, General Internal Medicine
School of Medicine

Affiliate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1984

B.A. — Carleton College

M.D. 1988

M.D. — University of Minnesota, Twin Cities

News:

A Need for Healthcare.gov 3.0

June 25, 2015 — St. Louis Post-Dispatch

Choices, Plans Overwhelming for Patients

April 13, 2016 — the Philadelphia Inquirer

Commentary: Choices, plans overwhelming for patients

April 08, 2016 — Philadelphia Inquirer

Dr. Peter Ubel: A need for Healthcare.gov 3.0

June 26, 2015 — South Florida Sun-Sentinel

Dr. Peter Ubel: In medical market, shoppers lack savvy

April 07, 2016 — The News & Observer

FDA’s New Food Labels Could Make You Fatter

September 17, 2015 — The Washington Post

Future Healthcare Spending

July 08, 2016 — Forbes

Health care costs? Let's talk

June 18, 2015 — Marketplace

Saving Billions on Medical Care

May 27, 2016 — Forbes

Grants:

No question too small: Development of a question prompt list for infants and their families

Administered By
Pediatrics, Neurology
AwardedBy
National Palliative Care Research Center
Role
Mentor
Start Date
July 01, 2016
End Date
June 30, 2018

HIV cure studies: risk, risk perception, and ethics

Administered By
Social Science Research Institute
AwardedBy
Harvard University
Role
Principal Investigator
Start Date
August 01, 2015
End Date
July 31, 2017

Promoting Professionalism and Accountability Through Nonfinancial Means: Framework Development

Administered By
Social Science Research Institute
AwardedBy
American Board of Internal Medicine Foundation
Role
Principal Investigator
Start Date
August 03, 2015
End Date
March 31, 2017

Subcontract for Integration of Whole Genome Sequencing into Clinical Medicine

Administered By
Social Science Research Institute
AwardedBy
Brigham and Women's Hospital
Role
Principal Investigator
Start Date
December 05, 2011
End Date
November 30, 2016

Michigan Center For Health Communication Research II

Administered By
Social Science Research Institute
AwardedBy
University of Michigan
Role
Principal Investigator
Start Date
September 01, 2010
End Date
August 31, 2014

Identifying and Reducing Cognitive Biases Created by Decision Aids

Administered By
Fuqua School of Business
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 2000
End Date
July 31, 2014
Show More

Publications:

Can Appealing to Patient Altruism Reduce Overuse of Health Care Services? An Experimental Survey.

A challenge to reducing overuse of health services is communicating recommendations against unnecessary health services to patients. The predominant approach has been to highlight the limited benefit and potential harm of such services for that patient, but the prudent use of health resources can also benefit others. Whether appealing to patient altruism can reduce overuse is unknown.To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings.Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults).U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys.In the control version of the vignettes, the physician's rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service.Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes.A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P < 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084).In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism can reduce overuse.

Authors
Riggs, KR; Ubel, PA; Saloner, B
MLA Citation
Riggs, KR, Ubel, PA, and Saloner, B. "Can Appealing to Patient Altruism Reduce Overuse of Health Care Services? An Experimental Survey." Journal of general internal medicine (February 2, 2017).
PMID
28155043
Source
epmc
Published In
Journal of General Internal Medicine
Publish Date
2017
DOI
10.1007/s11606-017-4002-5

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

Research suggests that anxiety may be a common response to a cancer diagnosis, but research is needed to examine anxiety before diagnosis. Anxiety before diagnosis may relate to the comprehension of relevant health information or openness to potential treatments. This study examined anxiety and these outcomes in men who were waiting to learn of a prostate cancer diagnosis.One goal of this study was to determine whether anxiety would increase as men came closer to learning the results of their prostate cancer biopsy. Another goal was to test whether anxiety was associated with knowledge about prostate cancer or openness to different treatments.Men (N = 265) who were facing a prostate cancer diagnosis were surveyed at two time points. Time 1 occurred at the time of biopsy, and Time 2 occurred immediately before men received their biopsy result. At each time point, men reported their anxiety about prostate cancer and their biopsy result. At Time 2, they completed a knowledge test of information about prostate cancer and reported their openness to different potential treatments.Anxiety symptoms increased as men came closer to learning their diagnosis. Also, higher anxiety was associated with lower knowledge and greater openness to particular treatments like surgery. Interactions showed that when anxiety increased from Time 1 to Time 2, having high or low knowledge mattered less to treatment openness.Waiting for a cancer diagnosis is an important time period in which anxiety may increase and relate to information processing and openness to treatments. Statement of contribution What is already known on this subject? Men undergoing prostate cancer screening have been found to experience high and low levels of anxiety. Research has shown that negative emotions like anxiety are common following a cancer diagnosis, but little research has examined emotions right before diagnosis. Anxiety has been associated with information processing and motivation to engage in preventive behaviours. What does this study add? Applies and tests a theoretical idea related to how anxiety may change as one approaches personally relevant threatening health feedback. Shows relationships between changes in anxiety and knowledge in the context of waiting for actual health feedback. Associates increased anxiety in the prostate cancer context with knowledge and openness to different treatments.

Authors
Dillard, AJ; Scherer, LD; Ubel, PA; Alexander, S; Fagerlin, A
MLA Citation
Dillard, AJ, Scherer, LD, Ubel, PA, Alexander, S, and Fagerlin, A. "Anxiety symptoms prior to a prostate cancer diagnosis: Associations with knowledge and openness to treatment." British journal of health psychology 22.1 (February 2017): 151-168.
PMID
27882638
Source
epmc
Published In
British Journal of Health Psychology
Volume
22
Issue
1
Publish Date
2017
Start Page
151
End Page
168
DOI
10.1111/bjhp.12222

Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments.

In order to empower patients as decision makers, physicians must educate them about their treatment options in a factual, nonbiased manner. We propose that site-specific availability of treatment options may be a novel source of bias, whereby physicians describe treatments more positively when they are available. We performed a content analysis of physicians' descriptions of robotic prostatectomy within 252 appointments at four Veterans Affairs medical centers where robotic surgery was either available or unavailable. We coded how physicians portrayed robotic versus open prostatectomy across specific clinical categories and in the appointment overall. We found that physicians were more likely to describe robotic prostatectomy as superior when it was available [F(1, 42) = 8.65, p = .005]. We also provide initial qualitative evidence that physicians may be shaping their descriptions of robotic prostatectomy in an effort to manage patients' emotions and demand for the robotic technology. To our knowledge, this is the first study to provide empirical evidence that treatment availability influences how physicians describe the advantages and disadvantages of treatment alternatives to patients during clinical encounters, which has important practical implications for patient empowerment and patient satisfaction.

Authors
Scherr, KA; Fagerlin, A; Wei, JT; Williamson, LD; Ubel, PA
MLA Citation
Scherr, KA, Fagerlin, A, Wei, JT, Williamson, LD, and Ubel, PA. "Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments." Health communication 32.1 (January 2017): 119-125.
PMID
27153051
Source
epmc
Published In
Health Communication
Volume
32
Issue
1
Publish Date
2017
Start Page
119
End Page
125

Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.

To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer.We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex.Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ(2)(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, Δχ(2)(2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ(2)(6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments).Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives.

Authors
Scherr, KA; Fagerlin, A; Hofer, T; Scherer, LD; Holmes-Rovner, M; Williamson, LD; Kahn, VC; Montgomery, JS; Greene, KL; Zhang, B; Ubel, PA
MLA Citation
Scherr, KA, Fagerlin, A, Hofer, T, Scherer, LD, Holmes-Rovner, M, Williamson, LD, Kahn, VC, Montgomery, JS, Greene, KL, Zhang, B, and Ubel, PA. "Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions." Medical decision making : an international journal of the Society for Medical Decision Making 37.1 (January 2017): 56-69.
PMID
27510740
Source
epmc
Published In
Medical Decision Making
Volume
37
Issue
1
Publish Date
2017
Start Page
56
End Page
69
DOI
10.1177/0272989x16662841

How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study.

To assess how informed patients are about breast reconstruction, and how involved they are in decision making.Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making.We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model.A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%).Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.

Authors
Lee, CN-H; Ubel, PA; Deal, AM; Blizard, LB; Sepucha, KR; Ollila, DW; Pignone, MP
MLA Citation
Lee, CN-H, Ubel, PA, Deal, AM, Blizard, LB, Sepucha, KR, Ollila, DW, and Pignone, MP. "How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study." Annals of surgery 264.6 (December 2016): 1103-1109.
PMID
26727092
Source
epmc
Published In
Annals of Surgery
Volume
264
Issue
6
Publish Date
2016
Start Page
1103
End Page
1109

Copay Assistance for Expensive Drugs: A Helping Hand That Raises Costs.

Authors
Ubel, PA; Bach, PB
MLA Citation
Ubel, PA, and Bach, PB. "Copay Assistance for Expensive Drugs: A Helping Hand That Raises Costs." Annals of internal medicine 165.12 (December 2016): 878-879.
PMID
27723893
Source
epmc
Published In
Annals of internal medicine
Volume
165
Issue
12
Publish Date
2016
Start Page
878
End Page
879
DOI
10.7326/m16-1334

Should Neonatologists Give Opinions Withdrawing Life-sustaining Treatment?

An infant has a massive intracranial hemorrhage. She is neurologically devastated and ventilator-dependent. The prognosis for pulmonary or neurologic recovery is bleak. The physicians and parents face a choice: withdraw the ventilator and allow her to die or perform a tracheotomy? The parents cling to hope for recovery. The physician must decide how blunt to be in communicating his own opinions and recommendations. Should the physician try to give just the facts? Or should he also make a recommendation based on his own values? In this article, experts in neonatology, decision-making, and bioethics discuss this situation and the choice that the physician faces.

Authors
Blumenthal-Barby, JS; Loftis, L; Cummings, CL; Meadow, W; Lemmon, M; Ubel, PA; McCullough, L; Rao, E; Lantos, JD
MLA Citation
Blumenthal-Barby, JS, Loftis, L, Cummings, CL, Meadow, W, Lemmon, M, Ubel, PA, McCullough, L, Rao, E, and Lantos, JD. "Should Neonatologists Give Opinions Withdrawing Life-sustaining Treatment?." Pediatrics 138.6 (December 2016).
PMID
27940720
Source
epmc
Published In
Pediatrics
Volume
138
Issue
6
Publish Date
2016

Gunmen and Ice Cream Cones: Harm to Autonomy and Harm to Persons.

Authors
Blumenthal-Barby, JS; Ubel, PA
MLA Citation
Blumenthal-Barby, JS, and Ubel, PA. "Gunmen and Ice Cream Cones: Harm to Autonomy and Harm to Persons." The American journal of bioethics : AJOB 16.11 (November 2016): 13-14.
PMID
27749180
Source
epmc
Published In
American Journal of Bioethics
Volume
16
Issue
11
Publish Date
2016
Start Page
13
End Page
14

What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized.We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs.Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively.Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression).Focus on 3 conditions with potentially high out-of-pocket costs.Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes.

Authors
Hunter, WG; Zhang, CZ; Hesson, A; Davis, JK; Kirby, C; Williamson, LD; Barnett, JA; Ubel, PA
MLA Citation
Hunter, WG, Zhang, CZ, Hesson, A, Davis, JK, Kirby, C, Williamson, LD, Barnett, JA, and Ubel, PA. "What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits." Medical decision making : an international journal of the Society for Medical Decision Making 36.7 (October 2016): 900-910.
PMID
26785714
Source
epmc
Published In
Medical Decision Making
Volume
36
Issue
7
Publish Date
2016
Start Page
900
End Page
910
DOI
10.1177/0272989x15626384

New strategies for aligning physicians with health system incentives.

Authors
Navathe, AS; Sen, AP; Rosenthal, MB; Pearl, RM; Ubel, PA; Emanuel, EJ; Volpp, KG
MLA Citation
Navathe, AS, Sen, AP, Rosenthal, MB, Pearl, RM, Ubel, PA, Emanuel, EJ, and Volpp, KG. "New strategies for aligning physicians with health system incentives." The American journal of managed care 22.9 (September 2016): 610-612.
PMID
27662223
Source
epmc
Published In
American Journal of Managed Care
Volume
22
Issue
9
Publish Date
2016
Start Page
610
End Page
612

A Mixed-Methods Investigation of the Motivations, Goals, and Aspirations of Male and Female Academic Medical Faculty.

Understanding the goals and aspirations of the physician-scientist workforce can inform policies to promote retention. The authors explored gender differences therein, given women's increasing representation.In 2010-2011, the authors qualitatively analyzed interviews with 100 former recipients of National Institutes of Health career development awards and 28 of their mentors. They also compared survey responses of 1,267 clinician-investigators who received these awards from 2006 to 2009, using logistic regression to evaluate gender differences after adjusting for other characteristics.Interview participants described relatively consistent career goals, including scientific contribution and desire to positively affect lives through research, clinical care, and teaching. For many, the specific ways they sought to achieve and measure goal attainment evolved over time. Survey respondents endorsed a goal of publishing high-quality research with highest frequency (97.3%, no significant gender difference). Women were more likely to endorse the importance of balancing work and other activities (95.5% vs. 90.5%, P < .001). There were no significant gender differences in the importance of patient care (86.6%), teaching (71.6%), or publishing prolifically (64.9%). Men were more likely than women to consider salary (49.4% vs. 41.8%, P < .001), reputation (84.2% vs. 77.6%, P = .004), and leadership positions (38.9% vs. 34.3%, P = .03) important.In an elite research-oriented sample, gender differences in initial aspirations were generally limited. Gender differences in career outcomes in such groups are unlikely to exclusively result from different baseline aspirations. Goals appear to evolve in response to challenges experienced.

Authors
Jones, RD; Griffith, KA; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
Jones, RD, Griffith, KA, Ubel, PA, Stewart, A, and Jagsi, R. "A Mixed-Methods Investigation of the Motivations, Goals, and Aspirations of Male and Female Academic Medical Faculty." Academic medicine : journal of the Association of American Medical Colleges 91.8 (August 2016): 1089-1097.
PMID
27254012
Source
epmc
Published In
Academic Medicine
Volume
91
Issue
8
Publish Date
2016
Start Page
1089
End Page
1097
DOI
10.1097/acm.0000000000001244

Effect of physician disclosure of specialty bias on patient trust and treatment choice

Authors
Sah, S; Fagerlin, A; Ubel, P
MLA Citation
Sah, S, Fagerlin, A, and Ubel, P. "Effect of physician disclosure of specialty bias on patient trust and treatment choice." Proceedings of the National Academy of Sciences 113.27 (July 5, 2016): 7465-7469.
Source
crossref
Published In
Proceedings of the National Academy of Sciences of USA
Volume
113
Issue
27
Publish Date
2016
Start Page
7465
End Page
7469
DOI
10.1073/pnas.1604908113

Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions.

Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions." Journal of the National Comprehensive Cancer Network : JNCCN 14.5 Suppl (May 2016): 691-693.
PMID
27226516
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
5 Suppl
Publish Date
2016
Start Page
691
End Page
693

Sexual Harassment and Discrimination Experiences of Academic Medical Faculty.

Authors
Jagsi, R; Griffith, KA; Jones, R; Perumalswami, CR; Ubel, P; Stewart, A
MLA Citation
Jagsi, R, Griffith, KA, Jones, R, Perumalswami, CR, Ubel, P, and Stewart, A. "Sexual Harassment and Discrimination Experiences of Academic Medical Faculty." JAMA 315.19 (May 2016): 2120-2121.
PMID
27187307
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
19
Publish Date
2016
Start Page
2120
End Page
2121
DOI
10.1001/jama.2016.2188

Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients' Out-Of-Pocket Spending.

Some experts contend that requiring patients to pay out of pocket for a portion of their care will bring consumer discipline to health care markets. But are physicians prepared to help patients factor out-of-pocket expenses into medical decisions? In this qualitative study of audiorecorded clinical encounters, we identified physician behaviors that stand in the way of helping patients navigate out-of-pocket spending. Some behaviors reflected a failure to fully engage with patients' financial concerns, from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending. Many of these failures resulted from systemic barriers to health care spending conversations, such as a lack of price transparency. For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters.

Authors
Ubel, PA; Zhang, CJ; Hesson, A; Davis, JK; Kirby, C; Barnett, J; Hunter, WG
MLA Citation
Ubel, PA, Zhang, CJ, Hesson, A, Davis, JK, Kirby, C, Barnett, J, and Hunter, WG. "Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients' Out-Of-Pocket Spending." Health affairs (Project Hope) 35.4 (April 2016): 654-661.
PMID
27044966
Source
epmc
Published In
Health Affairs
Volume
35
Issue
4
Publish Date
2016
Start Page
654
End Page
661
DOI
10.1377/hlthaff.2015.1280

Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates.

Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings.Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010-2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson's Chi-Square Tests.Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost--discussion of the patient's OoP costs for a healthcare service; (b) Cost/Coverage--discussion of the patient's OoP costs or insurance coverage; (c) Cost of Illness- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24% of clinic visits contained cost conversation (OOP Cost, Cost/Coverage, Cost of Illness, respectively; P < 0.001); depression: 30, 38, 43%, (P < 0.001); and rheumatoid arthritis, 26, 33, 35%, (P < 0.001).The estimated incidence of physician-patient cost conversation varied significantly depending on the definition used. Our findings and proposed definitions may assist in retrospective interpretation and prospective design of investigations on this topic.

Authors
Hunter, WG; Hesson, A; Davis, JK; Kirby, C; Williamson, LD; Barnett, JA; Ubel, PA
MLA Citation
Hunter, WG, Hesson, A, Davis, JK, Kirby, C, Williamson, LD, Barnett, JA, and Ubel, PA. "Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates." BMC health services research 16 (March 31, 2016): 108-.
PMID
27036177
Source
epmc
Published In
BMC Health Services Research
Volume
16
Publish Date
2016
Start Page
108
DOI
10.1186/s12913-016-1353-2

Value Promotion in Health Care: The Importance of Symmetry.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Value Promotion in Health Care: The Importance of Symmetry." JAMA 315.2 (January 2016): 133-134.
PMID
26720593
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
2
Publish Date
2016
Start Page
133
End Page
134
DOI
10.1001/jama.2015.18159

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

Authors
Emanuel, EJ; Ubel, PA; Kessler, JB; Meyer, G; Muller, RW; Navathe, AS; Patel, P; Pearl, R; Rosenthal, MB; Sacks, L; Sen, AP; Sherman, P; Volpp, KG
MLA Citation
Emanuel, EJ, Ubel, PA, Kessler, JB, Meyer, G, Muller, RW, Navathe, AS, Patel, P, Pearl, R, Rosenthal, MB, Sacks, L, Sen, AP, Sherman, P, and Volpp, KG. "Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care." Annals of internal medicine 164.2 (January 2016): 114-119.
PMID
26595370
Source
epmc
Published In
Annals of internal medicine
Volume
164
Issue
2
Publish Date
2016
Start Page
114
End Page
119
DOI
10.7326/m15-1330

Potential problems with increasing serving sizes on the Nutrition Facts label.

The United States Food and Drug Administration recently announced that the serving sizes on the Nutrition Facts labels for many products will be increased, but the effect of these increases remains unclear. The present research examined consumers' interpretation of the meaning of serving size information (study 1) and tested whether exposing consumers to the increased serving sizes of the proposed Nutrition Facts label leads consumers to serve and purchase more food for themselves and others (studies 2-4). Study 1 (N = 101; 44.7% female) tested what consumers believe the serving sizes on Nutrition Facts labels refer to, and the majority of participants (over 78%) incorrectly believed that the serving sizes refer to how much food can or should be consumed in one sitting as part of a healthy diet. Study 2 (N = 51; 41.2% female) tested how exposure to the current versus proposed Nutrition Facts label influences the amount of food that consumers serve themselves, and studies 3 (N = 60; 46.7% female) and 4 (N = 61; 48.2% female) assessed how exposure to the current versus proposed label influences the amount of food that people serve and purchase for others. In studies 2-4, the proposed label (vs. the current label) led consumers to serve themselves 41% more cookies (study 2); serve 27% more cheese crackers to another person (study 3); and buy 43% more lasagnas for others and divide a lasagna into 22% larger slices (study 4). The results suggest that the proposed Nutrition Facts label's increased serving sizes may lead people who use this information as a reference to serve more food to themselves and others.

Authors
Dallas, SK; Liu, PJ; Ubel, PA
MLA Citation
Dallas, SK, Liu, PJ, and Ubel, PA. "Potential problems with increasing serving sizes on the Nutrition Facts label." Appetite 95 (December 2015): 577-584.
PMID
26278876
Source
epmc
Published In
Appetite
Volume
95
Publish Date
2015
Start Page
577
End Page
584
DOI
10.1016/j.appet.2015.08.012

Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment.

Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters.We analyzed audio-recorded office visits of 252 men with presumed localized prostate cancer (Gleason 6 and Gleason 7 scores) who were seeing 45 physicians at 4 Veterans Affairs Medical Centers. Data were collected between September 2008 and May 2012 in a trial of 2 decision aids (DAs). Braddock's previously validated Informed Decision Making (IDM) system was used to measure quality. Latent variable models for ordinal data examined the relationship of IDM score to treatment received.Mean IDM score showed modest quality (7.61±2.45 out of 18) and high variability. Treatment choice and risks and benefits were discussed in approximately 95% of encounters. However, in more than one-third of encounters, physicians provided a partial set of treatment options and omitted surveillance as a choice. Informing quality was greater in patients treated with surveillance (β = 1.1, p = .04). Gleason score (7 vs 6) and lower age were often cited as reasons to exclude surveillance. Patient preferences were elicited in the majority of cases, but not used to guide treatment planning. Encounter time was modestly correlated with IDM score (r = 0.237, p = .01). DA type was not associated with IDM score.Physicians informed patients of options and risks and benefits, but infrequently engaged patients in core shared decision-making processes. Despite patients having received DAs, physicians rarely provided an opportunity for preference-driven decision making. More attention to the underused patient decision-making and engagement elements could result in improved shared decision making.

Authors
Holmes-Rovner, M; Montgomery, JS; Rovner, DR; Scherer, LD; Whitfield, J; Kahn, VC; Merkle, EC; Ubel, PA; Fagerlin, A
MLA Citation
Holmes-Rovner, M, Montgomery, JS, Rovner, DR, Scherer, LD, Whitfield, J, Kahn, VC, Merkle, EC, Ubel, PA, and Fagerlin, A. "Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment." Medical decision making : an international journal of the Society for Medical Decision Making 35.8 (November 2015): 999-1009.
PMID
26304063
Source
epmc
Published In
Medical Decision Making
Volume
35
Issue
8
Publish Date
2015
Start Page
999
End Page
1009
DOI
10.1177/0272989x15597226

The utility of cost discussions between patients with cancer and oncologists.

Patients with cancer can experience substantial financial burden. Little is known about patients' preferences for incorporating cost discussions into treatment decision making or about the ramifications of those discussions. The objective of this study was to determine patient preferences for and benefits of discussing costs with doctors.Cross-sectional, survey study.We enrolled insured adults with solid tumors on anticancer therapy who were treated at a referral cancer center or an affiliated rural cancer clinic. Patients were surveyed at enrollment and again 3 months later about cost discussions with doctors, decision making, and financial burden. Medical records were abstracted for disease and treatment data. Logistic regression investigated characteristics associated with greater desire to discuss costs.Of 300 patients (86% response rate), 52% expressed some desire to discuss treatment-related out-of-pocket costs with doctors and 51% wanted their doctor to take costs into account to some degree when making treatment decisions. However, only 19% had talked to their doctor about costs. Of those, 57% reported lower out-of-pocket costs as a result of cost discussions. In multivariable logistic regression, higher subjective financial distress was associated with greater likelihood to desire cost discussions (odds ratio [OR], 1.22; 95% CI, 1.10-1.36). Nonwhite race was associated with lower likelihood to desire cost discussions (OR, 0.53; 95% CI, 0.30-0.95).Patients with cancer varied in their desire to discuss costs with doctors, but most who discussed costs believed the conversations helped reduce their expenses. Patient-physician cost communication might reduce out-of-pocket costs even in oncology where treatment options are limited.

Authors
Zafar, SY; Chino, F; Ubel, PA; Rushing, C; Samsa, G; Altomare, I; Nicolla, J; Schrag, D; Tulsky, JA; Abernethy, AP; Peppercorn, JM
MLA Citation
Zafar, SY, Chino, F, Ubel, PA, Rushing, C, Samsa, G, Altomare, I, Nicolla, J, Schrag, D, Tulsky, JA, Abernethy, AP, and Peppercorn, JM. "The utility of cost discussions between patients with cancer and oncologists." The American journal of managed care 21.9 (September 2015): 607-615.
PMID
26618364
Source
epmc
Published In
American Journal of Managed Care
Volume
21
Issue
9
Publish Date
2015
Start Page
607
End Page
615

Summarizing polygenic risks for complex diseases in a clinical whole-genome report

Authors
Kong, SW; Lee, I-H; Leshchiner, I; Krier, J; Kraft, P; Rehm, HL; Green, RC; Kohane, IS; MacRae, CA
MLA Citation
Kong, SW, Lee, I-H, Leshchiner, I, Krier, J, Kraft, P, Rehm, HL, Green, RC, Kohane, IS, and MacRae, CA. "Summarizing polygenic risks for complex diseases in a clinical whole-genome report." Genetics in Medicine 17.7 (July 2, 2015): 536-544.
Source
crossref
Published In
Genetics in Medicine
Volume
17
Issue
7
Publish Date
2015
Start Page
536
End Page
544
DOI
10.1038/gim.2014.143

The author replies.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The author replies." The Hastings Center report 45.4 (July 2015): 4-.
PMID
26152379
Source
epmc
Published In
The Hastings Center report
Volume
45
Issue
4
Publish Date
2015
Start Page
4
DOI
10.1002/hast.463

Medical Facts versus Value Judgments--Toward Preference-Sensitive Guidelines.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Medical Facts versus Value Judgments--Toward Preference-Sensitive Guidelines." The New England journal of medicine 372.26 (June 2015): 2475-2477.
PMID
26107051
Source
epmc
Published In
The New England journal of medicine
Volume
372
Issue
26
Publish Date
2015
Start Page
2475
End Page
2477
DOI
10.1056/nejmp1504245

Healthcare.gov 3.0 — Behavioral Economics and Insurance Exchanges

Authors
Ubel, PA; Comerford, DA; Johnson, E
MLA Citation
Ubel, PA, Comerford, DA, and Johnson, E. "Healthcare.gov 3.0 — Behavioral Economics and Insurance Exchanges." Obstetrical & Gynecological Survey 70.6 (June 2015): 373-375.
Source
crossref
Published In
Obstetrical and Gynecological Survey
Volume
70
Issue
6
Publish Date
2015
Start Page
373
End Page
375
DOI
10.1097/01.ogx.0000466882.67743.cc

Acute Myeloid Leukemia (AML) Patients Understanding of Prognosis and Treatment Goals: A Mixed-Methods Study.

Authors
LeBlanc, TW; Bloom, CT; Davis, DM; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Bloom, CT, Davis, DM, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Acute Myeloid Leukemia (AML) Patients Understanding of Prognosis and Treatment Goals: A Mixed-Methods Study." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study.

Authors
LeBlanc, TW; Wolf, S; Davis, DM; Samsa, G; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Wolf, S, Davis, DM, Samsa, G, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Cost-related health literacy: a key component of high-quality cancer care.

Authors
Zafar, SY; Ubel, PA; Tulsky, JA; Pollak, KI
MLA Citation
Zafar, SY, Ubel, PA, Tulsky, JA, and Pollak, KI. "Cost-related health literacy: a key component of high-quality cancer care." Journal of oncology practice 11.3 (May 2015): 171-173.
PMID
25829522
Source
epmc
Published In
Journal of Oncology Practice
Volume
11
Issue
3
Publish Date
2015
Start Page
171
End Page
173
DOI
10.1200/jop.2015.004408

Gender Differences in Resources and Negotiation Among Highly Motivated Physician-Scientists

Authors
Holliday, E; Griffith, KA; De Castro, R; Stewart, A; Ubel, P; Jagsi, R
MLA Citation
Holliday, E, Griffith, KA, De Castro, R, Stewart, A, Ubel, P, and Jagsi, R. "Gender Differences in Resources and Negotiation Among Highly Motivated Physician-Scientists." Journal of General Internal Medicine 30.4 (April 2015): 401-407.
Source
crossref
Published In
Journal of General Internal Medicine
Volume
30
Issue
4
Publish Date
2015
Start Page
401
End Page
407
DOI
10.1007/s11606-014-2988-5

Why It's Not Time for Health Care Rationing.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Why It's Not Time for Health Care Rationing." The Hastings Center report 45.2 (March 2015): 15-19.
PMID
25739777
Source
epmc
Published In
The Hastings Center report
Volume
45
Issue
2
Publish Date
2015
Start Page
15
End Page
19
DOI
10.1002/hast.427

The role of professional societies in limiting indication creep.

New technology is a major driver of health care inflation. One contributor to this inflation is indication creep, the diffusion of interventions that have been proven beneficial in specific patient populations into untested broader populations who may be less likely to benefit. Professional societies sometimes promote indication creep, as we illustrate with the case of therapeutic hypothermia after cardiac arrest. Professional societies are in a unique position to limit indication creep. We propose that, at a minimum, professional societies should refrain from recommending new diagnostic and therapeutic technologies in their guidelines until they have been proven beneficial in the targeted populations. In some circumstances, professional societies could be more active in combatting indication creep, either recommending against expanded use of clinical interventions when evidence is lacking, or coordinating efforts to collect data in these broader populations.

Authors
Riggs, KR; Ubel, PA
MLA Citation
Riggs, KR, and Ubel, PA. "The role of professional societies in limiting indication creep." Journal of general internal medicine 30.2 (February 2015): 249-252. (Review)
PMID
25092014
Source
epmc
Published In
Journal of General Internal Medicine
Volume
30
Issue
2
Publish Date
2015
Start Page
249
End Page
252
DOI
10.1007/s11606-014-2980-0

Creating value in health by understanding and overcoming resistance to de-innovation.

As hard as it may be for clinicians to adopt new practices, it is often harder for them to "de-innovate," or give up old practices, even when new evidence reveals that those practices offer little value. In this article we explore recent controversies over screening for breast and prostate cancer and testing for sleep disorders. We show that these controversies are not caused solely by a lack of clinical data on the harms and benefits of these tests but are also influenced by several psychological biases that make it difficult for clinicians to de-innovate. De-innovation could be fostered by making sure that advisory panels and guideline committees include experts who have competing biases; emphasizing evidence over clinical judgment; resisting "indication creep," or the premature extension of innovations into unproven areas; and encouraging clinicians to explicitly consider how their experiences bias their interpretations of clinical evidence.

Authors
Ubel, PA; Asch, DA
MLA Citation
Ubel, PA, and Asch, DA. "Creating value in health by understanding and overcoming resistance to de-innovation." Health affairs (Project Hope) 34.2 (February 2015): 239-244.
PMID
25646103
Source
epmc
Published In
Health Affairs
Volume
34
Issue
2
Publish Date
2015
Start Page
239
End Page
244
DOI
10.1377/hlthaff.2014.0983

Healthcare.gov 3.0--behavioral economics and insurance exchanges.

Authors
Ubel, PA; Comerford, DA; Johnson, E
MLA Citation
Ubel, PA, Comerford, DA, and Johnson, E. "Healthcare.gov 3.0--behavioral economics and insurance exchanges." The New England journal of medicine 372.8 (February 2015): 695-698.
PMID
25693008
Source
epmc
Published In
The New England journal of medicine
Volume
372
Issue
8
Publish Date
2015
Start Page
695
End Page
698
DOI
10.1056/nejmp1414771

How behavioral economics can help to avoid 'The last mile problem' in whole genome sequencing.

Failure to consider lessons from behavioral economics in the case of whole genome sequencing may cause us to run into the 'last mile problem' - the failure to integrate newly developed technology, on which billions of dollars have been invested, into society in a way that improves human behavior and decision-making.

Authors
Blumenthal-Barby, JS; McGuire, AL; Green, RC; Ubel, PA
MLA Citation
Blumenthal-Barby, JS, McGuire, AL, Green, RC, and Ubel, PA. "How behavioral economics can help to avoid 'The last mile problem' in whole genome sequencing." Genome medicine 7.1 (January 22, 2015): 3-.
PMID
25614766
Source
epmc
Published In
Genome Medicine: medicine in the post-genomic era
Volume
7
Issue
1
Publish Date
2015
Start Page
3
DOI
10.1186/s13073-015-0132-8

'How many calories are in my burrito?' Improving consumers' understanding of energy (calorie) range information.

Energy (calorie) ranges currently appear on menu boards for customized menu items and will likely appear throughout the USA when menu-labelling legislation is implemented. Consumer welfare advocates have questioned whether energy ranges enable accurate energy estimates. In four studies, we examined: (i) whether energy range information improves energy estimation accuracy; (ii) whether misestimates persist because consumers misinterpret the meaning of the energy range end points; and (iii) whether energy estimates can be made more accurate by providing explicit information about the contents of items at the end points.Four studies were conducted, all randomized experiments.Study 1 took place outside a Chipotle restaurant. Studies 2 to 4 took place online.Participants in study 1 were customers exiting a Chipotle restaurant (n 306). Participants in studies 2 (n 205), 3 (n 290) and 4 (n 874) were from an online panel.Energy ranges reduced energy misestimation across different menu items (studies 1-4). One cause of remaining misestimation was misinterpretation of the low end point's meaning (study 2). Providing explicit information about the contents of menu items associated with energy range end points further reduced energy misestimation (study 3) across different menu items (study 4).Energy range information improved energy estimation accuracy and defining the meaning of the end points further improved accuracy. We suggest that when restaurants present energy range information to consumers, they should explicitly define the meaning of the end points.

Authors
Liu, PJ; Bettman, JR; Uhalde, AR; Ubel, PA
MLA Citation
Liu, PJ, Bettman, JR, Uhalde, AR, and Ubel, PA. "'How many calories are in my burrito?' Improving consumers' understanding of energy (calorie) range information." Public health nutrition 18.1 (January 2015): 15-24.
PMID
24762709
Source
epmc
Published In
Public health nutrition
Volume
18
Issue
1
Publish Date
2015
Start Page
15
End Page
24
DOI
10.1017/s1368980014000627

Gender Differences in Resources and Negotiation Among Highly Motivated Physician-Scientists

© 2014, Society of General Internal Medicine.BACKGROUND: Resources, including space, equipment, funding, personnel, and protected time, are essential in academic medical careers. Negotiation often plays a key role in the distribution of these resources. OBJECTIVE: This study explored gender differences in resources, negotiation behaviors, and negotiation outcomes in a sample of career development awardees. DESIGN: Postal survey of a cohort of 1,708 clinician-researchers with responses from 1,275 (75 % response rate). PARTICIPANTS: Researchers who received NIH K08 or K23 awards between 2006 and 2009. MAIN MEASURES: We analyzed gender differences in resources, negotiation behaviors, and negotiation outcomes, using regression models adjusted for race, K award type, K award year, degree, academic rank, specialty, and institutional funding. KEY RESULTS: Over one-fifth of respondents reported inadequate access to research space and one-third had asked for increased space or equipment. Perceived adequacy of these physical resources did not differ significantly by gender, but a higher proportion of women reported inadequate access to grants administrators (34.8 %) and statistical support (49.9 %) than men (26.9 %; p = 0.002 and 43.4 %; p = 0.025, respectively). Women were more likely to have asked for reduction in clinical hours (24.1 % vs. 19.3 %; p = 0.02) and to have raised concerns about unfair treatment (50.2 % vs. 38.2 %; p < 0.001). Overall, 42.9 % of women and 35.9 % of men asked for a raise in the two years preceding the survey (p = 0.09), and among those who had asked for increased resources, the likelihood that the request was granted did not differ significantly by gender. CONCLUSION: Many career development award recipients report resource needs and negotiate for increased resources. Gender differences in perceived access to research support personnel exist even in this select cohort of K awardees. Institutions should provide appropriate training in negotiation and ensure adequate and equitable distribution of resources to promote academic success.

Authors
Holliday, E; Griffith, KA; Castro, RD; Stewart, A; Ubel, P; Jagsi, R
MLA Citation
Holliday, E, Griffith, KA, Castro, RD, Stewart, A, Ubel, P, and Jagsi, R. "Gender Differences in Resources and Negotiation Among Highly Motivated Physician-Scientists." Journal of General Internal Medicine 30.4 (2015): 401-407.
Source
scival
Published In
Journal of General Internal Medicine
Volume
30
Issue
4
Publish Date
2015
Start Page
401
End Page
407
DOI
10.1007/s11606-014-2988-5

Patient-physician communication about early stage prostate cancer: Analysis of overall visit structure

© 2015 John Wiley & Sons Ltd.Background: We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer. Objective: To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses. Participants: Forty veterans and 18 urologists at one VA medical centre. Methods: We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities. Results: We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions. Conclusion: Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.

Authors
Henry, SG; Czarnecki, D; Kahn, VC; Chou, W-YS; Fagerlin, A; Ubel, PA; Rovner, DR; Alexander, SC; Knight, SJ; Holmes-Rovner, M
MLA Citation
Henry, SG, Czarnecki, D, Kahn, VC, Chou, W-YS, Fagerlin, A, Ubel, PA, Rovner, DR, Alexander, SC, Knight, SJ, and Holmes-Rovner, M. "Patient-physician communication about early stage prostate cancer: Analysis of overall visit structure." Health Expectations 18.5 (2015): 1757-1768.
Source
scival
Published In
Health Expectations
Volume
18
Issue
5
Publish Date
2015
Start Page
1757
End Page
1768
DOI
10.1111/hex.12168

Prognostic Disclosure in Acute Myeloid Leukemia (AML): A Qualitative Study of Patient Preferences and Physician Practices

Authors
LeBlanc, TW; Bloom, CT; Davis, DM; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Bloom, CT, Davis, DM, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Prognostic Disclosure in Acute Myeloid Leukemia (AML): A Qualitative Study of Patient Preferences and Physician Practices." BLOOD 124.21 (December 6, 2014).
Source
wos-lite
Published In
Blood
Volume
124
Issue
21
Publish Date
2014

Transplantation traffic--geography as destiny for transplant candidates.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Transplantation traffic--geography as destiny for transplant candidates." The New England journal of medicine 371.26 (December 2014): 2450-2452.
PMID
25539104
Source
epmc
Published In
The New England journal of medicine
Volume
371
Issue
26
Publish Date
2014
Start Page
2450
End Page
2452
DOI
10.1056/nejmp1407639

The black box of out-of-pocket cost communication. A path toward illumination.

Authors
Hunter, WG; Ubel, PA
MLA Citation
Hunter, WG, and Ubel, PA. "The black box of out-of-pocket cost communication. A path toward illumination." Annals of the American Thoracic Society 11.10 (December 2014): 1608-1609.
PMID
25549026
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
11
Issue
10
Publish Date
2014
Start Page
1608
End Page
1609
DOI
10.1513/annalsats.201410-475ed

Surcharges Plus Unhealthy Labels Reduce Demand for Unhealthy Menu Items

Authors
Shah, AM; Bettman, JR; Ubel, PA; Keller, PA; Edell, JA
MLA Citation
Shah, AM, Bettman, JR, Ubel, PA, Keller, PA, and Edell, JA. "Surcharges Plus Unhealthy Labels Reduce Demand for Unhealthy Menu Items." Journal of Marketing Research 51.6 (December 2014): 773-789.
Source
crossref
Published In
Journal of Marketing Research
Volume
51
Issue
6
Publish Date
2014
Start Page
773
End Page
789
DOI
10.1509/jmr.13.0434

Why information alone is not enough: behavioral economics and the future of genomic medicine.

Authors
Blumenthal-Barby, JS; McGuire, AL; Ubel, PA
MLA Citation
Blumenthal-Barby, JS, McGuire, AL, and Ubel, PA. "Why information alone is not enough: behavioral economics and the future of genomic medicine." Annals of internal medicine 161.8 (October 2014): 605-606.
PMID
25329206
Source
epmc
Published In
Annals of internal medicine
Volume
161
Issue
8
Publish Date
2014
Start Page
605
End Page
606
DOI
10.7326/m14-2074

Nudging the obese: a UK-US consideration.

Over recent years, nudge policies have become increasingly popular (if somewhat confused) internationally. This article attempts to clarify what a nudge entails, and critically summarises some of the nudge policies that have been proposed to motivate weight loss in the United Kingdom and the United States. Despite the fact that most of the evidence on nudge-related policy has so far been produced in the United States, and that the leading nudge champions are American, the United Kingdom, at least with respect to considering policy interventions of this kind at the national level, appears to be relatively advanced. That said, nudge interventions remain of marginal practical import everywhere, and are never going to solve completely the obesity problem. Nonetheless, even a marginal effect may extend and improve many lives, a result that would satisfy most behavioural economists.

Authors
Oliver, A; Ubel, P
MLA Citation
Oliver, A, and Ubel, P. "Nudging the obese: a UK-US consideration." Health economics, policy, and law 9.3 (July 2014): 329-342.
PMID
24759081
Source
epmc
Published In
Health Economics, Policy and Law
Volume
9
Issue
3
Publish Date
2014
Start Page
329
End Page
342
DOI
10.1017/s1744133114000103

Overcoming barriers to discussing out-of-pocket costs with patients.

Authors
Riggs, KR; Ubel, PA
MLA Citation
Riggs, KR, and Ubel, PA. "Overcoming barriers to discussing out-of-pocket costs with patients." JAMA internal medicine 174.6 (June 2014): 849-850.
PMID
24756731
Source
epmc
Published In
JAMA Internal Medicine
Volume
174
Issue
6
Publish Date
2014
Start Page
849
End Page
850
DOI
10.1001/jamainternmed.2014.853

Does cancer treatment-related financial distress worsen over time?

Authors
Van Nimwegen, L; Rushing, C; Chino, FL; Samsa, G; Altomare, I; Tulsky, JA; Ubel, PA; Nicolla, J; Abernethy, AP; Peppercorn, JM; Zafar, Y
MLA Citation
Van Nimwegen, L, Rushing, C, Chino, FL, Samsa, G, Altomare, I, Tulsky, JA, Ubel, PA, Nicolla, J, Abernethy, AP, Peppercorn, JM, and Zafar, Y. "Does cancer treatment-related financial distress worsen over time?." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Can we identify patients at risk for discordance in preferred and actual role in cancer treatment decision making?

Authors
Zullig, LL; Rushing, C; Chino, FL; Samsa, G; Altomare, I; Tulsky, JA; Ubel, PA; Nicolla, J; Abernethy, AP; Peppercorn, JM; Zafar, Y
MLA Citation
Zullig, LL, Rushing, C, Chino, FL, Samsa, G, Altomare, I, Tulsky, JA, Ubel, PA, Nicolla, J, Abernethy, AP, Peppercorn, JM, and Zafar, Y. "Can we identify patients at risk for discordance in preferred and actual role in cancer treatment decision making?." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Patient understanding of medical jargon: a survey study of U.S. medical students.

OBJECTIVE: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. METHODS: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. RESULTS: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p=0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. CONCLUSION: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. PRACTICE IMPLICATIONS: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: a survey study of U.S. medical students." Patient education and counseling 95.2 (May 2014): 238-242.
PMID
24525222
Source
epmc
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

Patient-oncologist cost communication, financial distress, and medication adherence.

Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care.We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions.Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence.Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.

Authors
Bestvina, CM; Zullig, LL; Rushing, C; Chino, F; Samsa, GP; Altomare, I; Tulsky, J; Ubel, P; Schrag, D; Nicolla, J; Abernethy, AP; Peppercorn, J; Zafar, SY
MLA Citation
Bestvina, CM, Zullig, LL, Rushing, C, Chino, F, Samsa, GP, Altomare, I, Tulsky, J, Ubel, P, Schrag, D, Nicolla, J, Abernethy, AP, Peppercorn, J, and Zafar, SY. "Patient-oncologist cost communication, financial distress, and medication adherence." Journal of oncology practice 10.3 (May 2014): 162-167.
PMID
24839274
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
3
Publish Date
2014
Start Page
162
End Page
167
DOI
10.1200/jop.2014.001406

Promoting population health through financial stewardship.

Authors
Ubel, PA; Jagsi, R
MLA Citation
Ubel, PA, and Jagsi, R. "Promoting population health through financial stewardship." The New England journal of medicine 370.14 (April 2014): 1280-1281.
PMID
24693887
Source
epmc
Published In
The New England journal of medicine
Volume
370
Issue
14
Publish Date
2014
Start Page
1280
End Page
1281
DOI
10.1056/nejmp1401335

The MedSeq Project: a randomized trial of integrating whole genome sequencing into clinical medicine.

Whole genome sequencing (WGS) is already being used in certain clinical and research settings, but its impact on patient well-being, health-care utilization, and clinical decision-making remains largely unstudied. It is also unknown how best to communicate sequencing results to physicians and patients to improve health. We describe the design of the MedSeq Project: the first randomized trials of WGS in clinical care.This pair of randomized controlled trials compares WGS to standard of care in two clinical contexts: (a) disease-specific genomic medicine in a cardiomyopathy clinic and (b) general genomic medicine in primary care. We are recruiting 8 to 12 cardiologists, 8 to 12 primary care physicians, and approximately 200 of their patients. Patient participants in both the cardiology and primary care trials are randomly assigned to receive a family history assessment with or without WGS. Our laboratory delivers a genome report to physician participants that balances the needs to enhance understandability of genomic information and to convey its complexity. We provide an educational curriculum for physician participants and offer them a hotline to genetics professionals for guidance in interpreting and managing their patients' genome reports. Using varied data sources, including surveys, semi-structured interviews, and review of clinical data, we measure the attitudes, behaviors and outcomes of physician and patient participants at multiple time points before and after the disclosure of these results.The impact of emerging sequencing technologies on patient care is unclear. We have designed a process of interpreting WGS results and delivering them to physicians in a way that anticipates how we envision genomic medicine will evolve in the near future. That is, our WGS report provides clinically relevant information while communicating the complexity and uncertainty of WGS results to physicians and, through physicians, to their patients. This project will not only illuminate the impact of integrating genomic medicine into the clinical care of patients but also inform the design of future studies.ClinicalTrials.gov identifier NCT01736566.

Authors
Vassy, JL; Lautenbach, DM; McLaughlin, HM; Kong, SW; Christensen, KD; Krier, J; Kohane, IS; Feuerman, LZ; Blumenthal-Barby, J; Roberts, JS; Lehmann, LS; Ho, CY; Ubel, PA; MacRae, CA; Seidman, CE; Murray, MF; McGuire, AL; Rehm, HL; Green, RC
MLA Citation
Vassy, JL, Lautenbach, DM, McLaughlin, HM, Kong, SW, Christensen, KD, Krier, J, Kohane, IS, Feuerman, LZ, Blumenthal-Barby, J, Roberts, JS, Lehmann, LS, Ho, CY, Ubel, PA, MacRae, CA, Seidman, CE, Murray, MF, McGuire, AL, Rehm, HL, and Green, RC. "The MedSeq Project: a randomized trial of integrating whole genome sequencing into clinical medicine." Trials 15 (March 20, 2014): 85-.
PMID
24645908
Source
epmc
Published In
Trials
Volume
15
Publish Date
2014
Start Page
85
DOI
10.1186/1745-6215-15-85

The role of perceived benefits and costs in patients' medical decisions

Background Many decisions can be understood in terms of actors' valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence. Methods In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health-care provider about during the past 2years. Participants were 2575 English-speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence. Results Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision. Conclusion The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients' confidence in their decision. © 2011 John Wiley & Sons Ltd.

Authors
Singer, E; Couper, MP; Fagerlin, A; Fowler, FJ; Levin, CA; Ubel, PA; Van Hoewyk, J; Zikmund-Fisher, BJ
MLA Citation
Singer, E, Couper, MP, Fagerlin, A, Fowler, FJ, Levin, CA, Ubel, PA, Van Hoewyk, J, and Zikmund-Fisher, BJ. "The role of perceived benefits and costs in patients' medical decisions." Health Expectations 17.1 (March 1, 2014): 4-14.
Source
scopus
Published In
Health Expectations
Volume
17
Issue
1
Publish Date
2014
Start Page
4
End Page
14
DOI
10.1111/j.1369-7625.2011.00739.x

Using Behavioral Economics to Design More Effective Food Policies to Address Obesity

Authors
Liu, PJ; Wisdom, J; Roberto, CA; Liu, LJ; Ubel, PA
MLA Citation
Liu, PJ, Wisdom, J, Roberto, CA, Liu, LJ, and Ubel, PA. "Using Behavioral Economics to Design More Effective Food Policies to Address Obesity." Applied Economic Perspectives and Policy 36.1 (March 1, 2014): 6-24.
Source
crossref
Published In
Applied Economic Perspectives and Policy
Volume
36
Issue
1
Publish Date
2014
Start Page
6
End Page
24
DOI
10.1093/aepp/ppt027

Does comparative effectiveness research promote rationing of cancer care?

Comparative effectiveness research aims to inform health-care decisions by patients, clinicians, and policy makers. However, questions related to what information is relevant, and how to view the relative attributes of alternative interventions have political, social, and medical considerations. In particular, questions about whether cost is a relevant factor, and whether cost-effectiveness is a desirable or necessary component of such research, have become increasingly controversial as the area has gained prominence. Debate has emerged about whether comparative effectiveness research promotes rationing of cancer care. At the heart of this debate are questions related to the role and limits of patient autonomy, physician discretion in health-care decision making, and the nature of scientific knowledge as an objective good. In this article, we examine the role of comparative effectiveness research in the USA, UK, Canada, and other health-care systems, and the relation between research and policy. As we show, all health systems struggle to balance access to cancer care and control of costs; comparative effectiveness data can clarify choices, but does not itself determine policy or promote rationing of care. © 2014 Elsevier Ltd.

Authors
Peppercorn, J; Zafar, SY; Houck, K; Ubel, P; Meropol, NJ
MLA Citation
Peppercorn, J, Zafar, SY, Houck, K, Ubel, P, and Meropol, NJ. "Does comparative effectiveness research promote rationing of cancer care?." The Lancet Oncology 15.3 (March 1, 2014). (Review)
Source
scopus
Published In
The Lancet Oncology
Volume
15
Issue
3
Publish Date
2014
DOI
10.1016/S1470-2045(13)70597-7

Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008.

BACKGROUND: Undergraduate education studies have suggested instructor sex can influence female students to pursue a discipline. We sought to evaluate a similar hypothesis in medical students. STUDY DESIGN: We obtained Association of American Medical Colleges (AAMC) data about the specialization of 2006-2008 graduates of US medical schools, the sex of their faculty and department chairs, and sex of residents in the residency programs in which they enrolled. We used logistic regression to examine associations between faculty and leadership sex and female students' pursuit of 5 surgical specialties along with 3 nonsurgical specialties for context. We used Wilcoxon rank-sum tests to evaluate whether women entered residency programs with a higher proportion of female residents. RESULTS: In 2006-2008, US medical school graduates included 23,642 women. Women were substantially under-represented among residents in neurosurgery, orthopaedics, urology, otolaryngology, general surgery, and radiology; women constituted 47.4% of US graduates specializing in internal medicine and 74.9% in pediatrics. We found no significant associations between exposure to a female department chair and selection of that specialty and no consistent associations with the proportion of female full-time faculty. Compared with male students, female students entered residency programs in their chosen specialty that had significantly higher proportions of women residents in the year before their graduation. CONCLUSIONS: Although we did not detect consistent significant associations between exposure to potential female faculty role models and specialty choice, we observed that female students were more likely than males to enter programs with higher proportions of female residents. Sex differences in students' specialization decisions merit additional investigation.

Authors
Jagsi, R; Griffith, KA; DeCastro, RA; Ubel, P
MLA Citation
Jagsi, R, Griffith, KA, DeCastro, RA, and Ubel, P. "Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008." Journal of the American College of Surgeons 218.3 (March 2014): 345-352.
PMID
24468225
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
218
Issue
3
Publish Date
2014
Start Page
345
End Page
352
DOI
10.1016/j.jamcollsurg.2013.11.012

Does comparative effectiveness research promote rationing of cancer care?

Authors
Peppercorn, J; Zafar, SY; Houck, K; Ubel, P; Meropol, NJ
MLA Citation
Peppercorn, J, Zafar, SY, Houck, K, Ubel, P, and Meropol, NJ. "Does comparative effectiveness research promote rationing of cancer care?." The Lancet Oncology 15.3 (March 2014): e132-e138.
Source
crossref
Published In
The Lancet Oncology
Volume
15
Issue
3
Publish Date
2014
Start Page
e132
End Page
e138
DOI
10.1016/S1470-2045(13)70597-7

Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers.

Female physician-researchers do not achieve career success at the same rate as men. Differences in nonprofessional responsibilities may partially explain this gap.To investigate the division of domestic labor by gender in a motivated group of early-career physician-researchers.Nationwide postal survey between 2010 and 2011.United States.Physician recipients of National Institutes of Health K08 or K23 awards between 2006 and 2009 with active academic affiliation at the time of the survey.Time spent on parenting and domestic tasks was determined through self-report. Among married or partnered respondents with children, a linear regression model of time spent on domestic activities was constructed considering age, gender, race, specialty, MD or MD/PhD status, age of youngest child, number of children, work hours, K award type, and spousal employment.A 74% response rate was achieved, and 1049 respondents were academic physicians. Women were more likely than men to have spouses or domestic partners who were employed full-time (85.6% [95% CI, 82.7% to 89.2%] vs. 44.9% [CI, 40.8% to 49.8%]). Among married or partnered respondents with children, after adjustment for work hours, spousal employment, and other factors, women spent 8.5 more hours per week on domestic activities. In the subgroup with spouses or domestic partners who were employed full-time, women were more likely to take time off during disruptions of usual child care arrangements than men (42.6% [CI, 36.6% to 49.0%] vs. 12.4% [CI, 5.4% to 19.5%]).Analyses relied on self-reported data. The study design did not enable investigation of the relationship between domestic activities and professional success.In this sample of career-oriented professionals, gender differences in domestic activities existed among those with children. Most men's spouses or domestic partners were not employed full-time, which contrasted sharply with the experiences of women.National Institutes of Health.

Authors
Jolly, S; Griffith, KA; DeCastro, R; Stewart, A; Ubel, P; Jagsi, R
MLA Citation
Jolly, S, Griffith, KA, DeCastro, R, Stewart, A, Ubel, P, and Jagsi, R. "Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers." Annals of internal medicine 160.5 (March 2014): 344-353.
PMID
24737273
Source
epmc
Published In
Annals of internal medicine
Volume
160
Issue
5
Publish Date
2014
Start Page
344
End Page
353
DOI
10.7326/m13-0974

Mentoring and the career satisfaction of male and female academic medical faculty.

PURPOSE: To explore aspects of mentoring that might influence medical faculty career satisfaction and to discover whether there are gender differences. METHOD: In 2010-2011, the authors surveyed 1,708 clinician-researchers who received (in 2006-2009) National Institutes of Health K08 and K23 awards, which provided mentoring for career development. The authors compared, by gender, the development and nature of mentoring relationships, mentor characteristics, extent of mentoring in various mentor roles, and satisfaction with mentoring. They evaluated associations between mentoring and career satisfaction using multivariable linear regression analysis. RESULTS: The authors received 1,275 responses (75% response rate). Of these respondents, 1,227 (96%) were receiving K award support at the time and constituted the analytic sample. Many respondents had > 1 designated mentor (440/558 women, 79%; 410/668 men, 61%; P < .001). Few were dissatisfied with mentoring (122/1,220, 10.0%; no significant gender difference). Career dissatisfaction was generally low, but 289/553 women (52%) and 268/663 men (40%) were dissatisfied with work-life balance (P < .001). Time spent meeting or communicating with the mentor, mentor behaviors, mentor prestige, extent of mentoring in various roles, and collegiality of the mentoring relationship were significantly associated with career satisfaction. Mentor gender, gender concordance of the mentoring pair, and number of mentors were not significantly associated with satisfaction. CONCLUSIONS: This study of junior faculty holding mentored career development awards showed strong associations between several aspects of mentoring and career satisfaction, indicating that those concerned about faculty attrition from academic medicine should consider mentor training and development.

Authors
DeCastro, R; Griffith, KA; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
DeCastro, R, Griffith, KA, Ubel, PA, Stewart, A, and Jagsi, R. "Mentoring and the career satisfaction of male and female academic medical faculty." Acad Med 89.2 (February 2014): 301-311.
PMID
24362376
Source
pubmed
Published In
Academic Medicine
Volume
89
Issue
2
Publish Date
2014
Start Page
301
End Page
311
DOI
10.1097/ACM.0000000000000109

Too much experience: a desensitization bias in emotional perspective taking.

People often use their own feelings as a basis to predict others' feelings. For example, when trying to gauge how much someone else enjoys a television show, people might think "How much do I enjoy it?" and use this answer as basis for estimating others' reactions. Although personal experience (such as actually watching the show oneself) often improves empathic accuracy, we found that gaining too much experience can impair it. Five experiments highlight a desensitization bias in emotional perspective taking, with consequences for social prediction, social judgment, and social behavior. Participants who viewed thrilling or shocking images many times predicted first-time viewers would react less intensely (Experiments 1 and 2); participants who heard the same funny joke or annoying noise many times estimated less intense reactions of first-time listeners (Experiments 3 and 4); and further, participants were less likely to actually share good jokes and felt less bad about blasting others with annoying noise after they themselves became desensitized to those events (Experiments 3-5). These effects were mediated by participants' own attenuated reactions. Moreover, observers failed to anticipate this bias, believing that overexposed participants (i.e., repeatedly exposed participants who became desensitized) would make better decisions on their behalf (Experiment 5). Taken together, these findings reveal a novel paradox in emotional perspective taking: If people experience an evocative event many times, they may not become wiser companions but worse, unable to disentangle self-change from other-oriented thinking. Just as lacking exposure to others' experiences can create gaps in empathy and understanding, so may gaining too much.

Authors
Campbell, T; O'Brien, E; Van Boven, L; Schwarz, N; Ubel, P
MLA Citation
Campbell, T, O'Brien, E, Van Boven, L, Schwarz, N, and Ubel, P. "Too much experience: a desensitization bias in emotional perspective taking." Journal of personality and social psychology 106.2 (February 2014): 272-285.
PMID
24467422
Source
epmc
Published In
Journal of Personality and Social Psychology
Volume
106
Issue
2
Publish Date
2014
Start Page
272
End Page
285
DOI
10.1037/a0035148

The role of perceived benefits and costs in patients' medical decisions.

BACKGROUND: Many decisions can be understood in terms of actors' valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence. METHODS: In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health-care provider about during the past 2 years. Participants were 2575 English-speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence. RESULTS: Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision. CONCLUSION: The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients' confidence in their decision.

Authors
Singer, E; Couper, MP; Fagerlin, A; Fowler, FJ; Levin, CA; Ubel, PA; Van Hoewyk, J; Zikmund-Fisher, BJ
MLA Citation
Singer, E, Couper, MP, Fagerlin, A, Fowler, FJ, Levin, CA, Ubel, PA, Van Hoewyk, J, and Zikmund-Fisher, BJ. "The role of perceived benefits and costs in patients' medical decisions." Health Expect 17.1 (February 2014): 4-14.
PMID
22070416
Source
pubmed
Published In
Health Expectations
Volume
17
Issue
1
Publish Date
2014
Start Page
4
End Page
14
DOI
10.1111/j.1369-7625.2011.00739.x

Mentoring and the career satisfaction of male and female academic medical faculty

Purpose: To explore aspects of mentoring that might influence medical faculty career satisfaction and to discover whether there are gender differences. METHOD: In 2010-2011, the authors surveyed 1,708 clinician-researchers who received (in 2006-2009) National Institutes of Health K08 and K23 awards, which provided mentoring for career development. The authors compared, by gender, the development and nature of mentoring relationships, mentor characteristics, extent of mentoring in various mentor roles, and satisfaction with mentoring. They evaluated associations between mentoring and career satisfaction using multivariable linear regression analysis. RESULTS: The authors received 1,275 responses (75% response rate). Of these respondents, 1,227 (96%) were receiving K award support at the time and constituted the analytic sample. Many respondents had > 1 designated mentor (440/558 women, 79%; 410/668 men, 61%; P < .001). Few were dissatisfied with mentoring (122/1,220, 10.0%; no significant gender difference). Career dissatisfaction was generally low, but 289/553 women (52%) and 268/663 men (40%) were dissatisfied with work-life balance (P < .001). Time spent meeting or communicating with the mentor, mentor behaviors, mentor prestige, extent of mentoring in various roles, and collegiality of the mentoring relationship were significantly associated with career satisfaction. Mentor gender, gender concordance of the mentoring pair, and number of mentors were not significantly associated with satisfaction. CONCLUSIONS: This study of junior faculty holding mentored career development awards showed strong associations between several aspects of mentoring and career satisfaction, indicating that those concerned about faculty attrition from academic medicine should consider mentor training and development.

Authors
Decastro, R; Griffith, KA; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
Decastro, R, Griffith, KA, Ubel, PA, Stewart, A, and Jagsi, R. "Mentoring and the career satisfaction of male and female academic medical faculty." Academic Medicine 89.2 (January 1, 2014): 301-311.
Source
scopus
Published In
Academic Medicine
Volume
89
Issue
2
Publish Date
2014
Start Page
301
End Page
311
DOI
10.1097/ACM.0000000000000109

Patient understanding of medical jargon: A survey study of U.S. medical students

Objective: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. Methods: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. Results: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p= 0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. Conclusion: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. Practice implications: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula. © 2014 Elsevier Ireland Ltd.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: A survey study of U.S. medical students." Patient Education and Counseling 95.2 (January 1, 2014): 238-242.
Source
scopus
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

AJOB Empirical Bioethics : A Home for Empirical Bioethics Scholarship

Authors
Feudtner, C; Sugarman, J; Koenig, BA; Ubel, PA; Ittenbach, RF; Roberts, LW; McCullough, LB
MLA Citation
Feudtner, C, Sugarman, J, Koenig, BA, Ubel, PA, Ittenbach, RF, Roberts, LW, and McCullough, LB. "AJOB Empirical Bioethics : A Home for Empirical Bioethics Scholarship." AJOB Empirical Bioethics 5.1 (January 2014): 1-2.
Source
crossref
Published In
Ajob Empirical Bioethics
Volume
5
Issue
1
Publish Date
2014
Start Page
1
End Page
2
DOI
10.1080/23294515.2013.867292

Agency is messy: get used to it.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Agency is messy: get used to it." The American journal of bioethics : AJOB 14.9 (January 2014): 37-38.
PMID
25127274
Source
epmc
Published In
American Journal of Bioethics
Volume
14
Issue
9
Publish Date
2014
Start Page
37
End Page
38
DOI
10.1080/15265161.2014.936246

Health numeracy: the importance of domain in assessing numeracy.

BACKGROUND AND OBJECTIVE: Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain. METHODS: Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54. RESULTS: We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require. CONCLUSIONS: These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

Authors
Levy, H; Ubel, PA; Dillard, AJ; Weir, DR; Fagerlin, A
MLA Citation
Levy, H, Ubel, PA, Dillard, AJ, Weir, DR, and Fagerlin, A. "Health numeracy: the importance of domain in assessing numeracy." Med Decis Making 34.1 (January 2014): 107-115.
PMID
23824401
Source
pubmed
Published In
Medical Decision Making
Volume
34
Issue
1
Publish Date
2014
Start Page
107
End Page
115
DOI
10.1177/0272989X13493144

Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008

Background Undergraduate education studies have suggested instructor sex can influence female students to pursue a discipline. We sought to evaluate a similar hypothesis in medical students. Study Design We obtained Association of American Medical Colleges (AAMC) data about the specialization of 2006-2008 graduates of US medical schools, the sex of their faculty and department chairs, and sex of residents in the residency programs in which they enrolled. We used logistic regression to examine associations between faculty and leadership sex and female students' pursuit of 5 surgical specialties along with 3 nonsurgical specialties for context. We used Wilcoxon rank-sum tests to evaluate whether women entered residency programs with a higher proportion of female residents. Results In 2006-2008, US medical school graduates included 23,642 women. Women were substantially under-represented among residents in neurosurgery, orthopaedics, urology, otolaryngology, general surgery, and radiology; women constituted 47.4% of US graduates specializing in internal medicine and 74.9% in pediatrics. We found no significant associations between exposure to a female department chair and selection of that specialty and no consistent associations with the proportion of female full-time faculty. Compared with male students, female students entered residency programs in their chosen specialty that had significantly higher proportions of women residents in the year before their graduation. Conclusions Although we did not detect consistent significant associations between exposure to potential female faculty role models and specialty choice, we observed that female students were more likely than males to enter programs with higher proportions of female residents. Sex differences in students' specialization decisions merit additional investigation. © 2014 by the American College of Surgeons Published by Elsevier Inc.

Authors
Jagsi, R; Griffith, KA; Decastro, RA; Ubel, P
MLA Citation
Jagsi, R, Griffith, KA, Decastro, RA, and Ubel, P. "Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008." Journal of the American College of Surgeons 218.3 (2014): 345-352.
Source
scival
Published In
Journal of The American College of Surgeons
Volume
218
Issue
3
Publish Date
2014
Start Page
345
End Page
352
DOI
10.1016/j.jamcollsurg.2013.11.012

The Role of Professional Societies in Limiting Indication Creep

© 2014, Society of General Internal Medicine.New technology is a major driver of health care inflation. One contributor to this inflation is indication creep, the diffusion of interventions that have been proven beneficial in specific patient populations into untested broader populations who may be less likely to benefit. Professional societies sometimes promote indication creep, as we illustrate with the case of therapeutic hypothermia after cardiac arrest. Professional societies are in a unique position to limit indication creep. We propose that, at a minimum, professional societies should refrain from recommending new diagnostic and therapeutic technologies in their guidelines until they have been proven beneficial in the targeted populations. In some circumstances, professional societies could be more active in combatting indication creep, either recommending against expanded use of clinical interventions when evidence is lacking, or coordinating efforts to collect data in these broader populations.

Authors
Riggs, KR; Ubel, PA
MLA Citation
Riggs, KR, and Ubel, PA. "The Role of Professional Societies in Limiting Indication Creep." Journal of General Internal Medicine 30.2 (2014): 249-252.
Source
scival
Published In
Journal of General Internal Medicine
Volume
30
Issue
2
Publish Date
2014
Start Page
249
End Page
252
DOI
10.1007/s11606-014-2980-0

Patient-physician communication about early stage prostate cancer: Analysis of overall visit structurePatient-physician communication about early stage prostate cancer: Analysis of overall visit structure

Background: We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer. Objective: To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses. Participants: Forty veterans and 18 urologists at one VA medical centre. Methods: We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities. Results: We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions. Conclusion: Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options. © 2013 John Wiley & Sons Ltd.

Authors
Henry, SG; Czarnecki, D; Kahn, VC; Chou, WYS; Fagerlin, A; Ubel, PA; Rovner, DR; Alexander, SC; Knight, SJ; Holmes-Rovner, M; Henry, SG; Czarnecki, D; Kahn, VC; Chou, WYSY; Fagerlin, A; Übel, PA; Rovner, DR; Alexander, SC; Knight, SJ; Holmes-Rovner, MM
MLA Citation
Henry, SG, Czarnecki, D, Kahn, VC, Chou, WYS, Fagerlin, A, Ubel, PA, Rovner, DR, Alexander, SC, Knight, SJ, Holmes-Rovner, M, Henry, SG, Czarnecki, D, Kahn, VC, Chou, WYSY, Fagerlin, A, Übel, PA, Rovner, DR, Alexander, SC, Knight, SJ, and Holmes-Rovner, MM. "Patient-physician communication about early stage prostate cancer: Analysis of overall visit structurePatient-physician communication about early stage prostate cancer: Analysis of overall visit structure (PublishedAccepted)." Health Expectations (December 25, 2013).
PMID
24372758
Source
scopus
Published In
Health Expectations
Publish Date
2013
DOI
10.1111/hex.12168

Work-life balance in academic medicine: Narratives of physician-researchers and their mentors

BACKGROUND: Leaders in academic medicine are often selected from the ranks of physician-researchers, whose demanding careers involve multiple professional commitments that must also be balanced with demands at home. OBJECTIVE: To gain a more nuanced understanding of work-life balance issues from the perspective of a large and diverse group of faculty clinician-researchers and their mentors. DESIGN: A qualitative study with semi-structured, in-depth interviews conducted from 2010 to 2011, using inductive analysis and purposive sampling. PARTICIPANTS: One hundred former recipients of U.S. National Institutes of Health (NIH) K08 or K23 career development awards and 28 of their mentors. APPROACH: Three researchers with graduate training in qualitative methods conducted the interviews and thematically coded verbatim transcripts. KEY RESULTS: Five themes emerged related to work-life balance: (1) the challenge and importance of work-life balance for contemporary physician-researchers, (2) how gender roles and spousal dynamics make these issues more challenging for women, (3) the role of mentoring in this area, (4) the impact of institutional policies and practices intended to improve work-life balance, and (5) perceptions of stereotype and stigma associated with utilization of these programs. CONCLUSIONS: In academic medicine, in contrast to other fields in which a lack of affordable childcare may be the principal challenge, barriers to work-life balance appear to be deeply rooted within professional culture. A combination of mentorship, interventions that target institutional and professional culture, and efforts to destigmatize reliance on flexibility (with regard to timing and location of work) are most likely to promote the satisfaction and success of the new generation of clinician-researchers who desire work-life balance. © 2013 Society of General Internal Medicine.

Authors
Strong, EA; De Castro, R; Sambuco, D; Stewart, A; Ubel, PA; Griffith, KA; Jagsi, R
MLA Citation
Strong, EA, De Castro, R, Sambuco, D, Stewart, A, Ubel, PA, Griffith, KA, and Jagsi, R. "Work-life balance in academic medicine: Narratives of physician-researchers and their mentors." Journal of General Internal Medicine 28.12 (December 1, 2013): 1596-1603.
Source
scopus
Published In
Journal of General Internal Medicine
Volume
28
Issue
12
Publish Date
2013
Start Page
1596
End Page
1603
DOI
10.1007/s11606-013-2521-2

Work-life balance in academic medicine: narratives of physician-researchers and their mentors.

BACKGROUND: Leaders in academic medicine are often selected from the ranks of physician-researchers, whose demanding careers involve multiple professional commitments that must also be balanced with demands at home. OBJECTIVE: To gain a more nuanced understanding of work-life balance issues from the perspective of a large and diverse group of faculty clinician-researchers and their mentors. DESIGN: A qualitative study with semi-structured, in-depth interviews conducted from 2010 to 2011, using inductive analysis and purposive sampling. PARTICIPANTS: One hundred former recipients of U.S. National Institutes of Health (NIH) K08 or K23 career development awards and 28 of their mentors. APPROACH: Three researchers with graduate training in qualitative methods conducted the interviews and thematically coded verbatim transcripts. KEY RESULTS: Five themes emerged related to work-life balance: (1) the challenge and importance of work-life balance for contemporary physician-researchers, (2) how gender roles and spousal dynamics make these issues more challenging for women, (3) the role of mentoring in this area, (4) the impact of institutional policies and practices intended to improve work-life balance, and (5) perceptions of stereotype and stigma associated with utilization of these programs. CONCLUSIONS: In academic medicine, in contrast to other fields in which a lack of affordable childcare may be the principal challenge, barriers to work-life balance appear to be deeply rooted within professional culture. A combination of mentorship, interventions that target institutional and professional culture, and efforts to destigmatize reliance on flexibility (with regard to timing and location of work) are most likely to promote the satisfaction and success of the new generation of clinician-researchers who desire work-life balance.

Authors
Strong, EA; De Castro, R; Sambuco, D; Stewart, A; Ubel, PA; Griffith, KA; Jagsi, R
MLA Citation
Strong, EA, De Castro, R, Sambuco, D, Stewart, A, Ubel, PA, Griffith, KA, and Jagsi, R. "Work-life balance in academic medicine: narratives of physician-researchers and their mentors." J Gen Intern Med 28.12 (December 2013): 1596-1603.
PMID
23765289
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
28
Issue
12
Publish Date
2013
Start Page
1596
End Page
1603
DOI
10.1007/s11606-013-2521-2

Patient-oncologist cost communication, financial distress, and medication adherence

Authors
Bestvina, CM; Zullig, LL; Rushing, C; Chino, FL; Samsa, G; Altomare, I; Tulsky, JA; Ubel, PA; Schrag, D; Nicolla, J; Abernethy, AP; Peppercorn, JM; Zafar, Y
MLA Citation
Bestvina, CM, Zullig, LL, Rushing, C, Chino, FL, Samsa, G, Altomare, I, Tulsky, JA, Ubel, PA, Schrag, D, Nicolla, J, Abernethy, AP, Peppercorn, JM, and Zafar, Y. "Patient-oncologist cost communication, financial distress, and medication adherence." November 1, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
31
Publish Date
2013

Gender differences in salary in a recent cohort of early-career physician-researchers.

PURPOSE: Studies have suggested that male physicians earn more than their female counterparts. The authors examined whether this disparity exists in a recently hired cohort. METHOD: In 2010-2011, the authors surveyed recent recipients of National Institutes of Health (NIH) mentored career development (i.e., K08 or K23) awards, receiving responses from 1,275 (75% response rate). For the 1,012 physicians with academic positions in clinical specialties who reported salary, they constructed linear regression models of salary considering gender, age, race, marital status, parental status, additional doctoral degree, academic rank, years on faculty, specialty, institution type, region, institution NIH funding rank, K award type, K award funding institute, K award year, work hours, and research time. They evaluated the explanatory value of spousal employment status using Peters-Belson regression. RESULTS: Mean salary was $141,325 (95% confidence interval [CI] 135,607-147,043) for women and $172,164 (95% CI 167,357-176,971) for men. Male gender remained an independent, significant predictor of salary (+$10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Peters-Belson analysis indicated that 17% of the overall disparity in the full sample was unexplained by the measured covariates. In the married subset, after accounting for spousal employment status, 10% remained unexplained. CONCLUSIONS: The authors observed, in this recent cohort of elite, early-career physician-researchers, a gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. Creating more equitable procedures for establishing salary is important.

Authors
Jagsi, R; Griffith, KA; Stewart, A; Sambuco, D; DeCastro, R; Ubel, PA
MLA Citation
Jagsi, R, Griffith, KA, Stewart, A, Sambuco, D, DeCastro, R, and Ubel, PA. "Gender differences in salary in a recent cohort of early-career physician-researchers." Acad Med 88.11 (November 2013): 1689-1699.
PMID
24072109
Source
pubmed
Published In
Academic Medicine
Volume
88
Issue
11
Publish Date
2013
Start Page
1689
End Page
1699
DOI
10.1097/ACM.0b013e3182a71519

Full disclosure--out-of-pocket costs as side effects.

Authors
Ubel, PA; Abernethy, AP; Zafar, SY
MLA Citation
Ubel, PA, Abernethy, AP, and Zafar, SY. "Full disclosure--out-of-pocket costs as side effects." N Engl J Med 369.16 (October 17, 2013): 1484-1486.
PMID
24131175
Source
pubmed
Published In
The New England journal of medicine
Volume
369
Issue
16
Publish Date
2013
Start Page
1484
End Page
1486
DOI
10.1056/NEJMp1306826

Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics.

OBJECTIVE: To examine when and why women disbelieve tailored information about their risk of developing breast cancer. METHODS: 690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why. RESULTS: Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history. CONCLUSIONS: The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally. PRACTICE IMPLICATIONS: Decision aids may provide risk information that is not accepted by patients, but addressing the patients' personal circumstances may lead to greater acceptance.

Authors
Scherer, LD; Ubel, PA; McClure, J; Greene, SM; Alford, SH; Holtzman, L; Exe, N; Fagerlin, A
MLA Citation
Scherer, LD, Ubel, PA, McClure, J, Greene, SM, Alford, SH, Holtzman, L, Exe, N, and Fagerlin, A. "Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics." Patient Educ Couns 92.2 (August 2013): 253-259.
PMID
23623330
Source
pubmed
Published In
Patient Education and Counseling
Volume
92
Issue
2
Publish Date
2013
Start Page
253
End Page
259
DOI
10.1016/j.pec.2013.03.016

Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer.

OBJECTIVE: To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use. METHODS: Postmenopausal women, age 46-74, with BCRAT 5-year risk ≥ 1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (n=690), Time 1 control (n=160), or 3-month control (n=162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively. RESULTS: Intervention participants had significantly lower decisional conflict levels at post-test (p<0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p<0.001) compared to control participants. CONCLUSION: GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk. PRACTICE IMPLICATIONS: Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values.

Authors
Banegas, MP; McClure, JB; Barlow, WE; Ubel, PA; Smith, DM; Zikmund-Fisher, BJ; Greene, SM; Fagerlin, A
MLA Citation
Banegas, MP, McClure, JB, Barlow, WE, Ubel, PA, Smith, DM, Zikmund-Fisher, BJ, Greene, SM, and Fagerlin, A. "Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer." Patient Educ Couns 91.3 (June 2013): 364-371.
PMID
23395006
Source
pubmed
Published In
Patient Education and Counseling
Volume
91
Issue
3
Publish Date
2013
Start Page
364
End Page
371
DOI
10.1016/j.pec.2012.12.014

Financial distress, communication, and cancer treatment decision making: Does cost matter?

Authors
Zafar, Y; Abernethy, AP; Tulsky, JA; Ubel, PA; Schrag, D; Rushing, C; Chino, F; Nicolla, J; Altomare, I; Samsa, G; Peppercorn, JM
MLA Citation
Zafar, Y, Abernethy, AP, Tulsky, JA, Ubel, PA, Schrag, D, Rushing, C, Chino, F, Nicolla, J, Altomare, I, Samsa, G, and Peppercorn, JM. "Financial distress, communication, and cancer treatment decision making: Does cost matter?." May 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
15
Publish Date
2013

The financial burden of cancer care: Do patients know what to expect?

Authors
Chino, F; Peppercorn, JM; Tulsky, JA; Ubel, PA; Schrag, D; Rushing, C; Nicolla, J; Altomare, I; Samsa, G; Abernethy, AP; Zafar, Y
MLA Citation
Chino, F, Peppercorn, JM, Tulsky, JA, Ubel, PA, Schrag, D, Rushing, C, Nicolla, J, Altomare, I, Samsa, G, Abernethy, AP, and Zafar, Y. "The financial burden of cancer care: Do patients know what to expect?." May 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
15
Publish Date
2013

The predictable irrationality of righteous minds, and the work of ethicists.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The predictable irrationality of righteous minds, and the work of ethicists." Hastings Cent Rep 43.3 (May 2013): 18-22.
PMID
23650064
Source
pubmed
Published In
The Hastings Center report
Volume
43
Issue
3
Publish Date
2013
Start Page
18
End Page
22
DOI
10.1002/hast.174

Imagining life with an ostomy: does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?

OBJECTIVE: To test a video intervention as a way to improve predictions of mood and quality-of-life with an emotionally evocative medical condition. Such predictions are typically inaccurate, which can be consequential for decision making. METHOD: In Part 1, people presently or formerly living with ostomies predicted how watching a video depicting a person changing his ostomy pouch would affect mood and quality-of-life forecasts for life with an ostomy. In Part 2, participants from the general public read a description about life with an ostomy; half also watched a video depicting a person changing his ostomy pouch. Participants' quality-of-life and mood forecasts for life with an ostomy were assessed. RESULTS: Contrary to our expectations, and the expectations of people presently or formerly living with ostomies, the video did not reduce mood or quality-of-life estimates, even among participants high in trait disgust sensitivity. Among low-disgust participants, watching the video increased quality-of-life predictions for ostomy. CONCLUSION: Video interventions may improve mood and quality-of-life forecasts for medical conditions, including those that may elicit disgust, such as ostomy. PRACTICE IMPLICATIONS: Video interventions focusing on patients' experience of illness continue to show promise as components of decision aids, even for emotionally charged health states such as ostomy.

Authors
Angott, AM; Comerford, DA; Ubel, PA
MLA Citation
Angott, AM, Comerford, DA, and Ubel, PA. "Imagining life with an ostomy: does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?." Patient Educ Couns 91.1 (April 2013): 113-119.
PMID
23177398
Source
pubmed
Published In
Patient Education and Counseling
Volume
91
Issue
1
Publish Date
2013
Start Page
113
End Page
119
DOI
10.1016/j.pec.2012.10.015

Mentor networks in academic medicine: moving beyond a dyadic conception of mentoring for junior faculty researchers.

PURPOSE: Career development award programs often require formal establishment of mentoring relationships. The authors sought to gain a nuanced understanding of mentoring from the perspective of a diverse national sample of faculty clinician-researchers who were all members of formal mentoring relationships. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Three relevant themes emerged: (1) the numerous roles and behaviors associated with mentoring in academic medicine, (2) the improbability of finding a single person who can fulfill the diverse mentoring needs of another individual, and (3) the importance and composition of mentor networks. Many respondents described the need to cultivate more than one mentor. Several participants discussed the use of peer mentors, citing benefits such as pooled resources and mutual learning. Female participants generally acknowledged the importance of having at least one female mentor. Some observed that their portfolio of mentors needed to evolve to remain effective. CONCLUSIONS: Those who seek to promote the careers of faculty in academic medicine should focus on developing mentoring networks rather than on hierarchical mentoring dyads. The members of each faculty member's mentoring team or network should reflect the protégé's individual needs and preferences, with special attention toward ensuring diversity in terms of area of expertise, academic rank, and gender.

Authors
DeCastro, R; Sambuco, D; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
DeCastro, R, Sambuco, D, Ubel, PA, Stewart, A, and Jagsi, R. "Mentor networks in academic medicine: moving beyond a dyadic conception of mentoring for junior faculty researchers." Acad Med 88.4 (April 2013): 488-496.
PMID
23425990
Source
pubmed
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
488
End Page
496
DOI
10.1097/ACM.0b013e318285d302

Batting 300 is good: perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers.

PURPOSE: Professional rejection is a frequent experience in an academic medical career. The authors sought to understand how rejection affects those pursuing such careers and why some individuals may be more resilient than others in a population of individuals with demonstrated ability and interest in research careers. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described a variety of experiences with criticism and rejection in their careers, as well as an acute need for persistence and resilience in the face of such challenges. Through their narratives, participants also vividly described a range of emotional and behavioral responses to their experiences of professional rejection. Their responses illuminated the important roles that various factors, including mentoring and gender, have played in shaping the ultimate influence of rejection on their own careers and on the careers of those they have mentored. CONCLUSIONS: Responses to rejection vary considerably, and negative responses can lead promising individuals to abandon careers in academic medicine. Resilience does not, however, seem to be immutable-It can be learned. Given the frequency of experiences with rejection in academic medicine, strategies such as training mentors to foster resilience may be particularly helpful in improving faculty retention in academic medicine.

Authors
DeCastro, R; Sambuco, D; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
DeCastro, R, Sambuco, D, Ubel, PA, Stewart, A, and Jagsi, R. "Batting 300 is good: perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers." Acad Med 88.4 (April 2013): 497-504.
PMID
23425991
Source
pubmed
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
497
End Page
504
DOI
10.1097/ACM.0b013e318285f3c0

Negotiation in academic medicine: narratives of faculty researchers and their mentors.

PURPOSE: Few researchers have explored the negotiation experiences of academic medical faculty even though negotiation is crucial to their career success. The authors sought to understand medical faculty researchers' experiences with and perceptions of negotiation. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described the importance of negotiation in academic medical careers but also expressed feeling naïve and unprepared for these negotiations, particularly as junior faculty. Award recipients focused on power, leverage, and strategy, and they expressed a need for training and mentorship to learn successful negotiation skills. Mentors, by contrast, emphasized the importance of flexibility and shared interests in creating win-win situations for both the individual faculty member and the institution. When faculty construed negotiation as adversarial and/or zero-sum, participants believed it required traditionally masculine traits and perceived women to be at a disadvantage. CONCLUSIONS: Academic medical faculty often lack the skills and knowledge necessary for successful negotiation, especially early in their careers. Many view negotiation as an adversarial process of the sort that experts call "hard positional bargaining." Increasing awareness of alternative negotiation techniques (e.g., "principled negotiation," in which shared interests, mutually satisfying options, and fair standards are emphasized) may encourage the success of medical faculty, particularly women.

Authors
Sambuco, D; Dabrowska, A; Decastro, R; Stewart, A; Ubel, PA; Jagsi, R
MLA Citation
Sambuco, D, Dabrowska, A, Decastro, R, Stewart, A, Ubel, PA, and Jagsi, R. "Negotiation in academic medicine: narratives of faculty researchers and their mentors." Acad Med 88.4 (April 2013): 505-511.
PMID
23425992
Source
pubmed
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
505
End Page
511
DOI
10.1097/ACM.0b013e318286072b

The hazards of correcting myths about health care reform.

CONTEXT: Misperceptions are a major problem in debates about health care reform and other controversial health issues. METHODS: We conducted an experiment to determine if more aggressive media fact-checking could correct the false belief that the Affordable Care Act would create "death panels." Participants from an opt-in Internet panel were randomly assigned to either a control group in which they read an article on Sarah Palin's claims about "death panels" or an intervention group in which the article also contained corrective information refuting Palin. FINDINGS: The correction reduced belief in death panels and strong opposition to the reform bill among those who view Palin unfavorably and those who view her favorably but have low political knowledge. However, it backfired among politically knowledgeable Palin supporters, who were more likely to believe in death panels and to strongly oppose reform if they received the correction. CONCLUSIONS: These results underscore the difficulty of reducing misperceptions about health care reform among individuals with the motivation and sophistication to reject corrective information.

Authors
Nyhan, B; Reifler, J; Ubel, PA
MLA Citation
Nyhan, B, Reifler, J, and Ubel, PA. "The hazards of correcting myths about health care reform." Med Care 51.2 (February 2013): 127-132.
PMID
23211778
Source
pubmed
Published In
Medical Care
Volume
51
Issue
2
Publish Date
2013
Start Page
127
End Page
132
DOI
10.1097/MLR.0b013e318279486b

Gender differences in salary in a recent cohort of early-career physician-researchers

PURPOSE: Studies have suggested that male physicians earn more than their female counterparts. The authors examined whether this disparity exists in a recently hired cohort. METHOD: In 2010-2011, the authors surveyed recent recipients of National Institutes of Health (NIH) mentored career development (i.e., K08 or K23) awards, receiving responses from 1,275 (75% response rate). For the 1,012 physicians with academic positions in clinical specialties who reported salary, they constructed linear regression models of salary considering gender, age, race, marital status, parental status, additional doctoral degree, academic rank, years on faculty, specialty, institution type, region, institution NIH funding rank, K award type, K award funding institute, K award year, work hours, and research time. They evaluated the explanatory value of spousal employment status using Peters-Belson regression. RESULTS: Mean salary was $141,325 (95% confidence interval [CI] 135,607-147,043) for women and $172,164 (95% CI 167,357-176,971) for men. Male gender remained an independent, significant predictor of salary (+$10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Peters-Belson analysis indicated that 17% of the overall disparity in the full sample was unexplained by the measured covariates. In the married subset, after accounting for spousal employment status, 10% remained unexplained. CONCLUSIONS: The authors observed, in this recent cohort of elite, early-career physician-researchers, a gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. Creating more equitable procedures for establishing salary is important.

Authors
Jagsi, R; Griffith, KA; Stewart, A; Sambuco, D; Decastro, R; Ubel, PA
MLA Citation
Jagsi, R, Griffith, KA, Stewart, A, Sambuco, D, Decastro, R, and Ubel, PA. "Gender differences in salary in a recent cohort of early-career physician-researchers." Academic Medicine 88.11 (January 1, 2013): 1689-1699.
Source
scopus
Published In
Academic Medicine
Volume
88
Issue
11
Publish Date
2013
Start Page
1689
End Page
1699
DOI
10.1097/ACM.0b013e3182a71519

Breast cancer anxiety's associations with responses to a chemoprevention decision aid.

Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women's anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes.

Authors
Dillard, AJ; Scherer, L; Ubel, PA; Smith, DM; Zikmund-Fisher, BJ; McClure, JB; Greene, S; Stark, A; Fagerlin, A
MLA Citation
Dillard, AJ, Scherer, L, Ubel, PA, Smith, DM, Zikmund-Fisher, BJ, McClure, JB, Greene, S, Stark, A, and Fagerlin, A. "Breast cancer anxiety's associations with responses to a chemoprevention decision aid." Soc Sci Med 77 (January 2013): 13-19.
PMID
23200299
Source
pubmed
Published In
Social Science and Medicine
Volume
77
Publish Date
2013
Start Page
13
End Page
19
DOI
10.1016/j.socscimed.2012.10.009

Imagining life with an ostomy: Does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?

Objective: To test a video intervention as a way to improve predictions of mood and quality-of-life with an emotionally evocative medical condition. Such predictions are typically inaccurate, which can be consequential for decision making. Method: In Part 1, people presently or formerly living with ostomies predicted how watching a video depicting a person changing his ostomy pouch would affect mood and quality-of-life forecasts for life with an ostomy. In Part 2, participants from the general public read a description about life with an ostomy; half also watched a video depicting a person changing his ostomy pouch. Participants' quality-of-life and mood forecasts for life with an ostomy were assessed. Results: Contrary to our expectations, and the expectations of people presently or formerly living with ostomies, the video did not reduce mood or quality-of-life estimates, even among participants high in trait disgust sensitivity. Among low-disgust participants, watching the video increased quality-of-life predictions for ostomy. Conclusion: Video interventions may improve mood and quality-of-life forecasts for medical conditions, including those that may elicit disgust, such as ostomy. Practice implications: Video interventions focusing on patients' experience of illness continue to show promise as components of decision aids, even for emotionally charged health states such as ostomy. © 2012 Elsevier Ireland Ltd.

Authors
Angott, AM; Comerford, DA; Ubel, PA
MLA Citation
Angott, AM, Comerford, DA, and Ubel, PA. "Imagining life with an ostomy: Does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?." Patient Education and Counseling 91.1 (2013): 113-119.
Source
scival
Published In
Patient Education and Counseling
Volume
91
Issue
1
Publish Date
2013
Start Page
113
End Page
119
DOI
10.1016/j.pec.2012.10.015

The hazards of correcting myths about health care reform

Context: Misperceptions are a major problem in debates about health care reform and other controversial health issues. Methods: We conducted an experiment to determine if more aggressive media fact-checking could correct the false belief that the Affordable Care Act would create "death panels." Participants from an opt-in Internet panel were randomly assigned to either a control group in which they read an article on Sarah Palin's claims about "death panels" or an intervention group in which the article also contained corrective information refuting Palin. Findings: The correction reduced belief in death panels and strong opposition to the reform bill among those who view Palin unfavorably and those who view her favorably but have low political knowledge. However, it backfired among politically knowledgeable Palin supporters, who were more likely to believe in death panels and to strongly oppose reform if they received the correction. Conclusions: These results underscore the difficulty of reducing misperceptions about health care reform among individuals with the motivation and sophistication to reject corrective information. © 2012 by Lippincott Williams & Wilkins.

Authors
Nyhan, B; Reifler, J; Ubel, PA
MLA Citation
Nyhan, B, Reifler, J, and Ubel, PA. "The hazards of correcting myths about health care reform." Medical Care 51.2 (2013): 127-132.
Source
scival
Published In
Medical Care
Volume
51
Issue
2
Publish Date
2013
Start Page
127
End Page
132
DOI
10.1097/MLR.0b013e318279486b

Negotiation in academic medicine: Narratives of faculty researchers and their mentors

PURPOSE: Few researchers have explored the negotiation experiences of academic medical faculty even though negotiation is crucial to their career success. The authors sought to understand medical faculty researchers' experiences with and perceptions of negotiation. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described the importance of negotiation in academic medical careers but also expressed feeling naïve and unprepared for these negotiations, particularly as junior faculty. Award recipients focused on power, leverage, and strategy, and they expressed a need for training and mentorship to learn successful negotiation skills. Mentors, by contrast, emphasized the importance of flexibility and shared interests in creating win-win situations for both the individual faculty member and the institution. When faculty construed negotiation as adversarial and/or zero-sum, participants believed it required traditionally masculine traits and perceived women to be at a disadvantage. CONCLUSIONS: Academic medical faculty often lack the skills and knowledge necessary for successful negotiation, especially early in their careers. Many view negotiation as an adversarial process of the sort that experts call "hard positional bargaining." Increasing awareness of alternative negotiation techniques (e.g., "principled negotiation," in which shared interests, mutually satisfying options, and fair standards are emphasized) may encourage the success of medical faculty, particularly women.

Authors
Sambuco, D; Dabrowska, A; Decastro, R; Stewart, A; Ubel, PA; Jagsi, R
MLA Citation
Sambuco, D, Dabrowska, A, Decastro, R, Stewart, A, Ubel, PA, and Jagsi, R. "Negotiation in academic medicine: Narratives of faculty researchers and their mentors." Academic Medicine 88.4 (2013): 505-511.
Source
scival
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
505
End Page
511
DOI
10.1097/ACM.0b013e318286072b

Batting 300 Is good: Perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers

PURPOSE: Professional rejection is a frequent experience in an academic medical career. The authors sought to understand how rejection affects those pursuing such careers and why some individuals may be more resilient than others in a population of individuals with demonstrated ability and interest in research careers. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described a variety of experiences with criticism and rejection in their careers, as well as an acute need for persistence and resilience in the face of such challenges. Through their narratives, participants also vividly described a range of emotional and behavioral responses to their experiences of professional rejection. Their responses illuminated the important roles that various factors, including mentoring and gender, have played in shaping the ultimate influence of rejection on their own careers and on the careers of those they have mentored. CONCLUSIONS: Responses to rejection vary considerably, and negative responses can lead promising individuals to abandon careers in academic medicine. Resilience does not, however, seem to be immutable - It can be learned. Given the frequency of experiences with rejection in academic medicine, strategies such as training mentors to foster resilience may be particularly helpful in improving faculty retention in academic medicine.

Authors
Decastro, R; Sambuco, D; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
Decastro, R, Sambuco, D, Ubel, PA, Stewart, A, and Jagsi, R. "Batting 300 Is good: Perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers." Academic Medicine 88.4 (2013): 497-504.
Source
scival
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
497
End Page
504
DOI
10.1097/ACM.0b013e318285f3c0

Mentor networks in academic medicine: Moving beyond a dyadic conception of mentoring for junior faculty researchers

PURPOSE: Career development award programs often require formal establishment of mentoring relationships. The authors sought to gain a nuanced understanding of mentoring from the perspective of a diverse national sample of faculty clinician-researchers who were all members of formal mentoring relationships. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Three relevant themes emerged: (1) the numerous roles and behaviors associated with mentoring in academic medicine, (2) the improbability of finding a single person who can fulfill the diverse mentoring needs of another individual, and (3) the importance and composition of mentor networks. Many respondents described the need to cultivate more than one mentor. Several participants discussed the use of peer mentors, citing benefits such as pooled resources and mutual learning. Female participants generally acknowledged the importance of having at least one female mentor. Some observed that their portfolio of mentors needed to evolve to remain effective. CONCLUSIONS: Those who seek to promote the careers of faculty in academic medicine should focus on developing mentoring networks rather than on hierarchical mentoring dyads. The members of each faculty member's mentoring team or network should reflect the protégé's individual needs and preferences, with special attention toward ensuring diversity in terms of area of expertise, academic rank, and gender.

Authors
Decastro, R; Sambuco, D; Ubel, PA; Stewart, A; Jagsi, R
MLA Citation
Decastro, R, Sambuco, D, Ubel, PA, Stewart, A, and Jagsi, R. "Mentor networks in academic medicine: Moving beyond a dyadic conception of mentoring for junior faculty researchers." Academic Medicine 88.4 (2013): 488-496.
Source
scival
Published In
Academic Medicine
Volume
88
Issue
4
Publish Date
2013
Start Page
488
End Page
496
DOI
10.1097/ACM.0b013e318285d302

Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer

Objective: To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use. Methods: Postmenopausal women, age 46-74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (. n=. 690), Time 1 control (. n=. 160), or 3-month control (. n=. 162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively. Results: Intervention participants had significantly lower decisional conflict levels at post-test (. p<. 0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (. p<. 0.001) compared to control participants. Conclusion: GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk. Practice implications: Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values. © 2013 .

Authors
Banegas, MP; McClure, JB; Barlow, WE; Ubel, PA; Smith, DM; Zikmund-Fisher, BJ; Greene, SM; Fagerlin, A
MLA Citation
Banegas, MP, McClure, JB, Barlow, WE, Ubel, PA, Smith, DM, Zikmund-Fisher, BJ, Greene, SM, and Fagerlin, A. "Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer." Patient Education and Counseling 91.3 (2013): 364-371.
Source
scival
Published In
Patient Education and Counseling
Volume
91
Issue
3
Publish Date
2013
Start Page
364
End Page
371
DOI
10.1016/j.pec.2012.12.014

Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics

Objective: To examine when and why women disbelieve tailored information about their risk of developing breast cancer. Methods: 690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why. Results: Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history. Conclusions: The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally. Practice implications: Decision aids may provide risk information that is not accepted by patients, but addressing the patients' personal circumstances may lead to greater acceptance. © 2013 Elsevier Ireland Ltd.

Authors
Scherer, LD; Ubel, PA; McClure, J; Greene, SM; Alford, SH; Holtzman, L; Exe, N; Fagerlin, A
MLA Citation
Scherer, LD, Ubel, PA, McClure, J, Greene, SM, Alford, SH, Holtzman, L, Exe, N, and Fagerlin, A. "Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics." Patient Education and Counseling 92.2 (2013): 253-259.
Source
scival
Published In
Patient Education and Counseling
Volume
92
Issue
2
Publish Date
2013
Start Page
253
End Page
259
DOI
10.1016/j.pec.2013.03.016

Effort Aversion: Job choice and compensation decisions overweight effort

The current research proposes that people avoid choosing effortful work even when they predict that it will provide them with a better working experience, a phenomenon we call Effort Aversion. In each of the studies, we presented a choice between an effortless but boring job and an effortful but enjoyable job. Study 1 found that participants were willing to accept lower wages to work at the effortless job, but they preferred the effortful job. This preference reversal is explained by the greater consideration wage setters gave to effort. Study 2 is a consequential lab experiment, in which participants were assigned to work at a job based on the wage they set. Those whose wage demands led them to be assigned to the effortless job experienced lower enjoyment than those who were assigned to the effortful job. Study 3 demonstrates that preference reversal was not attenuated by drawing attention to the hedonic experience afforded by work. © 2013 Elsevier B.V.

Authors
Comerford, DA; Ubel, PA
MLA Citation
Comerford, DA, and Ubel, PA. "Effort Aversion: Job choice and compensation decisions overweight effort." Journal of Economic Behavior and Organization 92 (2013): 152-162.
Source
scival
Published In
Journal of Economic Behavior & Organization
Volume
92
Publish Date
2013
Start Page
152
End Page
162
DOI
10.1016/j.jebo.2013.05.016

Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention.

INTRODUCTION: Tamoxifen and raloxifene are chemopreventive drugs that can reduce women’s relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women’s knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. METHODS: We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women’s intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable ‘informed choice’ (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman’s decision and relevant attitudes. RESULTS: Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. CONCLUSIONS: The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00967824

Authors
Korfage, IJ; Fuhrel-Forbis, A; Ubel, PA; Zikmund-Fisher, BJ; Greene, SM; McClure, JB; Smith, DM; Alford, SH; Fagerlin, A
MLA Citation
Korfage, IJ, Fuhrel-Forbis, A, Ubel, PA, Zikmund-Fisher, BJ, Greene, SM, McClure, JB, Smith, DM, Alford, SH, and Fagerlin, A. "Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention." Breast Cancer Res 15.5 (2013): R74-.
PMID
24004815
Source
pubmed
Published In
Breast Cancer Research
Volume
15
Issue
5
Publish Date
2013
Start Page
R74
DOI
10.1186/bcr3468

Beyond comprehension figuring out whether decision aids improve people's decisions

Authors
Ubel, P
MLA Citation
Ubel, P. "Beyond comprehension figuring out whether decision aids improve people's decisions." The Behavioral Foundations of Public Policy (2013): 351-360.
Source
scival
Published In
The Behavioral Foundations of Public Policy
Publish Date
2013
Start Page
351
End Page
360

Repeating an attending physician's unseemly remarks.

Authors
Ubel, PA; Veatch, RM
MLA Citation
Ubel, PA, and Veatch, RM. "Repeating an attending physician's unseemly remarks. (Published online)" Virtual Mentor 14.9 (September 1, 2012): 688-694.
PMID
23351345
Source
pubmed
Published In
The virtual mentor : VM
Volume
14
Issue
9
Publish Date
2012
Start Page
688
End Page
694
DOI
10.1001/virtualmentor.2012.14.9.ecas1-1209

Gender differences in the salaries of physician researchers.

CONTEXT: It is unclear whether male and female physician researchers who perform similar work are currently paid equally. OBJECTIVES: To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors. DESIGN AND SETTING: A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address. PARTICIPANTS: The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary. MAIN OUTCOME MEASURES: A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research. RESULTS: The mean salary within our cohort was $167,669 (95% CI, $158,417-$176,922) for women and $200,433 (95% CI, $194,249-$206,617) for men. Male gender was associated with higher salary (+$13,399; P = .001) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12,194 higher than observed. CONCLUSION: Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.

Authors
Jagsi, R; Griffith, KA; Stewart, A; Sambuco, D; DeCastro, R; Ubel, PA
MLA Citation
Jagsi, R, Griffith, KA, Stewart, A, Sambuco, D, DeCastro, R, and Ubel, PA. "Gender differences in the salaries of physician researchers." JAMA 307.22 (June 13, 2012): 2410-2417.
PMID
22692173
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
307
Issue
22
Publish Date
2012
Start Page
2410
End Page
2417
DOI
10.1001/jama.2012.6183

In a survey, marked inconsistency in how oncologists judged value of high-cost cancer drugs in relation to gains in survival.

Amid calls for physicians to become better stewards of the nation's health care resources, it is important to gain insight into how physicians think about the cost-effectiveness of new treatments. Expensive new cancer treatments that can extend life raise questions about whether physicians are prepared to make "value for money" trade-offs when treating patients. We asked oncologists in the United States and Canada how much benefit, in additional months of life expectancy, a new drug would need to provide to justify its cost and warrant its use in an individual patient. The majority of oncologists agreed that a new cancer treatment that might add a year to a patient's life would be worthwhile if the cost was less than $100,000. But when given a hypothetical case of an individual patient to review, the oncologists also endorsed a hypothetical drug whose cost might be as high as $250,000 per life-year gained. The results show that oncologists are not consistent in deciding how many months an expensive new therapy should extend a person's life before the cost of therapy is justified. Moreover, the benefit that oncologists demand from new treatments in terms of length of survival does not necessarily increase according to the price of the treatment. The findings suggest that policy makers should find ways to improve how physicians are educated on the use of cost-effectiveness information and to influence physician decision making through clinical guidelines that incorporate cost-effectiveness information.

Authors
Ubel, PA; Berry, SR; Nadler, E; Bell, CM; Kozminski, MA; Palmer, JA; Evans, WK; Strevel, EL; Neumann, PJ
MLA Citation
Ubel, PA, Berry, SR, Nadler, E, Bell, CM, Kozminski, MA, Palmer, JA, Evans, WK, Strevel, EL, and Neumann, PJ. "In a survey, marked inconsistency in how oncologists judged value of high-cost cancer drugs in relation to gains in survival." Health Aff (Millwood) 31.4 (April 2012): 709-717.
PMID
22492887
Source
pubmed
Published In
Health Affairs
Volume
31
Issue
4
Publish Date
2012
Start Page
709
End Page
717
DOI
10.1377/hlthaff.2011.0251

What's it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses.

OBJECTIVE: Allocation of resources for the treatment of mental illness is low relative to the burden imposed by these illnesses. The reason for this discrepancy has not been established. Few studies have directly and systematically compared public evaluations of the importance of treating mental illnesses and general medical illnesses. This study assessed public willingness to pay for treatments of mental health conditions and of general medical conditions to determine whether willingness to pay less for mental health treatments is due to the perception that mental health conditions are less burdensome. METHODS: U.S. adults (N=710) in a nationally representative sample were provided with descriptions of two mental and three general medical illnesses. Respondents rated their willingness to pay to avoid each illness and then their perception of the burdensomeness of each illness. RESULTS: Participants rated the two mental illnesses as relatively more burdensome than the general medical illnesses, but the amount they were willing to pay to avoid the mental illnesses was lower. Specifically, participants were willing to pay 40% less to avoid the mental illnesses compared with the general medical conditions, for a comparable benefit in terms of quality of life. CONCLUSIONS: Even though respondents recognized that severe mental illnesses can dramatically lower quality of life, they were less willing to pay to avoid such illnesses than they were to pay to cure less burdensome general medical illnesses.

Authors
Smith, DM; Damschroder, LJ; Kim, SYH; Ubel, PA
MLA Citation
Smith, DM, Damschroder, LJ, Kim, SYH, and Ubel, PA. "What's it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses." Psychiatr Serv 63.4 (April 2012): 319-324.
PMID
22388473
Source
pubmed
Published In
Psychiatric Services
Volume
63
Issue
4
Publish Date
2012
Start Page
319
End Page
324
DOI
10.1176/appi.ps.201000036

Contracts with patients in clinical practice.

Authors
Volk, ML; Lieber, SR; Kim, SY; Ubel, PA; Schneider, CE
MLA Citation
Volk, ML, Lieber, SR, Kim, SY, Ubel, PA, and Schneider, CE. "Contracts with patients in clinical practice." Lancet 379.9810 (January 7, 2012): 7-9.
PMID
21497394
Source
pubmed
Published In
The Lancet
Volume
379
Issue
9810
Publish Date
2012
Start Page
7
End Page
9
DOI
10.1016/S0140-6736(11)60170-0

Risk perception measures' associations with behavior intentions, affect, and cognition following colon cancer screening messages.

OBJECTIVE: Risk perception is important for motivating health behavior (e.g., Janz & Becker, 1984), but different measures of the construct may change how important that relationship appears. In two studies, we examined associations between four measures of risk perception, health behavior intentions and possible behavioral determinants. METHODS: Participants in these studies, who were due for colorectal cancer screening, read an online message about the importance of screening to reduce the chance of cancer. We examined bivariate and multivariate associations between risk perception measures, including absolute, comparative, and feelings-of-risk, and behavioral intentions to screen, general worry, and knowledge and attitudes related to screening. RESULTS: Results across the two studies were consistent, with all risk perception measures being correlated with intentions and attitudes. Multivariate analyses revealed that feelings-of-risk was most predictive of all variables, with the exception of general worry, for which comparative measures were the most predictive. CONCLUSIONS: Researchers interested in risk perception should assess feelings-of-risk along with more traditional measures. Those interested in influencing health behavior specifically should attempt to increase feelings of vulnerability rather than numerical risk.

Authors
Dillard, AJ; Ferrer, RA; Ubel, PA; Fagerlin, A
MLA Citation
Dillard, AJ, Ferrer, RA, Ubel, PA, and Fagerlin, A. "Risk perception measures' associations with behavior intentions, affect, and cognition following colon cancer screening messages." Health Psychol 31.1 (January 2012): 106-113.
PMID
21806302
Source
pubmed
Published In
Health Psychology
Volume
31
Issue
1
Publish Date
2012
Start Page
106
End Page
113
DOI
10.1037/a0024787

Issue emergence, evolution of controversy, and implications for competitive framing: The case of the HPV vaccine

Although scholarship on competitive framing acknowledges that framing is a dynamic process in which the early stages may matter most, very little research has focused on the dynamics of issue emergence. In this article, we draw on several literatures to develop theories for how controversy related to new issues will emerge and expand in news coverage. Through a comprehensive content analysis of 101 local newspapers across the fifty U.S. states, we explore the dynamic and evolving process wherein a new issue-the HPV vaccine-emerged into public discourse and a legislative debate over school requirements for vaccination began. We find that coverage of controversy is a function of proximity, driven primarily by events within a state, although external events also influence local coverage. We also find that the legislative discussion in the media did not necessarily start out as controversial, but as the issue evolved, we observe a large increase in the proliferation of both actors taking positions and the types of arguments made to influence debate. The findings yield important insight into issue emergence with implications for how future research might test competing frames to better understand how the presentation of controversy in the mass media affects public opinion. © The Author(s) 2012.

Authors
Fowler, EF; Gollust, SE; Dempsey, AF; Lantz, PM; Ubel, PA
MLA Citation
Fowler, EF, Gollust, SE, Dempsey, AF, Lantz, PM, and Ubel, PA. "Issue emergence, evolution of controversy, and implications for competitive framing: The case of the HPV vaccine." International Journal of Press/Politics 17.2 (2012): 169-189.
Source
scival
Published In
Harvard International Journal of Press-Politics
Volume
17
Issue
2
Publish Date
2012
Start Page
169
End Page
189
DOI
10.1177/1940161211425687

After Adversity Strikes: Predictions, Recollections and Reality Among People Experiencing the Onset of Adverse Circumstances

Numerous studies on affective forecasting have demonstrated that people frequently underestimate their ability to adapt to adverse circumstances. But to date, these studies have not assessed people's affective forecasts early in the experience of these new circumstances. We present two longitudinal studies of people experiencing new adversities. In the first study 54 patients experiencing new limb amputations were recruited to participate in a mailed survey. Patients assessed their well-being, functioning and general health (1) two weeks after discharge from the hospital and (2) three months later. At the first time point patients also predicted their well-being, functioning and general health at three months. In the second study 55 patients experiencing new colostomies were recruited and received mailed surveys at three time points; (1) at baseline (within one week after leaving the hospital), (2) one month after baseline, and (3) seven months after baseline. Again we assessed their actual and predicted well-being, functioning and general health. In both studies the actual change was compared to the change expected by patients. Across both studies, patients expected to significantly improve on all three domains but reported little actual improvement. Together, these studies demonstrated that people with new disabilities overestimate hedonic adaptation-they expect their overall well-being to improve more than it actually does. © 2011 Springer Science+Business Media B.V.

Authors
Peeters, Y; Smith, DM; Loewenstein, G; Ubel, PA
MLA Citation
Peeters, Y, Smith, DM, Loewenstein, G, and Ubel, PA. "After Adversity Strikes: Predictions, Recollections and Reality Among People Experiencing the Onset of Adverse Circumstances." Journal of Happiness Studies 13.4 (2012): 589-600.
Source
scival
Published In
Journal of Happiness Studies
Volume
13
Issue
4
Publish Date
2012
Start Page
589
End Page
600
DOI
10.1007/s10902-011-9281-7

Similarities and differences in the career trajectories of male and female career development award recipients.

PURPOSE: To examine the careers of career development award recipients. METHOD: In 2009, a postal survey was conducted of 818 recipients of K08 and K23 awards in 2000-2001 to examine career paths and personal characteristics. RESULTS: Of 589 respondents (72% response rate), 211 (35.9%) were female. Women were less likely to have children (P<.001) than men. The vast majority of respondents (89.6%) remained in academic medicine. Among those, over three-quarters continued to spend significant time on research. On univariate analysis, women were not significantly less likely to report promotion, leadership positions, or application for R01 grants. They were less likely to have received an R01 (P=.006) and to perceive themselves as successful (P=.002), and they published fewer papers (P=.001). Overall, 118 women (55.9%) and 274 men (72.5%) met at least one of the following criteria for success: serving as principal investigator on an R01 or grants>$1,000,000 since K award receipt, publishing at least 35 publications since K award year, or serving as dean, department chair, or division chief. In a multivariate model, gender (odds ratio 1.72, P=.003) was associated with the likelihood of success by this definition, and analysis revealed no significant interactions (including with parental status). CONCLUSIONS: Most of these promising investigators of both genders remained in academia and received promotions. However, gender differences in success existed, unrelated to parental status, suggesting a need for ongoing investigation of the causes of gender differences in academic medical careers.

Authors
Jagsi, R; DeCastro, R; Griffith, KA; Rangarajan, S; Churchill, C; Stewart, A; Ubel, PA
MLA Citation
Jagsi, R, DeCastro, R, Griffith, KA, Rangarajan, S, Churchill, C, Stewart, A, and Ubel, PA. "Similarities and differences in the career trajectories of male and female career development award recipients." Acad Med 86.11 (November 2011): 1415-1421.
PMID
21952061
Source
pubmed
Published In
Academic Medicine
Volume
86
Issue
11
Publish Date
2011
Start Page
1415
End Page
1421
DOI
10.1097/ACM.0b013e3182305aa6

'I'll do what they did": social norm information and cancer treatment decisions.

OBJECTIVE: Using a cancer-treatment scenario, we tested whether descriptive norm information (e.g., the proportion of other people choosing a particular treatment) would influence people's hypothetical treatment choices. METHODS: Women from an Internet sample (Study 1 N=2238; Study 2 N=2154) were asked to imagine deciding whether to take adjuvant chemotherapy following breast cancer surgery. Across participants, we varied the stated proportion of women who chose chemotherapy. This descriptive norm information was presented numerically in Study 1 and non-numerically in Study 2. RESULTS: The descriptive norm information influenced women's decisions, with higher interest in chemotherapy when social norm information suggested that such chemotherapy was popular. Exact statistics about other people's decisions had a greater effect than when norms were described using less precise verbal terms (e.g., "most women"). CONCLUSION: Providing patients with information about what other people have done can significantly influence treatment choices, but the power of such descriptive norms depends on their precision. PRACTICE IMPLICATIONS: Communication of descriptive norms is only helpful if prevailing decisions in the population represent good clinical practice. Strategic presentation of such statistics, when available, may encourage patient outliers to modify their medical decisions in ways that result in improved outcomes.

Authors
Zikmund-Fisher, BJ; Windschitl, PD; Exe, N; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Windschitl, PD, Exe, N, and Ubel, PA. "'I'll do what they did": social norm information and cancer treatment decisions." Patient Educ Couns 85.2 (November 2011): 225-229.
PMID
21367557
Source
pubmed
Published In
Patient Education and Counseling
Volume
85
Issue
2
Publish Date
2011
Start Page
225
End Page
229
DOI
10.1016/j.pec.2011.01.031

Helping patients decide: ten steps to better risk communication.

With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients' understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, and Ubel, PA. "Helping patients decide: ten steps to better risk communication." J Natl Cancer Inst 103.19 (October 5, 2011): 1436-1443.
PMID
21931068
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
103
Issue
19
Publish Date
2011
Start Page
1436
End Page
1443
DOI
10.1093/jnci/djr318

The distinct role of comparative risk perceptions in a breast cancer prevention program.

BACKGROUND: Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions. PURPOSE: We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk. METHODS: Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. They reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, the women reported their behavior. RESULTS: Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior 3 months later. After controlling for participants' actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior. CONCLUSIONS: Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information.

Authors
Dillard, AJ; Ubel, PA; Smith, DM; Zikmund-Fisher, BJ; Nair, V; Derry, HA; Zhang, A; Pitsch, RK; Alford, SH; McClure, JB; Fagerlin, A
MLA Citation
Dillard, AJ, Ubel, PA, Smith, DM, Zikmund-Fisher, BJ, Nair, V, Derry, HA, Zhang, A, Pitsch, RK, Alford, SH, McClure, JB, and Fagerlin, A. "The distinct role of comparative risk perceptions in a breast cancer prevention program." Ann Behav Med 42.2 (October 2011): 262-268.
PMID
21698518
Source
pubmed
Published In
Annals of Behavioral Medicine
Volume
42
Issue
2
Publish Date
2011
Start Page
262
End Page
268
DOI
10.1007/s12160-011-9287-8

Compared to what? A joint evaluation method for assessing quality of life.

PURPOSE: This study tests whether a joint evaluation method for assessing quality of life can stabilize ratings by providing contextual information, thereby helping participants calibrate responses on a rating scale. We also use the method to test for scale recalibration between patients and non-patients. METHOD: In an Internet survey, participants (N = 1,865) rated a target health condition, either diabetes or obesity, on a 100-point rating scale. Participants either rated several other items on the same rating scale first (joint evaluation), or rated the target condition first (single evaluation). We compared target condition ratings for joint versus single evaluation, as well as the rank position of that item among the other items. We also compared ratings and rankings for patients versus non-patients. RESULTS: The method effectively picked up distinct patterns of scale usage, with evidence of scale recalibration for obesity ratings, but not for diabetes ratings. The stabilizing effects of the method were mixed. For both diabetes and obesity, the joint evaluation task helped stabilize the rank position of the target condition, but not the rating. CONCLUSIONS: Results do not conclusively support joint evaluation as a method for reducing noise in rating scale usage, but do support its use for detecting scale recalibration between patients and non-patients.

Authors
Lacey, HP; Loewenstein, G; Ubel, PA
MLA Citation
Lacey, HP, Loewenstein, G, and Ubel, PA. "Compared to what? A joint evaluation method for assessing quality of life." Qual Life Res 20.8 (October 2011): 1169-1177.
PMID
21293930
Source
pubmed
Published In
Quality of Life Research
Volume
20
Issue
8
Publish Date
2011
Start Page
1169
End Page
1177
DOI
10.1007/s11136-011-9856-0

The choice for breast cancer surgery: can women accurately predict postoperative quality of life and disease-related stigma?

BACKGROUND: To make an informed choice, breast cancer patients facing surgery must imagine the effect of surgery on their future life experiences. However, the accuracy of patient predictions of postoperative quality of life (QoL) and disease-related stigma is not well understood. MATERIALS AND METHODS: Four groups of breast cancer patients at the University of Michigan Medical Center were surveyed by mail and interview (response rate 76.3%): (1) preoperative (N = 59), (2) mastectomy (N = 146), (3) mastectomy with reconstruction (N = 250), and (4) breast conservation (N = 705). Subjects rated their QoL (1 = lowest, 100 = highest) and stigma (1 = lowest, 5 = highest) and estimated QoL and stigma associated with mastectomy alone, mastectomy with reconstruction, and breast conserving surgery (BCS). Mean scores were compared using linear regression controlling for age, race, partnered status, and income. RESULTS: Preoperatively, women inaccurately predicted postoperative QoL and stigma for all surgical options, particularly for mastectomy. Preoperative patients underestimated the postoperative QoL for mastectomy alone (predicted: 56.8 vs actual: 83.7; P < .001). Preoperative patients underestimated QoL following mastectomy following reconstruction (predicted: 73.4 vs actual: 83.9; P < .001) and BCS (predicted: 72.2 vs actual: 88.6; P < .001). Additionally, preoperative patients overestimated stigma related to mastectomy (predicted: 3.25 vs actual: 2.43; P < .001). Finally, preoperative women overestimated stigma related to mastectomy with reconstruction (predicted: 2.54 vs actual: 2.03; P < .001) and BCS (predicted: 1.90 vs actual: 1.76; P < .001). CONCLUSION: Predicting QoL and stigma following breast cancer surgery is challenging for patients facing a diagnosis for surgery. Identifying strategies to better inform patients of surgical outcomes can improve the decision-making process.

Authors
Waljee, JF; Ubel, PA; Atisha, DM; Hu, ES; Alderman, AK
MLA Citation
Waljee, JF, Ubel, PA, Atisha, DM, Hu, ES, and Alderman, AK. "The choice for breast cancer surgery: can women accurately predict postoperative quality of life and disease-related stigma?." Ann Surg Oncol 18.9 (September 2011): 2477-2482.
PMID
21347791
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
18
Issue
9
Publish Date
2011
Start Page
2477
End Page
2482
DOI
10.1245/s10434-011-1582-x

The benefits of discussing adjuvant therapies one at a time instead of all at once.

Breast cancer patients must often decide between multiple adjuvant therapy options to prevent cancer recurrence. Standard practice, as implemented in current decision support tools, is to present information about all options simultaneously, but psychology research suggests that sequential decision processes might improve decision making. We tested whether asking women to consider hormonal therapy and chemotherapy separately would improve women's risk knowledge and/or affect treatment intentions. We conducted an Internet-administered experimental survey of a demographically diverse sample of 1,781 women ages 40-74. Participants were randomized to experience a standard, comprehensive decision process versus sequential (one at a time) decisions regarding adjuvant therapy options for a hypothetical breast cancer patient with an estrogen receptor-positive (ER+) tumor. We assessed comprehension of key statistics, perceptions of treatment effectiveness, and perceived interest in adjuvant chemotherapy, as well as participants' numeracy levels. When participants made sequential decisions, they demonstrated greater comprehension of decision-relevant risk statistics, as compared to when they made decisions all at once (all P's < 0.001). Among higher-numeracy participants, those making sequential decisions were less interested in chemotherapy (P < 0.001). Lower-numeracy participants who considered all options simultaneously were insensitive to the degree of risk reduction, but those who made sequential decisions were sensitive (P = 0.03). In conclusion, presenting adjuvant therapy options sequentially improves women's comprehension of incremental treatment benefit and increases less numerate women's sensitivity to the magnitude of the achievable risk reduction over standard, all at once approaches. Sequential approaches to adjuvant therapy decisions may reduce use of chemotherapy among those at low risk for recurrence.

Authors
Zikmund-Fisher, BJ; Angott, AM; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Angott, AM, and Ubel, PA. "The benefits of discussing adjuvant therapies one at a time instead of all at once." Breast Cancer Res Treat 129.1 (August 2011): 79-87.
PMID
20945090
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
129
Issue
1
Publish Date
2011
Start Page
79
End Page
87
DOI
10.1007/s10549-010-1193-4

Rule of rescue or the good of the many? An analysis of physicians' and nurses' preferences for allocating ICU beds.

PURPOSE: To examine intensive care unit (ICU) clinicians' willingness to trade off societal benefits in favor of a small chance of rescuing an identifiable critically ill patient. METHODS: We sent mixed-methods questionnaires to national samples of US ICU clinicians, soliciting their preferences for allocating their last bed to a gravely ill patient with little chance to survive, versus a deceased or dying patient for whom aggressive management could help others through organ donation. RESULTS: Complete responses were obtained from 684 of 2,206 physicians (31.0%) and 438 of 988 nurses (44.3%); there was no evidence of non-response bias. Physicians were more likely than nurses to adhere to the "rule of rescue" by allocating the last bed to the gravely ill patient (45.9 vs. 32.6%, difference = 13.2%; 95% CI 9.1-17.3%). The magnitude of the social benefit to be obtained through organ donor management (5 or 30 life-years added for transplant recipients) had small and inconsistent effects on clinicians' willingness to prioritize the donor. In qualitative analyses, the most common reason for allocating the last bed to an identifiable patient (identified by 65% of physicians and 75% of nurses) was that clinicians perceived strong obligations to identifiable living patients. CONCLUSIONS: More than one-third of ICU clinicians forewent substantial social benefits so as to devote resources to an individual patient unlikely to benefit from them. Such allegiance to the rule of rescue suggests challenges for efforts to reform ICU triage practices.

Authors
Kohn, R; Rubenfeld, GD; Levy, MM; Ubel, PA; Halpern, SD
MLA Citation
Kohn, R, Rubenfeld, GD, Levy, MM, Ubel, PA, and Halpern, SD. "Rule of rescue or the good of the many? An analysis of physicians' and nurses' preferences for allocating ICU beds." Intensive Care Med 37.7 (July 2011): 1210-1217.
PMID
21647719
Source
pubmed
Published In
Intensive Care Medicine
Volume
37
Issue
7
Publish Date
2011
Start Page
1210
End Page
1217
DOI
10.1007/s00134-011-2257-6

Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid.

Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women's interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer ≥ 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug.

Authors
Fagerlin, A; Dillard, AJ; Smith, DM; Zikmund-Fisher, BJ; Pitsch, R; McClure, JB; Greene, S; Alford, SH; Nair, V; Hayes, DF; Wiese, C; Ubel, PA
MLA Citation
Fagerlin, A, Dillard, AJ, Smith, DM, Zikmund-Fisher, BJ, Pitsch, R, McClure, JB, Greene, S, Alford, SH, Nair, V, Hayes, DF, Wiese, C, and Ubel, PA. "Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid." Breast Cancer Res Treat 127.3 (June 2011): 681-688.
PMID
21442198
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
127
Issue
3
Publish Date
2011
Start Page
681
End Page
688
DOI
10.1007/s10549-011-1450-1

How long and how well: oncologists' attitudes toward the relative value of life-prolonging v. quality of life-enhancing treatments.

OBJECTIVE: To determine how oncologists value quality-enhancing v. life-prolonging outcomes attributable to chemotherapy. METHODS: The authors surveyed a random sample of 1379 US medical oncologists (members of the American Society of Clinical Oncology), presenting them with 2 scenarios involving a hypothetical new chemotherapy drug. Given their responses, the authors derived the implicit cost-effectiveness ratios each physician attributed to quality-enhancing and life-prolonging chemotherapies. RESULTS: The authors received responses from 58% of the oncologists surveyed. On average, the responses implied that oncologists were willing to prescribe treatments that cost $245,972 per quality-adjusted life-year (QALY; SD $243,663 per QALY) in life-prolonging situations v. only $119,082 per QALY (SD $197,048 per QALY) for treatments that improve quality of life but do not prolong survival (P < 0.001). This difference did not depend on age, gender, percentage of time in clinical work, or self-reported preparedness to use and interpret cost-effectiveness information (P > 0.05 for all specifications). Differences across these situations persisted even among those who considered themselves to be "well-prepared" to make cost-effectiveness decisions. CONCLUSION: Cost-effectiveness thresholds for oncologists vary widely for life-prolonging chemotherapy compared to treatments that only enhance quality of life. This difference suggests that oncologists value length of survival more highly than quality of life when making chemotherapy decisions.

Authors
Kozminski, MA; Neumann, PJ; Nadler, ES; Jankovic, A; Ubel, PA
MLA Citation
Kozminski, MA, Neumann, PJ, Nadler, ES, Jankovic, A, and Ubel, PA. "How long and how well: oncologists' attitudes toward the relative value of life-prolonging v. quality of life-enhancing treatments." Med Decis Making 31.3 (May 2011): 380-385.
PMID
21088130
Source
pubmed
Published In
Medical Decision Making
Volume
31
Issue
3
Publish Date
2011
Start Page
380
End Page
385
DOI
10.1177/0272989X10385847

Physicians recommend different treatments for patients than they would choose for themselves.

BACKGROUND: Patients facing difficult decisions often ask physicians for recommendations. However, little is known regarding the ways that physicians' decisions are influenced by the act of making a recommendation. METHODS: We surveyed 2 representative samples of US primary care physicians-general internists and family medicine specialists listed in the American Medical Association Physician Masterfile-and presented each with 1 of 2 clinical scenarios. Both involved 2 treatment alternatives, 1 of which yielded a better chance of surviving a fatal illness but at the cost of potentially experiencing unpleasant adverse effects. We randomized physicians to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient. RESULTS: Among those asked to consider our colon cancer scenario (n = 242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (χ(2)(1) = 4.67, P = .03). Among those receiving our avian influenza scenario (n = 698), 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients (χ(2)(1) = 14.56, P < .001). CONCLUSIONS: The act of making a recommendation changes the ways that physicians think regarding medical choices. Better understanding of this thought process will help determine when or whether recommendations improve decision making.

Authors
Ubel, PA; Angott, AM; Zikmund-Fisher, BJ
MLA Citation
Ubel, PA, Angott, AM, and Zikmund-Fisher, BJ. "Physicians recommend different treatments for patients than they would choose for themselves." Arch Intern Med 171.7 (April 11, 2011): 630-634.
PMID
21482835
Source
pubmed
Published In
Archives of internal medicine
Volume
171
Issue
7
Publish Date
2011
Start Page
630
End Page
634
DOI
10.1001/archinternmed.2011.91

Afterword: Giving good advice: it is not what doctors say, but how they say it.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Afterword: Giving good advice: it is not what doctors say, but how they say it." Curr Probl Pediatr Adolesc Health Care 41.4 (April 2011): 128-130.
PMID
21440237
Source
pubmed
Published In
Current Problems in Pediatric and Adolescent Health Care
Volume
41
Issue
4
Publish Date
2011
Start Page
128
End Page
130
DOI
10.1016/j.cppeds.2010.10.009

Giving Good Advice: It Is Not What Doctors Say, but How They Say It Afterword

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Giving Good Advice: It Is Not What Doctors Say, but How They Say It Afterword." CURRENT PROBLEMS IN PEDIATRIC AND ADOLESCENT HEALTH CARE 41.4 (April 2011): 128-130.
Source
wos-lite
Published In
Current Problems in Pediatric and Adolescent Health Care
Volume
41
Issue
4
Publish Date
2011
Start Page
128
End Page
130

Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information.

Authors
Volk, ML; Ubel, PA
MLA Citation
Volk, ML, and Ubel, PA. "Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information." Arch Intern Med 171.6 (March 28, 2011): 487-488.
PMID
21444838
Source
pubmed
Published In
Archives of internal medicine
Volume
171
Issue
6
Publish Date
2011
Start Page
487
End Page
488
DOI
10.1001/archinternmed.2011.63

The experimental imperative.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The experimental imperative." Hastings Cent Rep 41.2 (March 2011): 3-.
PMID
21495500
Source
pubmed
Published In
The Hastings Center report
Volume
41
Issue
2
Publish Date
2011
Start Page
3

Science and behavior.

Authors
Ubel, PA; Silbergleit, R
MLA Citation
Ubel, PA, and Silbergleit, R. "Science and behavior." Am J Bioeth 11.2 (February 2011): W1-W2.
PMID
21337265
Source
pubmed
Published In
American Journal of Bioethics
Volume
11
Issue
2
Publish Date
2011
Start Page
W1
End Page
W2
DOI
10.1080/15265161.2011.556536

Behavioral equipoise: a way to resolve ethical stalemates in clinical research.

Randomized trials depend on clinicians feeling that they are morally justified in allowing their patients to be randomized across treatment arms. Typically such justification rides on what has been called "clinical equipoise"--when there is disagreement of opinion among the community of experts about whether one treatment is better than another, then physicians can ethically enter their patients into a clinical trial, even if individual physicians are not at equipoise. Recent debates over prominent studies, however, illustrate that controversy can be easily created rather than dispelled by trials, with many clinicians choosing not to use the proven therapy until they receive more convincing evidence of its superiority. In such situations, we propose that a new standard of equipoise be used to guide decisions about the ethical justifications for research trials--a standard of behavioral equipoise. Under behavioral equipoise, a trial is potentially justifiable if it addresses behavioral resistance to prior scientific evidence.

Authors
Ubel, PA; Silbergleit, R
MLA Citation
Ubel, PA, and Silbergleit, R. "Behavioral equipoise: a way to resolve ethical stalemates in clinical research." Am J Bioeth 11.2 (February 2011): 1-8.
PMID
21337264
Source
pubmed
Published In
American Journal of Bioethics
Volume
11
Issue
2
Publish Date
2011
Start Page
1
End Page
8
DOI
10.1080/15265161.2010.540061

Ignorance is bliss? - Reply

Authors
Volk, ML; Ubel, PA
MLA Citation
Volk, ML, and Ubel, PA. "Ignorance is bliss? - Reply." Archives of Internal Medicine 171.17 (2011): 1600-1601.
Source
scival
Published In
Archives of internal medicine
Volume
171
Issue
17
Publish Date
2011
Start Page
1600
End Page
1601

Partisan vision biases determination of voter intent

In close, disputed elections, outcomes can depend on determinations of voter intent for ballots that have been filled out improperly. We surveyed 899 adult Minnesotans during a time when the state's U.S. Senate election was still disputed and presented them with ambiguous ballots similar to ballots under dispute in the same election. We randomized participants to three experimental groups, across which we varied the names on the ballot. We found that participants' judgments of voter intent were strongly biased by their voting preferences (p <.002 in all four ballots). © Copyright American Political Science Association 2011.

Authors
Ubel, PA; Zikmund-Fisher, BJ
MLA Citation
Ubel, PA, and Zikmund-Fisher, BJ. "Partisan vision biases determination of voter intent." PS - Political Science and Politics 44.1 (2011): 81-84.
Source
scival
Published In
PS - Political Science and Politics
Volume
44
Issue
1
Publish Date
2011
Start Page
81
End Page
84
DOI
10.1017/S1049096510001915

Images of illness: how causal claims and racial associations influence public preferences toward diabetes research spending.

Despite the salience of health disparities in media and policy discourse, little previous research has investigated if imagery associating an illness with a certain racial group influences public perceptions. This study evaluated the influence of the media's presentation of the causes of type 2 diabetes and its implicit racial associations on attitudes toward people with diabetes and preferences toward research spending. Survey participants who viewed an article on genetic causation or social determinants of diabetes were more likely to support increased government spending on research than those viewing an article with no causal language, while participants viewing an article on behavioral choices were more likely to attribute negative stereotypes to people with diabetes. Participants who viewed a photo of a black woman accompanying the article were less likely to endorse negative stereotypes than those viewing a photo of a white woman, but those who viewed a photo of a glucose-testing device expressed the lowest negative stereotypes. The effect of social determinants language was significantly different for blacks and whites, lowering stereotypes only among blacks. Emphasizing the behavioral causes of diabetes, as is common in media coverage, may perpetuate negative stereotypes. While drawing attention to the social determinants that shape these behaviors could mitigate stereotypes, this strategy is unlikely to influence the public uniformly.

Authors
Gollust, SE; Lantz, PM; Ubel, PA
MLA Citation
Gollust, SE, Lantz, PM, and Ubel, PA. "Images of illness: how causal claims and racial associations influence public preferences toward diabetes research spending." J Health Polit Policy Law 35.6 (December 2010): 921-959.
PMID
21451158
Source
pubmed
Published In
Journal of Health Politics, Policy and Law
Volume
35
Issue
6
Publish Date
2010
Start Page
921
End Page
959
DOI
10.1215/03616878-2010-034

Risky feelings: why a 6% risk of cancer does not always feel like 6%.

OBJECTIVE: Emotion plays a strong role in the perception of risk information but is frequently underemphasized in the decision-making and communication literature. We sought to discuss and put into context several lines of research that have explored the links between emotion and risk perceptions. METHODS: In this article, we provide a focused, "state of the science" review of research revealing the ways that emotion, or affect, influences people's cancer-related decisions. We identify illustrative experimental research studies that demonstrate the role of affect in people's estimates of cancer risk, their decisions between different cancer treatments, their perceptions of the chance of cancer recurrence, and their reactions to different methods of presenting risk information. RESULTS: These studies show that people have strong affective reactions to cancer risk information and that the way risk information is presented often determines the emotional gist people take away from such communications. CONCLUSION: Cancer researchers, educators and oncologists need to be aware that emotions are often more influential in decision making about cancer treatments and prevention behaviors than factual knowledge is. PRACTICE IMPLICATIONS: Anticipating and assessing affective reactions is an essential step in the evaluation and improvement of cancer risk communications.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. "Risky feelings: why a 6% risk of cancer does not always feel like 6%." Patient Educ Couns 81 Suppl (December 2010): S87-S93. (Review)
PMID
20739135
Source
pubmed
Published In
Patient Education and Counseling
Volume
81 Suppl
Publish Date
2010
Start Page
S87
End Page
S93
DOI
10.1016/j.pec.2010.07.041

Controversy undermines support for state mandates on the human papillomavirus vaccine.

State actions requiring adolescent girls to receive the human papillomavirus (HPV) vaccine created controversy following the vaccine's approval in 2006. Some health professionals worried that the controversy might dampen public support for those state policies and for other school immunizations in general. We fielded an experimental Internet survey to determine how controversy affects attitudes about vaccines. We discovered that public support for the HPV vaccine mandates wanes when the public is informed that the policies are controversial. However, the experimental survey also revealed that exposure to this policy controversy did not spill over and reduce public support for immunizations in general.

Authors
Gollust, SE; Dempsey, AF; Lantz, PM; Ubel, PA; Fowler, EF
MLA Citation
Gollust, SE, Dempsey, AF, Lantz, PM, Ubel, PA, and Fowler, EF. "Controversy undermines support for state mandates on the human papillomavirus vaccine." Health Aff (Millwood) 29.11 (November 2010): 2041-2046.
PMID
21041746
Source
pubmed
Published In
Health Affairs
Volume
29
Issue
11
Publish Date
2010
Start Page
2041
End Page
2046
DOI
10.1377/hlthaff.2010.0174

A demonstration of ''less can be more'' in risk graphics.

BACKGROUND: Online tools such as Adjuvant! provide tailored estimates of the possible outcomes of adjuvant therapy options available to breast cancer patients. The graphical format typically displays 4 outcomes simultaneously: survival, mortality due to cancer, other-cause mortality, and incremental survival due to adjuvant treatment. OBJECTIVE: To test whether simpler formats that present only baseline and incremental survival would improve comprehension of the relevant risk statistics and/or affect treatment intentions. DESIGN: . Randomized experimental manipulation of risk graphics shown included in Internet-administered survey vignettes about adjuvant therapy decisions for breast cancer patients with ER + tumors. PARTICIPANTS: Demographically diverse, stratified random samples of women ages 40 to 74 y recruited from an Internet research panel. INTERVENTION: Participants were randomized to view either pictographs (icon arrays) that displayed all 4 possible outcomes or pictographs that showed only survival outcomes. MEASUREMENTS: Comprehension of key statistics, task completion times, graph evaluation ratings, and perceived interest in adjuvant chemotherapy. RESULTS: In the primary study (N = 832), participants who viewed survival-only pictographs had better accuracy when reporting the total chance of survival with both chemotherapy and hormonal therapy (63% v. 50%, P < 0.001), higher graph evaluation ratings (x = 7.98 v. 7.67, P = 0.04), and less interest in adding chemotherapy to hormonal therapy (43% v. 50%, P = 0.04; adjusted odds ratio [OR] = 0.68, P = 0.008). A replication study (N = 714) confirmed that participants who viewed survival-only graphs had higher graph evaluation ratings (x = 8.06 v. 7.72, P = 0.04) and reduced interest in chemotherapy (OR=0.67,P=0.03). LIMITATIONS: Studies used general public samples; actual patients may process risk information differently. CONCLUSIONS: Taking a ''less is more'' approach by omitting redundant mortality outcome statistics can be an effective method of risk communication and may be preferable when using visual formats such as pictographs.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. "A demonstration of ''less can be more'' in risk graphics." Med Decis Making 30.6 (November 2010): 661-671.
PMID
20375419
Source
pubmed
Published In
Medical Decision Making
Volume
30
Issue
6
Publish Date
2010
Start Page
661
End Page
671
DOI
10.1177/0272989X10364244

Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs.

PURPOSE: Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. METHODS: Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. RESULTS: Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. CONCLUSION: Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Authors
Berry, SR; Bell, CM; Ubel, PA; Evans, WK; Nadler, E; Strevel, EL; Neumann, PJ
MLA Citation
Berry, SR, Bell, CM, Ubel, PA, Evans, WK, Nadler, E, Strevel, EL, and Neumann, PJ. "Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs." J Clin Oncol 28.27 (September 20, 2010): 4149-4153.
PMID
20697077
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
28
Issue
27
Publish Date
2010
Start Page
4149
End Page
4153
DOI
10.1200/JCO.2010.29.1625

Deficits and variations in patients' experience with making 9 common medical decisions: the DECISIONS survey.

BACKGROUND: Although many researchers have examined patient involvement and patient-provider interactions within specific clinical environments, no nationally representative data exist to characterize patient perceptions of decision making and patient-provider communications across multiple common medical decisions. OBJECTIVE: To identify deficits and variations in the patient experience of making common medical decisions about initiation of prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; and surgeries for knee or hip replacement, cataracts, or lower back pain, as well as to identify factors associated with patient confidence in the decisions. SETTING: National sample of US adults identified by random-digit dialing. DESIGN: Cross-sectional survey conducted from November 2006 to May 2007. PARTICIPANTS: Included 2473 English-speaking adults age 40 and older who reported undertaking 1 or more of the above 9 medical actions or discussing doing so with a health care provider within the past 2 years. MEASUREMENTS: Patients reported who initiated discussions and made the final decisions, how much discussion of pros and cons occurred, whether they were asked about their preferences, and their confidence that the decision "was the right one." RESULTS: The proportion of patient-driven decisions varied significantly across decisions (range: blood pressure: 16% to knee/hip replacement: 48%). Most patients (78%-85%) reported that providers made a recommendation, and such recommendations generally favored taking medical action. Fewer patients reported that providers asked them about their preferences (range: colon cancer screening: 34% to knee/hip replacement: 80%) or discussed reasons not to take action (range: breast cancer screening: 20% to lower back surgery: 80%). Decision confidence was higher among patients who reported primarily making the decision themselves (odds ratio [OR] = 14.6, P < 0.001) or having been asked for their preference (OR = 1.32, P < 0.01) and was lower among patients whose patient-provider discussions included cons (OR = 0.74, P = 0.008). LIMITATIONS: Recall biases may affect patients' memories of their decision-making processes. CONCLUSIONS: DECISIONS participants reported wide variations in the proportion of discussions that included a conversation about reasons not to take action or a conversation about patients' preferences about what they would like to do. These factors appear directly related to patients' confidence that the decision was "right."

Authors
Zikmund-Fisher, BJ; Couper, MP; Singer, E; Ubel, PA; Ziniel, S; Fowler, FJ; Levin, CA; Fagerlin, A
MLA Citation
Zikmund-Fisher, BJ, Couper, MP, Singer, E, Ubel, PA, Ziniel, S, Fowler, FJ, Levin, CA, and Fagerlin, A. "Deficits and variations in patients' experience with making 9 common medical decisions: the DECISIONS survey." Med Decis Making 30.5 Suppl (September 2010): 85S-95S.
PMID
20881157
Source
pubmed
Published In
Medical Decision Making
Volume
30
Issue
5 Suppl
Publish Date
2010
Start Page
85S
End Page
95S
DOI
10.1177/0272989X10380466

The DECISIONS study: a nationwide survey of United States adults regarding 9 common medical decisions.

BACKGROUND: Patient involvement is required before patients' preferences can be reflected in the medical care they receive. Furthermore, patients are a vital link between physicians' assessments of patients' needs and actual implementation of appropriate care. Yet no study has specifically examined how and when a representative sample of patients considered, discussed, and made medical decisions. OBJECTIVE: To identify decision prevalence and decision-making processes regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression; 2) screening tests for colorectal, breast, or prostate cancer; and 3) surgeries for knee or hip replacement, cataracts, or lower back pain. DESIGN: Computer-assisted telephone interview survey. SETTING: Nationally representative sample of US adults in households with telephones. PARTICIPANTS: 3010 English-speaking adults age 40 and older identified using a stratified random sample of telephone numbers. MEASUREMENTS: Estimated prevalence of medical decisions, defined as the patient having initiated medications, been screened, or had surgery within the past 2 years or having discussed these actions with a health care provider during the same interval, as well as decision-specific data regarding patient knowledge, attitudes and patient-provider interactions. RESULTS: 82.2% of the target population reported making at least 1 medical decision in the preceding 2 years. The proportion of decisions resulting in patient action varied dramatically both across decision type (medications [61%] v. screening [83%] v. surgery [44%]; P < 0.001), and within each category (e.g., blood pressure medications [76%] v. cholesterol medications [55%] vs. depression medications [48%]; P < 0.001). Respondents reported making more decisions if they had a primary care provider or poorer health status and fewer decisions if they had lower education, were male, or were under age 50. Limitations. Retrospective self-reports may incorporate recall biases. CONCLUSIONS: Medical decisions with significant life-saving, quality of life, and cost implications are a pervasive part of life for most US adults. The DECISIONS dataset provides a rich research environment for exploring factors influencing when and how patients make common medical decisions.

Authors
Zikmund-Fisher, BJ; Couper, MP; Singer, E; Levin, CA; Fowler, FJ; Ziniel, S; Ubel, PA; Fagerlin, A
MLA Citation
Zikmund-Fisher, BJ, Couper, MP, Singer, E, Levin, CA, Fowler, FJ, Ziniel, S, Ubel, PA, and Fagerlin, A. "The DECISIONS study: a nationwide survey of United States adults regarding 9 common medical decisions." Med Decis Making 30.5 Suppl (September 2010): 20S-34S.
PMID
20393104
Source
pubmed
Published In
Medical Decision Making
Volume
30
Issue
5 Suppl
Publish Date
2010
Start Page
20S
End Page
34S
DOI
10.1177/0272989X09353792

Testing whether decision aids introduce cognitive biases: results of a randomized trial.

OBJECTIVE: Women at high risk of breast cancer face a difficult decision whether to take medications like tamoxifen to prevent a first breast cancer diagnosis. Decision aids (DAs) offer a promising method of helping them make this decision. But concern lingers that DAs might introduce cognitive biases. METHODS: We recruited 663 women at high risk of breast cancer and presented them with a DA designed to experimentally test potential methods of identifying and reducing cognitive biases that could influence this decision, by varying specific aspects of the DA across participants in a factorial design. RESULTS: Participants were susceptible to a cognitive bias - an order effect - such that those who learned first about the risks of tamoxifen thought more favorably of the drug than women who learned first about the benefits. This order effect was eliminated among women who received additional information about competing health risks. CONCLUSION: We discovered that the order of risk/benefit information influenced women's perceptions of tamoxifen. This bias was eliminated by providing contextual information about competing health risks. PRACTICE IMPLICATIONS: We have demonstrated the feasibility of using factorial experimental designs to test whether DAs introduce cognitive biases, and whether specific elements of DAs can reduce such biases.

Authors
Ubel, PA; Smith, DM; Zikmund-Fisher, BJ; Derry, HA; McClure, J; Stark, A; Wiese, C; Greene, S; Jankovic, A; Fagerlin, A
MLA Citation
Ubel, PA, Smith, DM, Zikmund-Fisher, BJ, Derry, HA, McClure, J, Stark, A, Wiese, C, Greene, S, Jankovic, A, and Fagerlin, A. "Testing whether decision aids introduce cognitive biases: results of a randomized trial." Patient Educ Couns 80.2 (August 2010): 158-163.
PMID
20004545
Source
pubmed
Published In
Patient Education and Counseling
Volume
80
Issue
2
Publish Date
2010
Start Page
158
End Page
163
DOI
10.1016/j.pec.2009.10.021

Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening.

Narratives from similar others may be an effective way to increase important health behaviors. In this study, we used a narrative intervention to promote colorectal cancer screening. Researchers have suggested that people may overestimate barriers to colorectal cancer screening. We recruited participants from the US, ages 49-60 who had never previously been screened for colorectal cancer, to read an educational message about screening for the disease. One-half of participants were randomly assigned to also receive a narrative within the message (control participants did not receive a narrative). The narrative intervention was developed according to predictions of affective forecasting theory. Compared to participants who received only the educational message, participants who received the message along with a narrative reported that the barriers to screening would have less of an impact on a future screening experience. The narrative also increased risk perception for colorectal cancer and interest in screening in the next year.

Authors
Dillard, AJ; Fagerlin, A; Dal Cin, S; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Dillard, AJ, Fagerlin, A, Dal Cin, S, Zikmund-Fisher, BJ, and Ubel, PA. "Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening." Soc Sci Med 71.1 (July 2010): 45-52.
PMID
20417005
Source
pubmed
Published In
Social Science and Medicine
Volume
71
Issue
1
Publish Date
2010
Start Page
45
End Page
52
DOI
10.1016/j.socscimed.2010.02.038

Foreigners traveling to the U.S. for transplantation may adversely affect organ donation: a national survey.

The aims of this study were (1) to determine attitudes among the American public regarding foreigners coming to the United States for the purposes of transplantation, and (2) to investigate the impact this practice might have on the public's willingness to donate organs. A probability-based national sample of adults age > or =18 was asked whether people should be allowed to travel to the United States to receive a transplant, and whether this practice would discourage the respondents from becoming an organ donor. Among 1049 participants, 30% (95% CI 25-34%) felt that people should not be allowed to travel to the United States to receive a deceased donor transplant, whereas 28% felt this would be acceptable in some cases. Thirty-eight percent (95% CI 33-42%) indicated that this practice might prevent them from becoming an organ donor. In conclusion, deceased-donor transplantation of foreigners is opposed by many Americans. Media coverage of this practice has the potential to adversely affect organ donation.

Authors
Volk, ML; Warren, GJW; Anspach, RR; Couper, MP; Merion, RM; Ubel, PA
MLA Citation
Volk, ML, Warren, GJW, Anspach, RR, Couper, MP, Merion, RM, and Ubel, PA. "Foreigners traveling to the U.S. for transplantation may adversely affect organ donation: a national survey." Am J Transplant 10.6 (June 2010): 1468-1472.
PMID
20486916
Source
pubmed
Published In
American Journal of Transplantation
Volume
10
Issue
6
Publish Date
2010
Start Page
1468
End Page
1472
DOI
10.1111/j.1600-6143.2010.03111.x

Why should changing the bathwater have to harm the baby?

Authors
Ubel, PA; Smith, DM
MLA Citation
Ubel, PA, and Smith, DM. "Why should changing the bathwater have to harm the baby?." Qual Life Res 19.4 (May 2010): 481-482.
PMID
20336489
Source
pubmed
Published In
Quality of Life Research
Volume
19
Issue
4
Publish Date
2010
Start Page
481
End Page
482
DOI
10.1007/s11136-010-9613-9

Abandoning the language of "response shift": a plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life.

Quality of life researchers have been studying "response shift" for a decade now, in an effort to clarify how best to measure QoL over time and across changing circumstances. However, we contend that this line of research has been impeded by conceptual confusion created by the term "response shift", that lumps together sources of measurement error (e.g., scale recalibration) with true causes of changing QoL (e.g., hedonic adaptation). We propose abandoning the term response shift, in favor of less ambiguous terms, like scale recalibration and adaptation.

Authors
Ubel, PA; Peeters, Y; Smith, D
MLA Citation
Ubel, PA, Peeters, Y, and Smith, D. "Abandoning the language of "response shift": a plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life." Qual Life Res 19.4 (May 2010): 465-471.
PMID
20112000
Source
pubmed
Published In
Quality of Life Research
Volume
19
Issue
4
Publish Date
2010
Start Page
465
End Page
471
DOI
10.1007/s11136-010-9592-x

Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians.

CONTEXT: Physicians are regularly confronted with research that is funded or presented by industry. OBJECTIVE: To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. DESIGN AND SETTING: Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: 'presenter conflict', 'researcher conflict' and 'no conflict'. PARTICIPANTS: 515 randomly selected Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. MAIN OBJECT MEASURES: The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. RESULTS: Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. CONCLUSION: While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies.

Authors
Silverman, GK; Loewenstein, GF; Anderson, BL; Ubel, PA; Zinberg, S; Schulkin, J
MLA Citation
Silverman, GK, Loewenstein, GF, Anderson, BL, Ubel, PA, Zinberg, S, and Schulkin, J. "Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians." J Med Ethics 36.5 (May 2010): 265-270.
PMID
20448003
Source
pubmed
Published In
Journal of medical ethics
Volume
36
Issue
5
Publish Date
2010
Start Page
265
End Page
270
DOI
10.1136/jme.2009.034496

Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers.

Being a caregiver for an ill or disabled loved one is widely recognized as a threat to the caregiver's quality of life. Nonetheless, research indicates that helping behavior, broadly construed, promotes well-being. Could helping behavior in a caregiving context promote well-being as well? In the present study, we used ecological momentary assessment to measure active helping behavior and both positive and negative affect in 73 spouse caregivers. Results indicate that when controlling for care recipient illness status and functional impairment and caregiver "on call" caregiving time, active helping predicted greater caregiver positive affect--especially for individuals who perceived themselves as interdependent with their spouse. In addition, although both helping and on-call time predicted greater negative affect for caregivers who perceived low interdependence, helping was unrelated to negative affect among caregivers perceiving high interdependence. Helping valued loved ones may promote caregivers' well-being.

Authors
Poulin, MJ; Brown, SL; Ubel, PA; Smith, DM; Jankovic, A; Langa, KM
MLA Citation
Poulin, MJ, Brown, SL, Ubel, PA, Smith, DM, Jankovic, A, and Langa, KM. "Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers." Psychol Aging 25.1 (March 2010): 108-117.
PMID
20230132
Source
pubmed
Published In
Psychology and Aging
Volume
25
Issue
1
Publish Date
2010
Start Page
108
End Page
117
DOI
10.1037/a0018064

Attitudes of the American public toward organ donation after uncontrolled (sudden) cardiac death.

Concerns about public support for organ donation after cardiac death have hindered expansion of this practice, particularly rapid organ recovery in the context of uncontrolled (sudden) cardiac death (uDCD). A nationally representative Internet-based panel was provided scenarios describing donation in the context of brain death, controlled cardiac death and uncontrolled cardiac death. Participants were randomized to receive questions about trust in the medical system before or after the rapid organ recovery scenario. Among 1631 panelists, 1049 (64%) completed the survey. Participants expressed slightly more willingness to donate in the context of controlled and uncontrolled cardiac death than after brain death (70% and 69% vs. 66%, respectively, p < 0.01). Eighty percent of subjects (95% CI 77-84%) would support having a rapid organ recovery program in their community, though 83% would require family consent or a signed donor card prior to invasive procedures for organ preservation. The idea of uDCD slightly decreased trust in the medical system from 59% expressing trust to 51% (p = 0.02), but did not increase belief that a signed donor card would interfere with medical care (28% vs. 32%, p = 0.37). These findings provide support for the careful expansion of uDCD, albeit with formal consent prior to organ preservation.

Authors
Volk, ML; Warren, GJW; Anspach, RR; Couper, MP; Merion, RM; Ubel, PA
MLA Citation
Volk, ML, Warren, GJW, Anspach, RR, Couper, MP, Merion, RM, and Ubel, PA. "Attitudes of the American public toward organ donation after uncontrolled (sudden) cardiac death." Am J Transplant 10.3 (March 2010): 675-680.
PMID
20121727
Source
pubmed
Published In
American Journal of Transplantation
Volume
10
Issue
3
Publish Date
2010
Start Page
675
End Page
680
DOI
10.1111/j.1600-6143.2009.02971.x

Women's decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid.

Tamoxifen reduces primary breast cancer incidence, yet causes serious side effects. To date, few women with increased breast cancer risk have elected to use tamoxifen for chemoprevention. The objective of the study was to determine women's knowledge of and attitudes toward tamoxifen following exposure to a tailored decision aid (DA). A total of 632 women with a 5-year risk of breast cancer > or = 1.66% (Mean = 2.56, range = 1.7-17.3) were recruited from two healthcare organizations. Participants viewed an online DA that informed them about their 5-year risk of breast cancer and presented individually tailored content depicting the risks/benefits of tamoxifen prophylaxis. Outcome measures included behavioral intentions (to seek additional information about tamoxifen, to talk to a physician about tamoxifen, and to take tamoxifen); knowledge; and perceived risks and benefits of tamoxifen. After viewing the DA, 29% of participants said they intended to seek more information or talk to their doctor about tamoxifen, and only 6% believed they would take tamoxifen. Knowledge was considerable, with 63% of women answering at least 5 of 6 knowledge questions correctly. Participants were concerned about the risks of tamoxifen, and many believed that the benefits of tamoxifen did not outweigh the risks. This study is the largest to date to test women's preferences for taking tamoxifen and one of the largest to have tested the impact of a tailored DA. After viewing the DA, women demonstrated good understanding of tamoxifen's risks and benefits, but most were not interested in taking tamoxifen for breast cancer chemoprevention.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Nair, V; Derry, HA; McClure, JB; Greene, S; Stark, A; Hensley Alford, S; Lantz, P; Hayes, DF; Wiese, C; Claud Zweig, S; Pitsch, R; Jankovic, A; Ubel, PA
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, Nair, V, Derry, HA, McClure, JB, Greene, S, Stark, A, Hensley Alford, S, Lantz, P, Hayes, DF, Wiese, C, Claud Zweig, S, Pitsch, R, Jankovic, A, and Ubel, PA. "Women's decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid." Breast Cancer Res Treat 119.3 (February 2010): 613-620.
PMID
19908143
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
119
Issue
3
Publish Date
2010
Start Page
613
End Page
620
DOI
10.1007/s10549-009-0618-4

Sex differences in career development awardees' subsequent grant attainment

Authors
Jagsi, R; Ubel, PA
MLA Citation
Jagsi, R, and Ubel, PA. "Sex differences in career development awardees' subsequent grant attainment." Annals of Internal Medicine 152.9 (2010): 617--.
Source
scival
Published In
Annals of internal medicine
Volume
152
Issue
9
Publish Date
2010
Start Page
617-

Cancer therapy costs influence treatment: A national survey of oncologists

A national survey of medical oncologists indicates that rising cancer treatment costs are influencing clinical practice, even as oncologists tend not to communicate with patients about costs. The survey shows that 84 percent of oncologists say that patients' out-ofpocket spending influences treatment recommendations. Only 43 percent always or frequently discuss costs with patients. Among those surveyed, 79 percent favor more comparative effectiveness research; 80 percent support more cost-effectiveness data, although only 42 percent feel well prepared to interpret it. The results suggest that physicians support federally funded comparative effectiveness research but that they wish to retain a central role in making decisions about how and when to use expensive cancer treatments. The results also support educating physicians about cost-effectiveness and how to communicate with patients regarding cost. © 2010 Project HOPE-The Peopleto-People Health Foundation, Inc.

Authors
Neumann, PJ; Palmer, JA; Nadler, E; Fang, C; Ubel, P
MLA Citation
Neumann, PJ, Palmer, JA, Nadler, E, Fang, C, and Ubel, P. "Cancer therapy costs influence treatment: A national survey of oncologists." Health Affairs 29.1 (2010): 196-202.
PMID
20048377
Source
scival
Published In
Health Affairs
Volume
29
Issue
1
Publish Date
2010
Start Page
196
End Page
202
DOI
10.1377/hlthaff.2009.0077

Beyond costs and benefits: understanding how patients make health care decisions.

Many medical decisions are "preference sensitive," where the best choice depends on the values a specific patient places on relevant outcomes. For example, a decision may require a patient to make a trade-off between a small increase in chance for survival and a large out-of-pocket expense. In such situations, patients need to understand the costs and benefits of the health care alternative, in order to decide the best course of action. However, findings from decision science research have demonstrated that people's decisions are often influenced not only by their perceptions of these costs and benefits, but also by subtle contextual factors that trigger intuitive and emotional decision processes. In this article, I describe some of these contextual factors, and lay out the challenges these factors raise for clinicians' efforts to help their patients make informed decisions.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Beyond costs and benefits: understanding how patients make health care decisions." Oncologist 15 Suppl 1 (2010): 5-10.
PMID
20237210
Source
pubmed
Published In
The oncologist
Volume
15 Suppl 1
Publish Date
2010
Start Page
5
End Page
10
DOI
10.1634/theoncologist.2010-S1-5

Sex differences in attainment of independent funding by career development awardees.

BACKGROUND: Concerns have been raised about the career pipeline in academic medicine, including whether women with a demonstrated commitment to research succeed at the same rate as male colleagues. OBJECTIVE: To determine the subsequent academic success of recipients of National Institutes of Health (NIH) career development awards. SETTING: United States. PARTICIPANTS: 2784 of 2799 (99.5%) recipients of K08 and K23 awards for whom sex could be ascertained from the NIH Computer Retrieval of Information on Scientific Projects database and other publicly available sources. MEASUREMENTS: Actuarial rates at which recipients of K08 and K23 awards from 1997 to 2003 went on to receive R01 awards. Sex-specific rates of R01 award attainment were calculated by using the Kaplan-Meier method, and sex differences were assessed by using a Cox proportional hazards model. RESULTS: Overall, 31.4% of the 1919 K08 awardees and 43.7% of the 865 K23 awardees were female (P < 0.001). Women were less likely than men to receive an R01 award (P < 0.001). The actuarial rate of R01 award attainment at 5 years was 22.7% overall, 18.8% among women, and 24.8% among men. At 10 years, the rate was 42.5% overall, 36.2% among women, and 45.6% among men. Sex persisted as an independent significant predictor of R01 award attainment (hazard ratio, 0.79 [95% CI, 0.68 to 0.92]; P = 0.002) in multivariate analysis controlling for K award type, year of award, funding institute, institution, and specialty. LIMITATION: Whether the lower rate of R01 award achievement among women is due to lower rates of application or lower rates of success in application could not be determined. CONCLUSION: Only a minority of K awardees studied achieved R01 award funding during the period assessed, and a significant sex disparity was evident.

Authors
Jagsi, R; Motomura, AR; Griffith, KA; Rangarajan, S; Ubel, PA
MLA Citation
Jagsi, R, Motomura, AR, Griffith, KA, Rangarajan, S, and Ubel, PA. "Sex differences in attainment of independent funding by career development awardees." Ann Intern Med 151.11 (December 1, 2009): 804-811.
PMID
19949146
Source
pubmed
Published In
Annals of internal medicine
Volume
151
Issue
11
Publish Date
2009
Start Page
804
End Page
811
DOI
10.7326/0003-4819-151-11-200912010-00009

The polarizing effect of news media messages about the social determinants of health.

Framing health problems in terms of the social determinants of health aims to shift policy attention to nonmedical strategies to improve population health, yet little is known about how the public responds to these messages. We conducted an experiment to test the effect of a news article describing the social determinants of type 2 diabetes on the public's support for diabetes prevention strategies. We found that exposure to the social determinants message led to a divergence between Republicans' and Democrats' opinions, relative to their opinions after viewing an article with no message about the causes of diabetes. These results signify that increasing public awareness of the social determinants of health may not uniformly increase public support for policy action.

Authors
Gollust, SE; Lantz, PM; Ubel, PA
MLA Citation
Gollust, SE, Lantz, PM, and Ubel, PA. "The polarizing effect of news media messages about the social determinants of health." Am J Public Health 99.12 (December 2009): 2160-2167.
PMID
19833981
Source
pubmed
Published In
American journal of public health
Volume
99
Issue
12
Publish Date
2009
Start Page
2160
End Page
2167
DOI
10.2105/AJPH.2009.161414

Happily hopeless: adaptation to a permanent, but not to a temporary, disability.

OBJECTIVE: The authors tracked patients with either irreversible or reversible colostomies over a 6-month period, beginning a week after the procedure, to examine how they adapted hedonically over time. Based on prior research and theorizing, the authors hypothesized that, paradoxically, those with irreversible colostomies would adapt more fully, and become happier, than would those with colostomies that were potentially reversible. DESIGN: The authors contacted 107 patients who had recently received either a colostomy or ileostomy. The initial interviews were conducted while patients were still in the hospital recovering from their surgery. Consenting participants were mailed surveys at three time points: 1 week after release from the hospital, 1 month after release, and 6 months after release. MAIN OUTCOME MEASURES: The surveys included measures of life satisfaction and perceived quality of life. RESULTS: As predicted, overall life satisfaction and quality of life increased with time for patients with permanent, but not temporary, ostomies. CONCLUSION: These findings suggest that knowing an adverse situation is temporary can interfere with adaptation, leading to a paradoxical situation in which people who are better off objectively are worse off subjectively.

Authors
Smith, DM; Loewenstein, G; Jankovic, A; Ubel, PA
MLA Citation
Smith, DM, Loewenstein, G, Jankovic, A, and Ubel, PA. "Happily hopeless: adaptation to a permanent, but not to a temporary, disability." Health Psychol 28.6 (November 2009): 787-791.
PMID
19916648
Source
pubmed
Published In
Health Psychology
Volume
28
Issue
6
Publish Date
2009
Start Page
787
End Page
791
DOI
10.1037/a0016624

Up from crisis: overhauling healthcare information, payment, and delivery in extraordinary times. Dialogue with featured speakers from the 6th annual connected health symposium.

Authors
Kvedar, JC; Hwang, J; Moorhead, T; Orlov, LM; Ubel, PA
MLA Citation
Kvedar, JC, Hwang, J, Moorhead, T, Orlov, LM, and Ubel, PA. "Up from crisis: overhauling healthcare information, payment, and delivery in extraordinary times. Dialogue with featured speakers from the 6th annual connected health symposium." Telemed J E Health 15.7 (September 2009): 634-641.
PMID
19747071
Source
pubmed
Published In
Telemedicine Journal and e-Health
Volume
15
Issue
7
Publish Date
2009
Start Page
634
End Page
641
DOI
10.1089/tmj.2009.9948

American Society of Clinical Oncology guidance statement: the cost of cancer care.

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

Authors
Meropol, NJ; Schrag, D; Smith, TJ; Mulvey, TM; Langdon, RM; Blum, D; Ubel, PA; Schnipper, LE; American Society of Clinical Oncology,
MLA Citation
Meropol, NJ, Schrag, D, Smith, TJ, Mulvey, TM, Langdon, RM, Blum, D, Ubel, PA, Schnipper, LE, and American Society of Clinical Oncology, . "American Society of Clinical Oncology guidance statement: the cost of cancer care." J Clin Oncol 27.23 (August 10, 2009): 3868-3874.
PMID
19581533
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
27
Issue
23
Publish Date
2009
Start Page
3868
End Page
3874
DOI
10.1200/JCO.2009.23.1183

Under-representation of women in high-impact published clinical cancer research.

BACKGROUND: Adequate representation of women in research has been deemed essential. METHODS: Cancer research published in 8 journals in 2006 was reviewed. The percentage of women among study participants was compared with the proportion expected from population-based estimates of sex-specific cancer incidence, using binomial tests. Differences were assessed in sex distribution of participants by funding source, author sex, and focus of research with the Student t test, and in a linear regression model controlling for cancer type. RESULTS: A total of 1534 cancer research articles were identified, of which 661 (representing 1,096,098 participants) were prospective clinical studies and were analyzed further. For all 7 non-sex-specific cancer types assessed, the majority of studies analyzed included a lower proportion of women than the proportion of women among patients having cancer of that type in the general population. Among studies focusing on cancer treatment, women constituted a significantly lower overall proportion of the participants in the analyzed studies than expected for 6 of 7 non-sex-specific cancer types (P < .001). Among non-sex-specific studies, the mean percentage of participants who were women was 38.8%. Non-sex-specific studies reporting government funding had a higher percentage of female participants (mean 41.3% vs 36.9%; P = .005). In a regression model controlling for cancer type, lack of government funding (P = .03) and focus on cancer treatment (P = .03) were found to be independent significant predictors of a lower percentage of female participants. CONCLUSIONS: Women were under-represented as participants in recently published, high-impact studies of non-sex-specific cancers. Studies that received government funding included a higher proportion of female subjects.

Authors
Jagsi, R; Motomura, AR; Amarnath, S; Jankovic, A; Sheets, N; Ubel, PA
MLA Citation
Jagsi, R, Motomura, AR, Amarnath, S, Jankovic, A, Sheets, N, and Ubel, PA. "Under-representation of women in high-impact published clinical cancer research." Cancer 115.14 (July 15, 2009): 3293-3301.
PMID
19507175
Source
pubmed
Published In
Cancer
Volume
115
Issue
14
Publish Date
2009
Start Page
3293
End Page
3301
DOI
10.1002/cncr.24366

Frequency, nature, effects, and correlates of conflicts of interest in published clinical cancer research.

BACKGROUND: Relationships between clinical researchers and industry are becoming increasingly complex. The frequency and impact of conflicts of interest in the full range of high-impact, published clinical cancer research is unknown. METHODS: The authors reviewed cancer research published in 8 journals in 2006 to determine frequency of self-reported conflicts of interest, source of study funding, and other characteristics. They assessed associations between the likelihood of conflicts of interest and other characteristics by using chi-squared testing. They also compared the likelihood of positive outcome in randomized trials with and without conflicts of interest by chi-squared testing. RESULTS: The authors identified 1534 original oncology studies; 29% had conflicts of interest (including industrial funding) and 17% declared industrial funding. Conflicts of interest varied by discipline (P < .001), continental origin (P < .001), and sex (P < .001) of the corresponding author and were most likely in articles with corresponding authors from departments of medical oncology (45%), those from North America (33%), and those with male first and senior authors (37%). Frequency of conflicts also varied considerably depending upon disease site studied. Studies with industrial funding were more likely to focus on treatment (62% vs 36%; P < .001), and randomized trials that assessed survival were more likely to report positive survival outcomes when a conflict of interest was present (P = .04). CONCLUSIONS: Conflicts of interest characterize a substantial minority of clinical cancer research published in high-impact journals. Therefore, attempts to disentangle the cancer research effort from industry merit further attention, and journals should embrace both rigorous standards of disclosure and heightened scrutiny when conflicts exist.

Authors
Jagsi, R; Sheets, N; Jankovic, A; Motomura, AR; Amarnath, S; Ubel, PA
MLA Citation
Jagsi, R, Sheets, N, Jankovic, A, Motomura, AR, Amarnath, S, and Ubel, PA. "Frequency, nature, effects, and correlates of conflicts of interest in published clinical cancer research." Cancer 115.12 (June 15, 2009): 2783-2791.
PMID
19434666
Source
pubmed
Published In
Cancer
Volume
115
Issue
12
Publish Date
2009
Start Page
2783
End Page
2791
DOI
10.1002/cncr.24315

Caregiving behavior is associated with decreased mortality risk.

Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N= 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.

Authors
Brown, SL; Smith, DM; Schulz, R; Kabeto, MU; Ubel, PA; Poulin, M; Yi, J; Kim, C; Langa, KM
MLA Citation
Brown, SL, Smith, DM, Schulz, R, Kabeto, MU, Ubel, PA, Poulin, M, Yi, J, Kim, C, and Langa, KM. "Caregiving behavior is associated with decreased mortality risk." Psychol Sci 20.4 (April 2009): 488-494.
PMID
19320860
Source
pubmed
Published In
Psychological Science
Volume
20
Issue
4
Publish Date
2009
Start Page
488
End Page
494
DOI
10.1111/j.1467-9280.2009.02323.x

Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?

STUDY OBJECTIVE: To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension. METHODS: We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance). RESULTS: Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension. CONCLUSION: Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.

Authors
Engel, KG; Heisler, M; Smith, DM; Robinson, CH; Forman, JH; Ubel, PA
MLA Citation
Engel, KG, Heisler, M, Smith, DM, Robinson, CH, Forman, JH, and Ubel, PA. "Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?." Ann Emerg Med 53.4 (April 2009): 454-461.e15.
PMID
18619710
Source
pubmed
Published In
Annals of Emergency Medicine
Volume
53
Issue
4
Publish Date
2009
Start Page
454
End Page
461.e15
DOI
10.1016/j.annemergmed.2008.05.016

Can a moral reasoning exercise improve response quality to surveys of healthcare priorities?

OBJECTIVE: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities METHODS: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from -5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. RESULTS: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. CONCLUSIONS: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities.

Authors
Johri, M; Damschroder, LJ; Zikmund-Fisher, BJ; Kim, SYH; Ubel, PA
MLA Citation
Johri, M, Damschroder, LJ, Zikmund-Fisher, BJ, Kim, SYH, and Ubel, PA. "Can a moral reasoning exercise improve response quality to surveys of healthcare priorities?." J Med Ethics 35.1 (January 2009): 57-64.
PMID
19103946
Source
pubmed
Published In
Journal of medical ethics
Volume
35
Issue
1
Publish Date
2009
Start Page
57
End Page
64
DOI
10.1136/jme.2008.024810

Up from crisis: overhauling healthcare information, payment, and delivery in extraordinary times. Dialogue with featured speakers from the 6th annual connected health symposium

Authors
Kvedar, JC; Hwang, J; Moorhead, T; Orlov, LM; Ubel, PA
MLA Citation
Kvedar, JC, Hwang, J, Moorhead, T, Orlov, LM, and Ubel, PA. "Up from crisis: overhauling healthcare information, payment, and delivery in extraordinary times. Dialogue with featured speakers from the 6th annual connected health symposium." Telemedicine journal and e-health : the official journal of the American Telemedicine Association 15.7 (2009): 634-641.
Source
scival
Published In
Telemedicine Journal and e-Health
Volume
15
Issue
7
Publish Date
2009
Start Page
634
End Page
641
DOI
10.1089/tmj.2009.9948

How bad is depression? Preference score estimates from depressed patients and the general population

Objective. To compare depression health state preference scores across four groups: (1) general population, (2) previous history of depression but not currently depressed, (3) less severe current depression, and (4) more severe current depression. Data Sources. Primary data were collected from 95 general population, 163 primary care, and 83 specialty mental health subjects. Study Design. Stratified sampling frames were used to recruit general population and patient subjects. Subjects completed cross-sectional surveys. Key variables included rating scale and standard gamble scores assigned to depression health state descriptions developed from the Patient Health Questionnaire-9 (PHQ-9) and SF-12. Data Collection/Extraction Methods. Each subject completed an in-person interview. Forty-nine subjects completed test/retest reliability interviews. Principal Findings. Depressed patient preference scores for three of six SF-12 depression health states were significantly lower than the general population using the rating scale and two of sixwere significantly lower using standard gamble.Depressed patient scores for five of six PHQ-9 depression health states were significantly lower than the general population using the rating scale and two of sixwere significantly lower using standard gamble. Conclusions. Depressed patients report lower preference scores for depression health states than the general population. In effect, they perceived depression to be worse than the general public perceived it to be. Additional research is needed to examine the implications for cost-effectiveness ratios using general population preference scores versus depressed patient preference scores. © Health Research and Educational Trust.

Authors
Pyne, JM; Fortney, JC; Tripathi, S; Feeny, D; Ubel, P; Brazier, J
MLA Citation
Pyne, JM, Fortney, JC, Tripathi, S, Feeny, D, Ubel, P, and Brazier, J. "How bad is depression? Preference score estimates from depressed patients and the general population." Health Services Research 44.4 (2009): 1406-1423.
PMID
19453391
Source
scival
Published In
Health Services Research
Volume
44
Issue
4
Publish Date
2009
Start Page
1406
End Page
1423
DOI
10.1111/j.1475-6773.2009.00974.x

Pruning the regulatory tree

Authors
Kim, S; Ubel, P; Vries, RD
MLA Citation
Kim, S, Ubel, P, and Vries, RD. "Pruning the regulatory tree." Nature 457.7229 (2009): 534-535.
PMID
19177111
Source
scival
Published In
Nature
Volume
457
Issue
7229
Publish Date
2009
Start Page
534
End Page
535
DOI
10.1038/457534a

Improving understanding of adjuvant therapy options by using simpler risk graphics.

BACKGROUND: To help oncologists and breast cancer patients make informed decisions about adjuvant therapies, online tools such as Adjuvant! provide tailored estimates of mortality and recurrence risks. However, the graphical format used to display these results (a set of 4 horizontal stacked bars) may be suboptimal. The authors tested whether using simpler formats would improve comprehension of the relevant risk statistics. METHODS: A total of 1,619 women, aged 40-74 years, completed an Internet-administered survey vignette about adjuvant therapy decisions for a patient with an estrogen receptor-positive tumor. Participants were randomized to view 1 of 4 risk graphics, a base version that mirrored the Adjuvant! format, an alternate graph that showed only 2 options (those that included hormonal therapy), a graph that used a pictograph format, or a graph that included both changes. Outcome measures included comprehension of key statistics, time required to complete the task, and graph-perception ratings. RESULTS: The simplifying format changes significantly improved comprehension, especially when both changes were implemented together. Compared with participants who viewed the base 4-option bar graph, respondents who, instead, viewed a 2-option pictograph version were more accurate when they reported the incremental risk reduction achievable from adding chemotherapy to hormonal therapy (77% vs 51%; P< .001), answered that question more quickly (median time, 28 seconds vs 42 seconds; P< .001), and liked the graph more (mean, 7.67 vs 6.88; P< .001). CONCLUSIONS: Although most patients will only view risk calculators such as Adjuvant! in consultation with their clinicians, simplifying design graphics could significantly improve patients' comprehension of statistics essential for informed decision making about adjuvant therapies.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. "Improving understanding of adjuvant therapy options by using simpler risk graphics." Cancer 113.12 (December 15, 2008): 3382-3390.
PMID
19012353
Source
pubmed
Published In
Cancer
Volume
113
Issue
12
Publish Date
2008
Start Page
3382
End Page
3390
DOI
10.1002/cncr.23959

Are they really that happy? Exploring scale recalibration in estimates of well-being.

OBJECTIVE: The authors addressed a lingering concern in research on hedonic adaptation to adverse circumstances. This research typically relies on self-report measures of well-being, which are subjective and depend on the standards that people use in making judgments. The authors employed a novel method to test for, and rule out, such scale recalibration in self-reports of well-being. DESIGN: The authors asked patients with chronic illness (either lung disease or diabetes) and nonpatients to evaluate quality of life (QoL) for the patients' disease. In addition, the authors also asked them to rank and rate the aversiveness of a diverse set of adverse circumstances, allowing examination of both the numerical ratings and ordering among items. MAIN OUTCOME MEASURES: The authors compared patients' and nonpatients' ratings and rankings for the patients' disease and other conditions. RESULTS AND CONCLUSION: The authors found that patients not only assigned higher numerical QoL ratings to their own disease than did nonpatients but also ranked it higher among the broad set of conditions. These results suggest that scale recalibration cannot account for discrepant QoL ratings between patients and nonpatients. More generally, this study presents a new approach for measuring well-being that is not subject to the problem of scale recalibration.

Authors
Lacey, HP; Fagerlin, A; Loewenstein, G; Smith, DM; Riis, J; Ubel, PA
MLA Citation
Lacey, HP, Fagerlin, A, Loewenstein, G, Smith, DM, Riis, J, and Ubel, PA. "Are they really that happy? Exploring scale recalibration in estimates of well-being." Health Psychol 27.6 (November 2008): 669-675.
PMID
19025261
Source
pubmed
Published In
Health Psychology
Volume
27
Issue
6
Publish Date
2008
Start Page
669
End Page
675
DOI
10.1037/0278-6133.27.6.669

Outside the operating room--economic, regulatory, and legal challenges: a collection of perspectives and panel discussion.

Authors
Altman, LK; Mussallem, MA; Dresser, R; Lombardo, PA; Ubel, PA; White, CL
MLA Citation
Altman, LK, Mussallem, MA, Dresser, R, Lombardo, PA, Ubel, PA, and White, CL. "Outside the operating room--economic, regulatory, and legal challenges: a collection of perspectives and panel discussion." Cleve Clin J Med 75 Suppl 6 (November 2008): S61-S70.
PMID
19024955
Source
pubmed
Published In
Cleveland Clinic Journal of Medicine
Volume
75 Suppl 6
Publish Date
2008
Start Page
S61
End Page
S70

Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs.

OBJECTIVE: To experimentally test whether using pictographs (image matrices), incremental risk formats, and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers. METHODS: We recruited 631 women with elevated breast cancer risk from two healthcare organizations. Participants saw tailored estimates of the risks of 5 side effects: endometrial cancer, blood clotting, cataracts, hormonal symptoms, and sexual problems. Presentation format was randomly varied in a three factor design: (A) risk information was displayed either in pictographs or numeric text; (B) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making; and (C) risk estimates used 100 or 1000 person denominators. Primary outcome measures included risk perceptions and gist knowledge. RESULTS: Incremental risk formats consistently lowered perceived risk of side effects but resulted in low knowledge when displayed by numeric text only. Adding pictographs, however, produced significantly higher comprehension levels. CONCLUSIONS: Pictographs make risk statistics easier to interpret, reducing biases associated with incremental risk presentations. PRACTICE IMPLICATIONS: Including graphs in risk communications is essential to support an informed treatment decision-making process.

Authors
Zikmund-Fisher, BJ; Ubel, PA; Smith, DM; Derry, HA; McClure, JB; Stark, A; Pitsch, RK; Fagerlin, A
MLA Citation
Zikmund-Fisher, BJ, Ubel, PA, Smith, DM, Derry, HA, McClure, JB, Stark, A, Pitsch, RK, and Fagerlin, A. "Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs." Patient Educ Couns 73.2 (November 2008): 209-214.
PMID
18602242
Source
pubmed
Published In
Patient Education and Counseling
Volume
73
Issue
2
Publish Date
2008
Start Page
209
End Page
214
DOI
10.1016/j.pec.2008.05.010

Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation.

BACKGROUND & AIMS: Although priority for liver transplantation is determined by the model for end-stage liver disease (MELD) score, the quality of organs used is subject to physician discretion. We aimed to determine whether implementation of MELD affected the quality of organs transplanted, the type of patients who receive the higher-risk organs, and the impact of these changes on their posttransplant survival. METHODS: Data were analyzed from the United Network for Organ Sharing of adults who underwent deceased-donor liver transplantation between January 1, 2007, and August 1, 2007 (n = 47,985). Dependent variables included the donor risk index (a continuous variable that measures the risk of graft failure associated with a particular organ) and patient survival after transplantation. RESULTS: The overall organ quality of transplanted livers has worsened since MELD implementation, with an increase in the donor risk index equivalent to a 4% increased risk of graft failure after adjusting for temporal trends (P < .001). This was accompanied by a shift from using the higher-risk organs in the more urgent patients (in the pre-MELD era) to using the higher-risk organs in the less urgent patients (in the post-MELD era). Posttransplant survival has worsened over time (hazard ratio, 1.017/y; P = .005) among the less urgent patients (MELD scores, <20); mediation analysis suggests this change in survival was caused primarily by changes in organ quality. CONCLUSIONS: As an unintended consequence of the MELD allocation policy, patients that are least in need of a liver transplant now receive the highest-risk organs. This has reduced posttransplant survival in recent years among patients with low MELD scores.

Authors
Volk, ML; Lok, ASF; Pelletier, SJ; Ubel, PA; Hayward, RA
MLA Citation
Volk, ML, Lok, ASF, Pelletier, SJ, Ubel, PA, and Hayward, RA. "Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation." Gastroenterology 135.5 (November 2008): 1568-1574.
PMID
19009713
Source
pubmed
Published In
Gastroenterology
Volume
135
Issue
5
Publish Date
2008
Start Page
1568
End Page
1574

Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation.

BACKGROUND: The utilitarian foundation of decision analysis limits its usefulness for many social policy decisions. In this study, the authors examine a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with acute liver failure (ALF). METHODS: A Markov model was constructed to compare the benefit of transplantation for a patient with ALF versus the harm caused to other patients on the waiting list and to determine the lowest acceptable 5-y posttransplant survival for the ALF patient. The weighting of the ALF patient and other patients was then adjusted using a multiattribute variable incorporating utilitarianism, urgency, and other principles such as fair chances. RESULTS: In the base-case analysis, the strategy of transplanting the ALF patient resulted in a 0.8% increase in the risk of death and a utility loss of 7.8 quality-adjusted days of life for each of the other patients on the waiting list. These harms cumulatively outweighed the benefit of transplantation for an ALF patient having a posttransplant survival of less than 48% at 5 y. However, the threshold for an acceptable posttransplant survival for the ALF patient ranged from 25% to 56% at 5 y, depending on the ethical principles involved. DISCUSSION: The results of the decision analysis vary depending on the ethical perspective. This study demonstrates how competing ethical principles can be numerically incorporated in a decision analysis.

Authors
Volk, ML; Lok, ASF; Ubel, PA; Vijan, S
MLA Citation
Volk, ML, Lok, ASF, Ubel, PA, and Vijan, S. "Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation." Med Decis Making 28.5 (September 2008): 763-772.
PMID
18725405
Source
pubmed
Published In
Medical Decision Making
Volume
28
Issue
5
Publish Date
2008
Start Page
763
End Page
772
DOI
10.1177/0272989X08316999

The accuracy of predicting parity as a prerequisite for cesarean delivery on maternal request.

OBJECTIVE: The National Institutes of Health and American College of Obstetricians and Gynecologists consensus guidelines state that cesarean delivery on maternal request is not recommended for women desiring several children. We sought to estimate the accuracy with which women were able to predict their final parity. METHODS: Women (N=1,719) completed an Internet survey regarding childbearing. Parous women finished with childbearing recalled the maximum number of children they planned to give birth to while pregnant with their first child. This estimate was compared with their final parity. RESULTS: Of the women who completed the survey, 458 women planned a maximum of two or fewer children and had completed childbearing. Correlation between planned maximum number of children and actual parity was poor (r=0.04, 95% confidence interval 0.00-0.13). In fact, 39% (95% confidence interval 34-43%) underestimated their final parity. CONCLUSION: At the time of first pregnancy, many women underestimate their final parity. This raises questions about making an estimate of parity a consideration for offering cesarean delivery on maternal request.

Authors
Keeton, K; Zikmund-Fisher, BJ; Ubel, PA; Fenner, DE; Fagerlin, A
MLA Citation
Keeton, K, Zikmund-Fisher, BJ, Ubel, PA, Fenner, DE, and Fagerlin, A. "The accuracy of predicting parity as a prerequisite for cesarean delivery on maternal request." Obstet Gynecol 112.2 Pt 1 (August 2008): 285-289.
PMID
18669724
Source
pubmed
Published In
Obstetrics & Gynecology (Elsevier)
Volume
112
Issue
2 Pt 1
Publish Date
2008
Start Page
285
End Page
289
DOI
10.1097/AOG.0b013e3181809e4b

Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life.

PURPOSE: Although breast-conserving surgery (BCS) is often assumed to result in minimal deformity, many patients report postoperative breast asymmetry. Understanding the effect of asymmetry on psychosocial functioning is essential for patients to make an informed choice for surgery. PATIENTS AND METHODS: All women who underwent BCS at the University of Michigan Medical Center (Ann Arbor, MI) during a 4-year period were surveyed using a mailed questionnaire (N = 714; response rate = 79.5%). Women were queried regarding five aspects of psychosocial functioning: quality of life (QOL), depression, fear of recurrence, stigmatization, and perceived change in health status. Postoperative breast asymmetry was assessed using items from the Breast Cancer Treatment and Outcomes Survey. Multiple regression was used to examine the relationship between breast asymmetry and each outcome, controlling for age, time from surgery in years, race, education level, disease stage, surgical treatment, and the occurrence of postoperative complications. RESULTS: Women with pronounced breast asymmetry were significantly more likely to feel stigmatized as a result of their breast cancer treatment (odds ratio [OR] = 4.58; 95% CI, 2.77 to 7.55) and less likely to report unchanged or improved health after treatment (OR = 0.43; 95% CI, 0.27 to 0.66). Minimal breast asymmetry was associated with higher QOL scores (86.3 v 82.4, P < .001). Finally, women with pronounced breast asymmetry were more likely to exhibit depressive symptoms (minimal asymmetry, 16.2%; moderate asymmetry, 18.0%; pronounced asymmetry, 33.7%, Wald test = 16.6; P = .002). CONCLUSION: Pronounced breast asymmetry after BCS is significantly correlated with poor psychosocial functioning. Identifying patients at risk for postoperative asymmetry at the time of consultation may allow for improved referral for supportive counseling, prosthetics, and reconstruction.

Authors
Waljee, JF; Hu, ES; Ubel, PA; Smith, DM; Newman, LA; Alderman, AK
MLA Citation
Waljee, JF, Hu, ES, Ubel, PA, Smith, DM, Newman, LA, and Alderman, AK. "Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life." J Clin Oncol 26.20 (July 10, 2008): 3331-3337.
PMID
18612149
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
26
Issue
20
Publish Date
2008
Start Page
3331
End Page
3337
DOI
10.1200/JCO.2007.13.1375

A gift of life: ethical and practical problems with conditional and directed donation.

Authors
Volk, ML; Ubel, PA
MLA Citation
Volk, ML, and Ubel, PA. "A gift of life: ethical and practical problems with conditional and directed donation." Transplantation 85.11 (June 15, 2008): 1542-1544. (Review)
PMID
18551055
Source
pubmed
Published In
Transplantation
Volume
85
Issue
11
Publish Date
2008
Start Page
1542
End Page
1544
DOI
10.1097/TP.0b013e318172da30

Considering adaptation in preference elicitations.

OBJECTIVE: Patients with chronic health conditions usually place higher utility on their condition than the public does. One explanation for this discrepancy is that healthy people focus on the negative aspects of the condition without considering their own ability to emotionally adapt to the condition over time. The aim of this randomized experimental study was to test whether people would give higher utility ratings for chronic health conditions when they were encouraged to consider their own ability to adapt to difficult situations before giving their ratings. MAIN OUTCOME MEASURE: Utility ratings for four chronic health conditions. RESULTS: The authors presented scenarios describing 4 chronic health conditions to 1,117 respondents drawn from a demographically balanced U.S. Internet panel. The adaptation exercise did not influence respondents' valuations. However, utility values increasingly improved with decreasing ratings of how upsetting it would be to live with the condition over time. CONCLUSION: The authors speculate that asking people to think about adaptation changes their evaluations of what it would feel like to live with chronic illness, but doing so does not change how much they are willing to trade off to avoid that chronic illness.

Authors
Damschroder, LJ; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Damschroder, LJ, Zikmund-Fisher, BJ, and Ubel, PA. "Considering adaptation in preference elicitations." Health Psychol 27.3 (May 2008): 394-399.
PMID
18624605
Source
pubmed
Published In
Health Psychology
Volume
27
Issue
3
Publish Date
2008
Start Page
394
End Page
399
DOI
10.1037/0278-6133.27.3.394

Alternate methods of framing information about medication side effects: incremental risk versus total risk of occurrence.

Communications of treatment risk, such as medication package inserts, commonly report total rates of adverse reactions (e.g., 4% get heartburn with placebo, 9% with medication). This approach, however, requires mental arithmetic to distinguish the incremental risk caused by medication (here, 5%) from the total post-treatment risk. In two Internet-administered survey experiments (N = 2,012 and 1,393), we tested whether explicitly reporting the incremental risk and framing it as the "additional risk" of complications influenced people's impressions of adverse event risks. Study 1 compared side-by-side displays of total risks against sequential presentations that highlighted the incremental risk, using both text and graphical formats. Results showed that incremental risk formats significantly lowered participants' worry about complications and reduced biases caused by varying the risk denominator. Study 2 unpacked this factor and showed that its effect on both perceived likelihood and worry derives primarily from the incremental risk framing rather than from sequential presentation. Explicitly reporting incremental risk statistics appears to facilitate recognition of how much risk already exists at baseline. Presenting adverse reaction risks in this manner may improve patient comprehension of the effects of treatment decisions and support effective risk communication.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Roberts, TR; Derry, HA; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, Roberts, TR, Derry, HA, and Ubel, PA. "Alternate methods of framing information about medication side effects: incremental risk versus total risk of occurrence." J Health Commun 13.2 (March 2008): 107-124.
PMID
18300064
Source
pubmed
Published In
Journal of Health Communication
Volume
13
Issue
2
Publish Date
2008
Start Page
107
End Page
124
DOI
10.1080/10810730701854011

Are subjective well-being measures any better than decision utility measures?

There are a number of substantial problems with using decision-based utility measures such as the time trade off and standard gamble to value improvements in health. Dolan (this issue) argues that because of these problems, it would be better to use measures of real experiences (subjective well being). We review evidence that supports criticisms of decision-based utility measures, whether provided by patients or non-patients. But we also review a number of substantial problems with currently used measures of subjective well-being, and point out that there is no definitive evidence that they represent any improvement over decision utility measures. We conclude with a call for expanded research into developing new tools for quantifying health-related quality of life that are more valid, more sensitive to changes in health status, and less biased.

Authors
Smith, DM; Brown, SL; Ubel, PA
MLA Citation
Smith, DM, Brown, SL, and Ubel, PA. "Are subjective well-being measures any better than decision utility measures?." Health Econ Policy Law 3.Pt 1 (January 2008): 85-91. (Review)
PMID
18634635
Source
pubmed
Published In
Health Economics, Policy and Law
Volume
3
Issue
Pt 1
Publish Date
2008
Start Page
85
End Page
91
DOI
10.1017/S1744133107004367

Screening experiments and the use of fractional factorial designs in behavioral intervention research

Health behavior intervention studies have focused primarily on comparing new programs and existing programs via randomized controlled trials. However, numbers of possible components (factors) are increasing dramatically as a result of developments in science and technology (e.g., Web-based surveys). These changes dictate the need for alternative methods that can screen and quickly identify a large set of potentially important treatment components. We have developed and implemented a multiphase experimentation strategy for accomplishing this goal. We describe the screening phase of this strategy and the use of fractional factorial designs (FFDs) in studying several components economically. We then use 2 ongoing behavioral intervention projects to illustrate the usefulness of FFDs. FFDs should be supplemented with follow-up experiments in the refining phase so any critical assumptions about interactions can be verified.

Authors
Nair, V; Strecher, V; Fagerlin, A; Ubel, P; Resnicow, K; Murphy, S; Little, R; Chakraborty, B; Zhang, A
MLA Citation
Nair, V, Strecher, V, Fagerlin, A, Ubel, P, Resnicow, K, Murphy, S, Little, R, Chakraborty, B, and Zhang, A. "Screening experiments and the use of fractional factorial designs in behavioral intervention research." American Journal of Public Health 98.8 (2008): 1354-1359.
PMID
18556602
Source
scival
Published In
American journal of public health
Volume
98
Issue
8
Publish Date
2008
Start Page
1354
End Page
1359
DOI
10.2105/AJPH.2007.127563

Response: The impracticality of overriding family rejection of donation

Authors
Volk, ML; Ubel, PA
MLA Citation
Volk, ML, and Ubel, PA. "Response: The impracticality of overriding family rejection of donation." Transplantation 86.11 (2008): 1631-1632.
Source
scival
Published In
Transplantation
Volume
86
Issue
11
Publish Date
2008
Start Page
1631
End Page
1632
DOI
10.1097/TP.0b013e31818f9d69

Will running the numbers first violate the principles of patient-centered care? [1]

Authors
Vijan, S; Hayward, RA; Ubel, P
MLA Citation
Vijan, S, Hayward, RA, and Ubel, P. "Will running the numbers first violate the principles of patient-centered care? [1]." Annals of Internal Medicine 149.11 (2008): 839--.
PMID
19047038
Source
scival
Published In
Annals of internal medicine
Volume
149
Issue
11
Publish Date
2008
Start Page
839-

The impact of the format of graphical presentation on health-related knowledge and treatment choices

Objective: To evaluate the ability of six graph formats to impart knowledge about treatment risks/benefits to low and high numeracy individuals. Methods: Participants were randomized to receive numerical information about the risks and benefits of a hypothetical medical treatment in one of six graph formats. Each described the benefits of taking one of two drugs, as well as the risks of experiencing side effects. Main outcome variables were verbatim (specific numerical) and gist (general impression) knowledge. Participants were also asked to rate their perceptions of the graphical format and to choose a treatment. Results: 2412 participants completed the survey. Viewing a pictograph was associated with adequate levels of both types of knowledge, especially for lower numeracy individuals. Viewing tables was associated with a higher likelihood of having adequate verbatim knowledge vs. other formats (p < 0.001) but lower likelihood of having adequate gist knowledge (p < 0.05). All formats were positively received, but pictograph was trusted by both high and low numeracy respondents. Verbatim and gist knowledge were significantly (p < 0.01) associated with making a medically superior treatment choice. Conclusion: Pictographs are the best format for communicating probabilistic information to patients in shared decision making environments, particularly among lower numeracy individuals. Practice Implications: Providers can consider using pictographs to communicate risk and benefit information to patients of different numeracy levels.

Authors
Hawley, ST; Zikmund-Fisher, B; Ubel, P; Jancovic, A; Lucas, T; Fagerlin, A
MLA Citation
Hawley, ST, Zikmund-Fisher, B, Ubel, P, Jancovic, A, Lucas, T, and Fagerlin, A. "The impact of the format of graphical presentation on health-related knowledge and treatment choices." Patient Education and Counseling 73.3 (2008): 448-455.
PMID
18755566
Source
scival
Published In
Patient Education and Counseling
Volume
73
Issue
3
Publish Date
2008
Start Page
448
End Page
455
DOI
10.1016/j.pec.2008.07.023

Mispredicting and Misremembering: Patients With Renal Failure Overestimate Improvements in Quality of Life After a Kidney Transplant

Objective: People tend to overestimate the impact that future events will have on their quality of life. In the case of a medical treatment like kidney transplant, this should result in biased predictions-overestimates of how much the transplant will benefit quality of life. The authors surveyed kidney transplant patients, both before and after transplant, to test whether they would overestimate the benefits of a successful transplant for their quality of life. Design: The authors interviewed 307 patients on a waiting list for cadaveric renal or renal-pancreatic transplant, and 195 patients one year after a successful transplant. A sub sample of patients were interviewed both before and after transplant. Main Outcome Measures: The survey included measures of quality of life, both in terms of an overall estimate (0-100), and across sub domains, including health, employment, and travel. Results: Cross-sectional results suggested that overall quality of life improved after transplant, but the predictions of pretransplant patients overestimated the magnitude of the improvement (p < .01). In addition, patients predicted large improvements in specific life domains that did not change. These results were confirmed in longitudinal, prospective analyses. Additional analyses showed that posttransplant patients recalled their pretransplant quality of life to be much lower than what they had reported at the time. Conclusion: Consistent with an impact bias, patients substantially overestimated the benefits of a successful kidney transplant, both in terms of predictions of life after treatment, and in their memories of QOL before the transplant. © 2008 American Psychological Association.

Authors
Smith, D; Loewenstein, G; Jepson, C; Jankovich, A; Feldman, H; Ubel, P
MLA Citation
Smith, D, Loewenstein, G, Jepson, C, Jankovich, A, Feldman, H, and Ubel, P. "Mispredicting and Misremembering: Patients With Renal Failure Overestimate Improvements in Quality of Life After a Kidney Transplant." Health Psychology 27.5 (2008): 653-658.
PMID
18823192
Source
scival
Published In
Health Psychology
Volume
27
Issue
5
Publish Date
2008
Start Page
653
End Page
658
DOI
10.1037/a0012647

Pain and suffering awards: They shouldn't be (just) about pain and suffering

In this paper, we challenge the conventional view that pain-and-suffering awards should be interpreted literally as a compensation for feelings of pain and suffering. People adapt to conditions as serious as paraplegia and blindness, returning rapidly to near-normal levels of happiness, which means that pain-and-suffering awards based literally on pain and suffering would be small. We argue that compensation for these types of conditions should be larger than would be dictated by pain and suffering alone because people legitimately care about more than just the pain and suffering that results from an injury; they also care about a variety of other factors, such as their capabilities to perform various functions, that often do not affect happiness. We propose the outlines of a method for determining noneconomic damages that divides the problem into three judgments, each to be made by the constituency most competent to make it. © 2008 by The University of Chicago. All rights reserved.

Authors
Ubel, PA; Loewenstein, G
MLA Citation
Ubel, PA, and Loewenstein, G. "Pain and suffering awards: They shouldn't be (just) about pain and suffering." Journal of Legal Studies 37.SUPPL. 2 (2008): S195-S216.
Source
scival
Published In
Journal of Legal Studies
Volume
37
Issue
SUPPL. 2
Publish Date
2008
Start Page
S195
End Page
S216
DOI
10.1086/529072

Mispredictions and misrecollections: challenges for subjective outcome measurement.

PURPOSE: To review research from the behavioral sciences that demonstrates how predictions of future events--and memories of past events--are often systematically biased. METHOD: Description of how these biases present challenges for subjective outcome measurement in rehabilitation settings, and for measuring health utility. RESULTS: Two new techniques for outcome measurement that have been specifically designed to resist these biases Ecological Momentary Assessment and the Day Reconstruction Method are successful. CONCLUSION: We propose that these techniques could be adopted for measuring rehabilitation outcomes.

Authors
Smith, DM; Brown, SL; Ubel, PA
MLA Citation
Smith, DM, Brown, SL, and Ubel, PA. "Mispredictions and misrecollections: challenges for subjective outcome measurement." Disabil Rehabil 30.6 (2008): 418-424.
PMID
17943514
Source
pubmed
Published In
Disability & Rehabilitation (Informa)
Volume
30
Issue
6
Publish Date
2008
Start Page
418
End Page
424
DOI
10.1080/09638280701625237

"If I'm better than average, then I'm ok?": Comparative information influences beliefs about risk and benefits.

OBJECTIVE: To test whether providing comparative risk information changes risk perceptions. METHODS: Two hundred and forty-nine female visitors to a hospital cafeteria were randomized to one of two conditions which differed in whether their hypothetical breast cancer risks was lower or higher than the average women's. Participants read a scenario describing a breast cancer prevention pill and indicated their: (1) likelihood of taking the pill and (2) perception of whether the pill provides breast cancer risk reduction. RESULTS: Women told that their hypothetical risk of breast cancer was above average were more likely to endorse taking the pill (2.79 vs. 2.23, F=4.95, p=0.002) and more likely to believe that the pill provided a significant risk reduction in breast cancer (3.15 vs. 2.73, F=4.32, p=0.005), even though the risks were equivalent. CONCLUSIONS: Providing people with comparative risk information changes their risk perceptions. People who have above average risk may feel compelled to take a treatment because they are at above average risk and therefore may not thoroughly consider the trade-offs in the risks and benefits of treatment. PRACTICE IMPLICATIONS: Physicians and decision aid developers must reconsider the practice of communicating "average risk" information to patients.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, and Ubel, PA. ""If I'm better than average, then I'm ok?": Comparative information influences beliefs about risk and benefits." Patient Educ Couns 69.1-3 (December 2007): 140-144.
PMID
17942271
Source
pubmed
Published In
Patient Education and Counseling
Volume
69
Issue
1-3
Publish Date
2007
Start Page
140
End Page
144
DOI
10.1016/j.pec.2007.08.008

Does labeling prenatal screening test results as negative or positive affect a woman's responses?

OBJECTIVE: We tested whether adding interpretive labels (eg, "negative test") to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis. STUDY DESIGN: Women (N = 1688) completed a hypothetical pregnancy scenario on the Internet. We randomly assigned participants into 2 groups: high risk of fetal chromosomal problems (12.5/1000) or low risk (2/1000). After prenatal screening, estimated risk was identical (5/1000) for all participants, but results were provided either alone or with interpretive labels. RESULTS: When receiving test results without labels, all participants react similarly. With labels, the participants who received "positive" or "abnormal" results reported a higher perceived risk (P < .001), greater worry (P < .001), and greater interest in amniocentesis (57% vs 37%; P < .001) than did the participants who received "negative" or "normal" results. CONCLUSION: Interpretive labels for test results can induce larger changes to a woman's risk perception and behavioral intention than can numeric results alone, which create decision momentum. This finding has broad clinical implications for patient-provider communication.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Keeton, K; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, Keeton, K, and Ubel, PA. "Does labeling prenatal screening test results as negative or positive affect a woman's responses?." Am J Obstet Gynecol 197.5 (November 2007): 528.e1-528.e6.
PMID
17880902
Source
pubmed
Published In
American Journal of Obstetrics & Gynecology
Volume
197
Issue
5
Publish Date
2007
Start Page
528.e1
End Page
528.e6
DOI
10.1016/j.ajog.2007.03.076

Provider experience and attitudes toward family presence during resuscitation procedures.

Authors
Engel, KG; Barnosky, AR; Berry-Bovia, M; Desmond, JS; Ubel, PA
MLA Citation
Engel, KG, Barnosky, AR, Berry-Bovia, M, Desmond, JS, and Ubel, PA. "Provider experience and attitudes toward family presence during resuscitation procedures." J Palliat Med 10.5 (October 2007): 1007-1009. (Letter)
PMID
17985951
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
10
Issue
5
Publish Date
2007
Start Page
1007
End Page
1009
DOI
10.1089/jpm.2007.0096

Harnessing the power of default options to improve health care.

Authors
Halpern, SD; Ubel, PA; Asch, DA
MLA Citation
Halpern, SD, Ubel, PA, and Asch, DA. "Harnessing the power of default options to improve health care." N Engl J Med 357.13 (September 27, 2007): 1340-1344.
PMID
17898105
Source
pubmed
Published In
The New England journal of medicine
Volume
357
Issue
13
Publish Date
2007
Start Page
1340
End Page
1344
DOI
10.1056/NEJMsb071595

Confessions of a bedside rationer: commentary on Hurst and Danis.

Samia Hurst and Marion Danis provide a thoughtful framework for how to judge the morality of bedside rationing decisions. In this commentary, I applaud Hurst and Danis for advancing the level of debate about bedside rationing. But when I attempt to apply the framework to my own clinical practice, I conclude that the framework comes up short.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Confessions of a bedside rationer: commentary on Hurst and Danis." Kennedy Inst Ethics J 17.3 (September 2007): 267-269.
PMID
18210984
Source
pubmed
Published In
Kennedy Institute of Ethics Journal
Volume
17
Issue
3
Publish Date
2007
Start Page
267
End Page
269

Validation of the Subjective Numeracy Scale: effects of low numeracy on comprehension of risk communications and utility elicitations.

BACKGROUND: In a companion article, the authors describe the Subjective Numeracy Scale (SNS), a self-assessment of numerical aptitude and preferences for numbers that correlates strongly with objective numeracy. OBJECTIVE: The objective of this article is to validate the Subjective Numeracy Scale using measures of subjects' capacity to recall and comprehend complex risk statistics and to complete utility elicitations. RESEARCH DESIGN: The study is composed of 3 general public surveys: 2 administered via the Web and 1 by paper and pencil. Subjects. Studies 1 and 3 surveyed 862 and 1234 people, respectively, recruited via a nationwide commercial Internet survey panel. Study 2 involved 245 people who completed paper-and-pencil surveys in a Veterans Administration hospital. MEASURES: The authors tested whether one's score on the SNS predicted the likelihood of correct recall and interpretation of risk information (studies 1 and 2A) or the likelihood of effectively completing a time tradeoff or person-tradeoff utility elicitation (studies 2B and 3). In Studies 1 and 2, the authors also tested whether an objective test of quantitative ability would predict performance. RESULTS: In all studies, survey participants with higher SNS scores performed significantly better than other respondents. The predictive ability of the SNS approached that observed for objective numeracy. CONCLUSIONS: The SNS effectively predicts both risk comprehension and completion of utility elicitations without requiring survey participants to complete time-consuming and stress-inducing mathematics tests. The authors encourage the use of the SNS in a variety of health services research contexts.

Authors
Zikmund-Fisher, BJ; Smith, DM; Ubel, PA; Fagerlin, A
MLA Citation
Zikmund-Fisher, BJ, Smith, DM, Ubel, PA, and Fagerlin, A. "Validation of the Subjective Numeracy Scale: effects of low numeracy on comprehension of risk communications and utility elicitations." Med Decis Making 27.5 (September 2007): 663-671.
PMID
17652180
Source
pubmed
Published In
Medical Decision Making
Volume
27
Issue
5
Publish Date
2007
Start Page
663
End Page
671
DOI
10.1177/0272989X07303824

Measuring numeracy without a math test: development of the Subjective Numeracy Scale.

BACKGROUND: Basic numeracy skills are necessary before patients can understand the risks of medical treatments. Previous research has used objective measures, similar to mathematics tests, to evaluate numeracy. OBJECTIVES: To design a subjective measure (i.e., self-assessment) of quantitative ability that distinguishes low- and high-numerate individuals yet is less aversive, quicker to administer, and more usable for telephone and Internet surveys than existing numeracy measures. RESEARCH DESIGN: Paper-and-pencil questionnaires. SUBJECTS: The general public (N = 703) surveyed at 2 hospitals. MEASURES: Forty-nine subjective numeracy questions were compared to measures of objective numeracy. RESULTS: An 8-item measure, the Subjective Numeracy Scale (SNS), was developed through several rounds of testing. Four items measure people's beliefs about their skill in performing various mathematical operations, and 4 measure people's preferences regarding the presentation of numerical information. The SNS was significantly correlated with Lipkus and others' objective numeracy scale (correlations: 0.63-0.68) yet was completed in less time (24 s/item v. 31 s/item, P < 0.05) and was perceived as less stressful (1.62 v. 2.69, P < 0.01) and less frustrating (1.92 v. 2.88, P < 0.01). Fifty percent of participants who completed the SNS volunteered to participate in another study, whereas only 8% of those who completed the Lipkus and others scale similarly volunteered (odds ratio = 11.00, 95% confidence interval = 2.14-56.65). CONCLUSIONS: The SNS correlates well with mathematical test measures of objective numeracy but can be administered in less time and with less burden. In addition, it is much more likely to leave participants willing to participate in additional research and shows much lower rates of missing or incomplete data.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Ubel, PA; Jankovic, A; Derry, HA; Smith, DM
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, Ubel, PA, Jankovic, A, Derry, HA, and Smith, DM. "Measuring numeracy without a math test: development of the Subjective Numeracy Scale." Med Decis Making 27.5 (September 2007): 672-680.
PMID
17641137
Source
pubmed
Published In
Medical Decision Making
Volume
27
Issue
5
Publish Date
2007
Start Page
672
End Page
680
DOI
10.1177/0272989X07304449

Rethinking the objectives of decision aids: a call for conceptual clarity.

Health decision aids are a potentially valuable adjunct to patient-physician communication and decision making. Although the overarching goal of decision aids--to help patients make informed, preference-sensitive choices--is widely accepted, experts do not agree on the means to achieve this end. In this article, the authors critically examine the theoretical basis and appropriateness of 2 widely accepted criteria used to evaluate decision aids: values clarification and reduction of decisional conflict. First, they argue that although clarifying values is central to decision making under uncertainty, it is not clear that decision aids--as they have been conceived and operationalized so far--can and should be used to achieve this goal. The pursuit of clarifying values, particularly values clarification exercises, raises a number of ethical, methodological, and conceptual issues, and the authors suggest research questions that should be addressed before values clarification is routinely endorsed. Second, the authors argue that the goal of reducing decisional conflict is conceptually untenable and propose that it be eliminated as an objective of decision aids.

Authors
Nelson, WL; Han, PKJ; Fagerlin, A; Stefanek, M; Ubel, PA
MLA Citation
Nelson, WL, Han, PKJ, Fagerlin, A, Stefanek, M, and Ubel, PA. "Rethinking the objectives of decision aids: a call for conceptual clarity." Med Decis Making 27.5 (September 2007): 609-618.
PMID
17873251
Source
pubmed
Published In
Medical Decision Making
Volume
27
Issue
5
Publish Date
2007
Start Page
609
End Page
618
DOI
10.1177/0272989X07306780

Making numbers matter: present and future research in risk communication.

OBJECTIVE: To summarize existing research on individual numeracy and methods for presenting risk information to patients. METHODS: We selectively retrieved articles from MEDLINE and the Social Sciences Citation Index. RESULTS: Many Americans have low numeracy skills, a deficit that impedes effective health care. Approaches to risk communication vary in current practice, but how risks are presented can significantly affect both patients' risk perceptions and their knowledge. CONCLUSIONS: Adhering to some basic principles for presenting risk information to patients can improve understanding. However, different risk-communication methods may be needed for individuals with high versus low levels of numeracy.

Authors
Fagerlin, A; Ubel, PA; Smith, DM; Zikmund-Fisher, BJ
MLA Citation
Fagerlin, A, Ubel, PA, Smith, DM, and Zikmund-Fisher, BJ. "Making numbers matter: present and future research in risk communication." Am J Health Behav 31 Suppl 1 (September 2007): S47-S56.
PMID
17931136
Source
pubmed
Published In
American Journal of Health Behavior
Volume
31 Suppl 1
Publish Date
2007
Start Page
S47
End Page
S56
DOI
10.5555/ajhb.2007.31.supp.S47

Sensitivity to disgust, stigma, and adjustment to life with a colostomy.

We examined whether trait disgust sensitivity predicts well-being in colostomy patients, and whether disgust predicts stigmatizing attitudes about colostomy in non-patients. 195 patients with a colostomy returned a mailed survey including measures of disgust sensitivity, life satisfaction, mood, and feelings of being stigmatized. We also conducted an internet-survey of a non-patient sample (n = 523). In the patient sample, we observed negative correlations between a bowel-specific measure of disgust sensitivity and life satisfaction (r = -.34, p<.01), and colostomy adjustment ( r = -.42, p<.01), and a positive correlation with feeling stigmatized because of the colostomy (r = .54, p<.01). Correlations between a general trait disgust measure and these outcomes were more modest. A structural equation model indicated that colostomy patients who had high disgust sensitivity felt more stigmatized, and this was in turn strongly related to lower life satisfaction. Concordantly, in the non-patient sample we observed that disgust sensitivity was a significant, positive predictor of wanting less contact with colostomy patients (r = .22, p < .01).

Authors
Smith, DM; Loewenstein, G; Rozin, P; Sherriff, RL; Ubel, PA
MLA Citation
Smith, DM, Loewenstein, G, Rozin, P, Sherriff, RL, and Ubel, PA. "Sensitivity to disgust, stigma, and adjustment to life with a colostomy." J Res Pers 41.4 (August 2007): 787-803.
PMID
17940585
Source
pubmed
Published In
Journal of Research in Personality
Volume
41
Issue
4
Publish Date
2007
Start Page
787
End Page
803
DOI
10.1016/j.jrp.2006.09.006

The ethics of swimming pools.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The ethics of swimming pools." Hastings Cent Rep 37.4 (July 2007): 51-55.
PMID
17844924
Source
pubmed
Published In
The Hastings Center report
Volume
37
Issue
4
Publish Date
2007
Start Page
51
End Page
55

Why people refuse to make tradeoffs in person tradeoff elicitations: a matter of perspective?

OBJECTIVE: Person tradeoff (PTO) elicitations assess people's values for health states by asking them to compare the value of treatment programs. For example, people might be asked how many patients need to be cured of health condition X to equal the benefit of curing 100 people of condition Y. However, when faced with PTO elicitations, people frequently refuse to make quantifiable tradeoffs, exhibiting 2 kinds of refusals: 1) They say that 2 treatment programs have equal value, that curing 100 of X is just as good as curing 100 of Y, even if X is a less serious condition than Y, or 2) they say that the 2 programs are incomparable, that millions of people need to be cured of X to be as good as curing 100 of Y. The authors explore whether people would be more willing to make tradeoffs if the focus was changed from trading off groups of patients to choosing the best decision or evaluating treatment benefits. DESIGN: . Two randomized trials used diverse samples (N=2400) via the Internet to test for the effect of perspective on refusal rates. The authors predicted that perspectives that removed people from decision-making roles would increase their willingness make tradeoffs. RESULTS: Contrary to expectations, refusal rates increased when people were removed from decision-making roles. In fact, the more pressure put on people to make a decision, the less likely they were to refuse to make tradeoffs. CONCLUSION: To reduce PTO refusals, it is best to adopt a decision-maker perspective.

Authors
Damschroder, LJ; Roberts, TR; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Damschroder, LJ, Roberts, TR, Zikmund-Fisher, BJ, and Ubel, PA. "Why people refuse to make tradeoffs in person tradeoff elicitations: a matter of perspective?." Med Decis Making 27.3 (May 2007): 266-280.
PMID
17545497
Source
pubmed
Published In
Medical Decision Making
Volume
27
Issue
3
Publish Date
2007
Start Page
266
End Page
280
DOI
10.1177/0272989X07300601

Mortality versus survival graphs: improving temporal consistency in perceptions of treatment effectiveness.

OBJECTIVE: Previous research has demonstrated that people perceive treatments as less effective when survival graphs show fewer years of data versus more data. We tested whether using mortality graphs would reduce this temporal inconsistency bias. METHODS: A demographically diverse sample of 1461 Internet users read about a hypothetical disease and then were randomized to view either survival or mortality graphs that showed either 5 years of data or 15 years of treatment outcomes data. Participants identified the most effective treatment, provided ratings comparing the effectiveness of two treatments, and answered comprehension questions. RESULTS: Treatment effectiveness ratings varied significantly between respondents seeing the 5 year and 15 year survival graphs even though the relative risk reduction was the same in both cases. This variation was significantly reduced in the mortality graph conditions. Responses on comprehension measures were mixed: viewers of mortality graphs were less able to identify which treatment was more effective but better able to correctly report individual data points. CONCLUSIONS: Perceptions of treatment effectiveness appear more temporally consistent with mortality graphs than with survival graphs. PRACTICE IMPLICATIONS: All line-based risk graphics (whether framed in survival or mortality terms) should highlight duration information to facilitate improved comprehension of treatment effectiveness.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. "Mortality versus survival graphs: improving temporal consistency in perceptions of treatment effectiveness." Patient Educ Couns 66.1 (April 2007): 100-107.
PMID
17137743
Source
pubmed
Published In
Patient Education and Counseling
Volume
66
Issue
1
Publish Date
2007
Start Page
100
End Page
107
DOI
10.1016/j.pec.2006.10.013

An Alternative Approach for Eliciting Willingness-to-Pay: A Randomized Internet Trial

Authors
Ubel, PA; Damschroder, LJ; Riis, J; Smith, DM
MLA Citation
Ubel, PA, Damschroder, LJ, Riis, J, and Smith, DM. "An Alternative Approach for Eliciting Willingness-to-Pay: A Randomized Internet Trial." Judgment and decision making 2.2 (2007): 96-106.
Source
manual
Published In
Judgment and decision making
Volume
2
Issue
2
Publish Date
2007
Start Page
96
End Page
106

Assessing the economic challenges posed by orphan drugs: A response to McCabe et al. [2]

Authors
Drummond, MF; Wilson, DA; Kanavos, P; Ubel, PA; Rovira, J
MLA Citation
Drummond, MF, Wilson, DA, Kanavos, P, Ubel, PA, and Rovira, J. "Assessing the economic challenges posed by orphan drugs: A response to McCabe et al. [2]." International Journal of Technology Assessment in Health Care 23.3 (2007): 401-404.
Source
scival
Published In
International Journal of Technology Assessment in Health Care
Volume
23
Issue
3
Publish Date
2007
Start Page
401
End Page
404
DOI
10.1017/S0266462307071024

Assessing the economic challenges posed by orphan drugs

Historically, patients with rare diseases have been underserved by commercial drug development. In several jurisdictions, specific legislation has been enacted to encourage the development of drugs for rare diseases (orphan drugs), which would otherwise not be commercially viable. However, because of the small market, these drugs are often very expensive. Under the standard methods of health technology assessment (HTA) incorporating economic evaluation, orphan drugs do not usually prove to be cost-effective and this, coupled with their high cost, means that funding and patient access may be limited. However, these restrictions may not be in line with societal preferences. Therefore, this study discusses whether the standard methods of HTA are adequate for assisting decisions on patient access to and funding of orphan drugs and outlines a research agenda to help understand the societal value of orphan drugs and issues surrounding their development, funding, and use. Copyright © 2007 Cambridge University Press.

Authors
Drummond, MF; Wilson, DA; Kanavos, P; Ubel, P; Rovira, J
MLA Citation
Drummond, MF, Wilson, DA, Kanavos, P, Ubel, P, and Rovira, J. "Assessing the economic challenges posed by orphan drugs." International Journal of Technology Assessment in Health Care 23.1 (2007): 36-42.
PMID
17234015
Source
scival
Published In
International Journal of Technology Assessment in Health Care
Volume
23
Issue
1
Publish Date
2007
Start Page
36
End Page
42
DOI
10.1017/S0266462307051550

Patient decision making

A 73-year-old man requests a prostate-specific antigen (PSA) test from his primary care physician, but the physician does not believe the test is in the patient's best interest. A woman with metastatic colon cancer has continued to progress on standard therapy. She asks her oncologist whether she should enter a Phase I trial or, instead, enter a hospice program. A woman with a strong family history of breast cancer, and a BRCA-1 mutation, asks her genetic counselor to explain the pros and cons of a prophylactic mastectomy. A 55-year-old man with myelodysplasia comes to a cancer referral center to see whether they think a bone marrow transplant is feasible in someone his age. © 2006 Springer Science+Business Media, Inc.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Patient decision making." (December 1, 2006): 177-183. (Chapter)
Source
scopus
Publish Date
2006
Start Page
177
End Page
183
DOI
10.1007/0-387-31056-8_13

Who decides? Living donor liver transplantation for advanced hepatocellular carcinoma.

Few effective treatment options are available for patients with advanced hepatocellular carcinoma (HCC). Some transplant centers have begun offering living donor liver transplantation (LDLT) for selected patients whose HCC exceeds Milan criteria by a small margin. However, this remains a controversial subject. In this article, we weigh the arguments for and against LDLT for advanced HCC. Because donor autonomy forms the crux of this dilemma, the real question becomes: to whom does the decision belong, the individual donors or the medical community? We argue that donor autonomy should not be paramount in settings where the recipient benefit is uncertain.

Authors
Volk, ML; Marrero, JA; Lok, AS; Ubel, PA
MLA Citation
Volk, ML, Marrero, JA, Lok, AS, and Ubel, PA. "Who decides? Living donor liver transplantation for advanced hepatocellular carcinoma." Transplantation 82.9 (November 15, 2006): 1136-1139. (Review)
PMID
17102762
Source
pubmed
Published In
Transplantation
Volume
82
Issue
9
Publish Date
2006
Start Page
1136
End Page
1139
DOI
10.1097/01.tp.0000245670.75583.3d

Tough questions, even harder answers.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Tough questions, even harder answers." J Gen Intern Med 21.11 (November 2006): 1209-1210.
PMID
17026736
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
21
Issue
11
Publish Date
2006
Start Page
1209
End Page
1210
DOI
10.1111/j.1525-1497.2006.00617.x

Misremembering colostomies? Former patients give lower utility ratings than do current patients.

Community members often evaluate health conditions more negatively than do the patients who have them. The authors investigated whether experience with a health condition reduces this discrepancy by surveying colostomy patients by mail (n = 195), some of whom (n = 100) had their colostomies reversed and normal bowel function restored. The authors also surveyed a community sample recruited via the Internet (n = 567). They then compared all 3 groups' utility value for life with a colostomy by using the time trade-off utility measure and by examining ratings of current quality of life. Despite having direct experience with the health condition, former colostomy patients provided much lower utility valuations than did current patients. In fact, their valuations were similar to those given by a community sample. Rather than accurately remembering their actual experiences with colostomies, the former patients may have applied a theory of how colostomies had influenced their lives; this is consistent with other research on theory driven recall bias.

Authors
Smith, DM; Sherriff, RL; Damschroder, L; Loewenstein, G; Ubel, PA
MLA Citation
Smith, DM, Sherriff, RL, Damschroder, L, Loewenstein, G, and Ubel, PA. "Misremembering colostomies? Former patients give lower utility ratings than do current patients." Health Psychol 25.6 (November 2006): 688-695.
PMID
17100497
Source
pubmed
Published In
Health Psychology
Volume
25
Issue
6
Publish Date
2006
Start Page
688
End Page
695
DOI
10.1037/0278-6133.25.6.688

A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.

BACKGROUND: 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], Ps<.001; chemotherapy: 68% & 68% vs 60%, Ps<.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, Ps<.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.

Authors
Zikmund-Fisher, BJ; Sarr, B; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Sarr, B, Fagerlin, A, and Ubel, PA. "A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions." J Gen Intern Med 21.6 (June 2006): 618-622.
PMID
16808746
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
21
Issue
6
Publish Date
2006
Start Page
618
End Page
622
DOI
10.1111/j.1525-1497.2006.00410.x

Are Medical Treatments for Individuals and Groups Like Single-Play and Multiple-Play Gambles?

Authors
Ubel, PA; DeKay, ML; Hershey, JC; Spranca, MD; Asch, DA
MLA Citation
Ubel, PA, DeKay, ML, Hershey, JC, Spranca, MD, and Asch, DA. "Are Medical Treatments for Individuals and Groups Like Single-Play and Multiple-Play Gambles?." Judgment and decision making 1.2 (2006): 134-145.
Source
manual
Published In
Judgment and decision making
Volume
1
Issue
2
Publish Date
2006
Start Page
134
End Page
145

Can Avoidance of Complications Lead to Biased Healthcare Decisions?

Authors
Ubel, PA; Amsterlaw, J; Zikmund-Fisher, BJ; Fagerlin, A
MLA Citation
Ubel, PA, Amsterlaw, J, Zikmund-Fisher, BJ, and Fagerlin, A. "Can Avoidance of Complications Lead to Biased Healthcare Decisions?." Judgment and decision making 1.1 (2006): 64-75.
Source
manual
Published In
Judgment and decision making
Volume
1
Issue
1
Publish Date
2006
Start Page
64
End Page
75

It Must be Awful for Them: Healthy People Overlook Disease Variability in Quality of Life Judgments

Authors
Ubel, PA; Lacey, HP; Fagerlin, A; Loewenstein, G; Smith, D; Riis, J
MLA Citation
Ubel, PA, Lacey, HP, Fagerlin, A, Loewenstein, G, Smith, D, and Riis, J. "It Must be Awful for Them: Healthy People Overlook Disease Variability in Quality of Life Judgments." Judgment and decision making 1.2 (2006): 146-152.
Source
manual
Published In
Judgment and decision making
Volume
1
Issue
2
Publish Date
2006
Start Page
146
End Page
152

Hope I die before I get old: Mispredicting happiness across the adult lifespan

The tendency to overestimate the influence of circumstances on well-being has been demonstrated for a range of life events, but the perceived impact of aging on well-being has been largely overlooked. People seem to dread growing old, despite evidence that well-being improves with age. We compared the self-reported happiness of younger adults (mean age = 31) and older adults (mean age = 68) with their estimates of happiness at different ages. Self-reports confirmed increasing happiness with age, yet both younger and older participants believed that happiness declines. Both groups estimated declining happiness for the average person, but only older adults estimated this decline for themselves. © Springer 2006.

Authors
Lacey, HP; Smith, DM; Ubel, PA
MLA Citation
Lacey, HP, Smith, DM, and Ubel, PA. "Hope I die before I get old: Mispredicting happiness across the adult lifespan." Journal of Happiness Studies 7.2 (2006): 167-182.
Source
scival
Published In
Journal of Happiness Studies
Volume
7
Issue
2
Publish Date
2006
Start Page
167
End Page
182
DOI
10.1007/s10902-005-2748-7

Why are you calling me? How study introductions change response patterns

Purpose: Research on survey methodology has demonstrated that seemingly innocuous aspects of a survey's design, such as the order of questions, can produce biased results. The current investigation extends this work by testing whether standard survey introductions alter the observed associations between variables. Methods: In two experimental studies, we invited Parkinson's disease (PD) patients to participate in a telephone survey of (a) Parkinson's patients, conducted by a regional medical center, or (b) the general population, conducted by a regional university. The survey in Study 1 (n = 156) first assessed life-satisfaction, and subsequently health satisfaction. In Study 2 (n = 99), we reversed the order of the two questions, asking the health questions first. Results: When the introduction focused on Parkinson's disease, we observed an increased correlation between life-satisfaction and a later question about health satisfaction (r = 0.34 vs. 0.63 after general population versus Parkinson's introduction, respectively; Study 1). In Study 2, asking the health questions first resulted in high correlations regardless of the introduction; in addition, judgments of life-satisfaction were lower after the Parkinson's-focused introduction. Conclusions: When participants were informed prior to the survey that its purpose was to examine well-being in PD, health satisfaction was a much more important component of life-satisfaction, accounting for three times as much variation. We hypothesize that the survey introduction primed participants' health status, resulting in an artificially large correlation with life-satisfaction. © Springer 2006.

Authors
Smith, DM; Schwarz, N; Roberts, TR; Ubel, PA
MLA Citation
Smith, DM, Schwarz, N, Roberts, TR, and Ubel, PA. "Why are you calling me? How study introductions change response patterns." Quality of Life Research 15.4 (2006): 621-630.
PMID
16688495
Source
scival
Published In
Quality of Life Research
Volume
15
Issue
4
Publish Date
2006
Start Page
621
End Page
630
DOI
10.1086/504164

Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations.

PURPOSE: Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. PATIENTS AND METHODS: This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. RESULTS: Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. CONCLUSION: The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline.

Authors
Armstrong, K; Weber, B; Ubel, PA; Peters, N; Holmes, J; Schwartz, JS
MLA Citation
Armstrong, K, Weber, B, Ubel, PA, Peters, N, Holmes, J, and Schwartz, JS. "Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations." J Clin Oncol 23.36 (December 20, 2005): 9319-9328.
PMID
16361631
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
36
Publish Date
2005
Start Page
9319
End Page
9328
DOI
10.1200/JCO.2005.06.119

Do incentives matter? Providing benefits to families of organ donors.

Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p < 0.001) and medical expenses (92% vs. 84%; p = 0.013). Among those not registered as donors, more nonwhites supported direct payment (64% vs. 46%; p = 0.001). Most respondents believed that benefits would not influence their own behavior concerning donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.

Authors
Bryce, CL; Siminoff, LA; Ubel, PA; Nathan, H; Caplan, A; Arnold, RM
MLA Citation
Bryce, CL, Siminoff, LA, Ubel, PA, Nathan, H, Caplan, A, and Arnold, RM. "Do incentives matter? Providing benefits to families of organ donors." Am J Transplant 5.12 (December 2005): 2999-3008.
PMID
16303016
Source
pubmed
Published In
American Journal of Transplantation
Volume
5
Issue
12
Publish Date
2005
Start Page
2999
End Page
3008
DOI
10.1111/j.1600-6143.2005.01106.x

Trading people versus trading time: what is the difference?

BACKGROUND: Person trade-off (PTO) elicitations yield different values than standard utility measures, such as time trade-off (TTO) elicitations. Some people believe this difference arises because the PTO captures the importance of distributive principles other than maximizing treatment benefits. We conducted a qualitative study to determine whether people mention considerations related to distributive principles other than QALY-maximization more often in PTO elicitations than in TTO elicitations and whether this could account for the empirical differences. METHODS: 64 members of the general public were randomized to one of three different face-to-face interviews, thinking aloud as they responded to TTO and PTO elicitations. Participants responded to a TTO followed by a PTO elicitation within contexts that compared either: 1) two life-saving treatments; 2) two cure treatments; or 3) a life-saving treatment versus a cure treatment. RESULTS: When people were asked to choose between life-saving treatments, non-maximizing principles were more common with the PTO than the TTO task. Only 5% of participants considered non-maximizing principles as they responded to the TTO elicitation compared to 68% of participants who did so when responding to the PTO elicitation. Non-maximizing principles that emerged included importance of equality of life and a desire to avoid discrimination. However, these principles were less common in the other two contexts. Regardless of context, though, participants were significantly more likely to respond from a societal perspective with the PTO compared to the TTO elicitation. CONCLUSION: When lives are at stake, within the context of a PTO elicitation, people are more likely to consider non-maximizing principles, including the importance of equal access to a life-saving treatment, avoiding prejudice or discrimination, and in rare cases giving treatment priority based purely on the position of being worse-off.

Authors
Damschroder, LJ; Roberts, TR; Goldstein, CC; Miklosovic, ME; Ubel, PA
MLA Citation
Damschroder, LJ, Roberts, TR, Goldstein, CC, Miklosovic, ME, and Ubel, PA. "Trading people versus trading time: what is the difference? (Published online)." Popul Health Metr 3 (November 10, 2005): 10-.
PMID
16281982
Source
pubmed
Published In
Population Health Metrics
Volume
3
Publish Date
2005
Start Page
10
DOI
10.1186/1478-7954-3-10

Cure me even if it kills me: preferences for invasive cancer treatment.

PURPOSE: When making medical decisions, people often care not only about what happens but also about whether the outcome was a result of actions voluntarily taken or a result of inaction. This study assessed the proportion of people choosing nonoptimal treatments (treatments which reduced survival chances) when presented with hypothetical cancer scenarios which varied by outcome cause. METHODS: A randomized survey experiment tested preferences for curing an existent cancer with 2 possible treatments (medication or surgery) and 2 effects of treatment (beneficial or harmful). Participants were 112 prospective jurors in the Philadelphia County Courthouse and 218 visitors to the Detroit-Wayne County Metropolitan Airport. RESULTS: When treatment was beneficial, 27% of participants rejected medication, whereas only 10% rejected surgery with identical outcomes ( 2 = 5.87, P < 0.02). When treatment was harmful, participants offered surgery were significantly more inclined to take action (65% v. 38%, chi(2) = 11.40, P = 0.001), even though doing so reduced overall survival chances. CONCLUSIONS: Faced with hypothetical cancer diagnoses, many people say they would pursue treatment even if doing so would increase their chance of death. This tendency toward active treatment is notably stronger when the treatment offered is surgery instead of medication. Our study suggests that few people can imagine standing by and doing nothing after being diagnosed with cancer, and it should serve to remind clinicians that, for many patients, the best treatment alternative may not only depend on the medical outcomes they can expect to experience but also on whether those outcomes are achieved actively or passively.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, and Ubel, PA. "Cure me even if it kills me: preferences for invasive cancer treatment." Med Decis Making 25.6 (November 2005): 614-619.
PMID
16282212
Source
pubmed
Published In
Medical Decision Making
Volume
25
Issue
6
Publish Date
2005
Start Page
614
End Page
619
DOI
10.1177/0272989X05282639

What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings.

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age. METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration. RESULTS: A total of 1015 subjects responded to the rating task (98% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P's<0.075), whereas responses to the your-age scale did not (P=0.8). CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

Authors
Ubel, PA; Jankovic, A; Smith, D; Langa, KM; Fagerlin, A
MLA Citation
Ubel, PA, Jankovic, A, Smith, D, Langa, KM, and Fagerlin, A. "What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings." Med Care 43.10 (October 2005): 1054-1057.
PMID
16166876
Source
pubmed
Published In
Medical Care
Volume
43
Issue
10
Publish Date
2005
Start Page
1054
End Page
1057

Changing times, changing opinions: history informing the family presence debate.

Authors
Kopelman, MB; Ubel, PA; Engel, KG
MLA Citation
Kopelman, MB, Ubel, PA, and Engel, KG. "Changing times, changing opinions: history informing the family presence debate." Acad Emerg Med 12.10 (October 2005): 999-1002.
PMID
16204145
Source
pubmed
Published In
Academic Emergency Medicine
Volume
12
Issue
10
Publish Date
2005
Start Page
999
End Page
1002
DOI
10.1197/j.aem.2005.05.027

Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability.

We examined the hypothesis that the relationship between financial status and subjective well-being, typically found to be very small in cross-sectional studies, is moderated by health status. Specifically, we predicted that wealth would buffer well-being after the onset of a disability. Using data from the Health and Retirement Study, a longitudinal study of people at and approaching retirement age, we employed within-subjects analyses to test whether wealth measured prior to the onset of a disability protected participants' well-being from some of the negative effects of a new disability. We found support for this hypothesis: Participants who were above the median in total net worth reported a much smaller decline in well-being after a new disability than did participants who were below the median. We also found some evidence that the buffering effect of wealth faded with time, as below-median participants recovered some of their well-being.

Authors
Smith, DM; Langa, KM; Kabeto, MU; Ubel, PA
MLA Citation
Smith, DM, Langa, KM, Kabeto, MU, and Ubel, PA. "Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability." Psychol Sci 16.9 (September 2005): 663-666.
PMID
16137249
Source
pubmed
Published In
Psychological Science
Volume
16
Issue
9
Publish Date
2005
Start Page
663
End Page
666
DOI
10.1111/j.1467-9280.2005.01592.x

Reducing the influence of anecdotal reasoning on people's health care decisions: is a picture worth a thousand statistics?

BACKGROUND: People's treatment decisions are often influenced by anecdotal rather than statistical information. This can lead to patients making decisions based on others' experiences rather than on evidence-based medicine. OBJECTIVE: . To test whether the use of a quiz or pictograph decreases people's reliance on anecdotal information. DESIGN: . Two cross-sectional survey studies using hypothetical scenarios. Participants read a scenario describing angina and indicated a preference for either bypass surgery or balloon angioplasty. The cure rate of both treatments was presented using prose, a pictograph, a quiz, or a pictograph and quiz combination. Participants read anecdotes from hypothetical patients who described the outcome of their treatment; the number of successful anecdotes was either representative or unrepresentative of the cure rates. Setting and Participants. Prospective jurors at the Philadelphia County Courthouse and travelers at the Detroit-Wayne County Metropolitan Airport. Measurements. Proportion of respondents preferring bypass over balloon angioplasty. RESULTS: . In study 1, when statistical information was presented in prose, treatment choices were influenced by anecdotes, with 41% of participants choosing bypass when the anecdotes were representative and only 20% choosing it when the anecdotes were unrepresentative (x(2) = 14.40, P < 0.001). When statistics were reinforced with the pictograph and quiz, anecdotes had no significant influence on treatment decisions (38% choosing bypass when anecdotes were representative v. 44% when unrepresentative, x(2) = 1.08, P > 0.20). In study 2, the tradeoff quiz did not reduce the impact of the anecdotes (27% v. 28% choosing bypass after receiving or not receiving the quiz, x(2) < 1, P > 0.20). However, the pictograph significantly reduced the impact of anecdotes, with 27% choosing bypass after receiving no pictograph and 40% choosing bypass after receiving a pictograph (x(2) = 6.44, P < 0.001). CONCLUSIONS: . Presenting statistical information using a pictograph can reduce the undue influence of anecdotal reasoning on treatment choices.

Authors
Fagerlin, A; Wang, C; Ubel, PA
MLA Citation
Fagerlin, A, Wang, C, and Ubel, PA. "Reducing the influence of anecdotal reasoning on people's health care decisions: is a picture worth a thousand statistics?." Med Decis Making 25.4 (July 2005): 398-405.
PMID
16061891
Source
pubmed
Published In
Medical Decision Making
Volume
25
Issue
4
Publish Date
2005
Start Page
398
End Page
405
DOI
10.1177/0272989X05278931

Misimagining the unimaginable: the disability paradox and health care decision making.

Good decision making often requires accurate predictions about how potential outcomes will make one feel. However, people often mispredict the emotional impact of unfamiliar circumstances. For example, they often overestimate the emotional impact that chronic illnesses and disability will have on their lives. In the present article, the authors look at possible sources of error in both the happiness reports of patients with chronic illness or disability and the happiness predictions of healthy people asked to imagine the same illnesses and disabilities. On balance, the available evidence suggests that, whereas patients misreport their well-being, healthy people also mispredict the emotional impact that chronic illness and disability will have on their lives.

Authors
Ubel, PA; Loewenstein, G; Schwarz, N; Smith, D
MLA Citation
Ubel, PA, Loewenstein, G, Schwarz, N, and Smith, D. "Misimagining the unimaginable: the disability paradox and health care decision making." Health Psychol 24.4S (July 2005): S57-S62.
PMID
16045420
Source
pubmed
Published In
Health Psychology
Volume
24
Issue
4S
Publish Date
2005
Start Page
S57
End Page
S62
DOI
10.1037/0278-6133.24.4.S57

The impact of considering adaptation in health state valuation.

Patients with chronic health conditions often rate their quality of life (QoL) significantly higher than non-patients. One explanation for this discrepancy is that non-patients focus on the negative aspects of the onset of a condition, especially the early difficulties people face when they first experience a debilitating condition, without considering that patients can adapt to it over time. To test this hypothesis, we had 359 people perform person tradeoff (PTO) elicitations in an online survey, varying whether the treatment programs under consideration saved the lives of patients (a) with pre-existing paraplegia; or (b) who would experience new onset of paraplegia. Half of each group completed an "adaptation exercise" which encouraged them to consider their own ability to emotionally adapt to negative events in general and specifically to having paraplegia. The adaptation manipulation increased the value participants placed on pre-existing paraplegia (p=0.03) and on new onset paraplegia (p=0.05), relative to saving healthy lives. Moreover, the adaptation exercise dramatically reduced the differences between evaluations of pre-existing and new onset paraplegia to values within 2% of each other. Our findings suggest that asking non-patients to do an adaptation exercise before giving QoL ratings may help close the gap in ratings between patients and citizen non-patients.

Authors
Damschroder, LJ; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Damschroder, LJ, Zikmund-Fisher, BJ, and Ubel, PA. "The impact of considering adaptation in health state valuation." Soc Sci Med 61.2 (July 2005): 267-277.
PMID
15893044
Source
pubmed
Published In
Social Science & Medicine
Volume
61
Issue
2
Publish Date
2005
Start Page
267
End Page
277
DOI
10.1016/j.socscimed.2004.11.060

The importance of age in allocating health care resources: does intervention-type matter?

BACKGROUND: Recent proposals to reform cost-effectiveness analysis (CEA) by weighting health benefits [(Quality-adjusted life-years) QALYs] by recipients' age are based on studies examining age-related preferences in life-saving contexts. We investigated whether the perceived importance of age in resource allocation decisions differs among intervention-types. METHODS: 160 individuals were recruited from a cafeteria of a university medical centre and asked to choose between hypothetical health care programmes. Scenario A described two programmes treating life-threatening conditions and Scenario B two programmes providing palliative care. Programmes were identical except in average patient age (35 versus 65). Respondents also directly rated the importance of age for allocating resources for six types of interventions. RESULTS: Responses for the life-saving scenario favoured younger age groups while those for the palliative care scenario showed no age preference. The difference between scenarios was statistically significant. When directly rating the importance of age in allocating treatment resources, people placed greatest importance on age in treating infertility and life-saving, and least importance in treating depression. DISCUSSION: The importance people place on age as a resource allocation criterion depends on the clinical context. As QALYs serve as a common measure of health benefits for all intervention types, age weighting of QALYs is premature.

Authors
Johri, M; Damschroder, LJ; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Johri, M, Damschroder, LJ, Zikmund-Fisher, BJ, and Ubel, PA. "The importance of age in allocating health care resources: does intervention-type matter?." Health Econ 14.7 (July 2005): 669-678.
PMID
15497189
Source
pubmed
Published In
Health Economics
Volume
14
Issue
7
Publish Date
2005
Start Page
669
End Page
678
DOI
10.1002/hec.958

Disability and sunshine: can hedonic predictions be improved by drawing attention to focusing illusions or emotional adaptation?

People frequently mispredict the long-term emotional impact of circumstances. The authors examine 2 causes of such mispredictions-a focusing illusion and underappreciation of adaptation. In Experiment 1, the authors found, in 852 adults, that quality of life estimates (for living with disability) were not increased by reducing focusing illusions. In Experiment 2, the authors found, in 698 adults, that people's disability estimates were increased by asking them to reflect on adaptation. In Experiment 3, the authors found, across 312 Midwestern college students, that both approaches reduced the participants' predictions of the life satisfaction of their peers living in southern California. In the case of living in a better climate, the results suggest that attention to either cause influences people's predictions, whereas in the case of chronic disability, the results suggest that it is easier to get people to appreciate adaptation than it is to reduce focusing illusions.

Authors
Ubel, PA; Loewenstein, G; Jepson, C
MLA Citation
Ubel, PA, Loewenstein, G, and Jepson, C. "Disability and sunshine: can hedonic predictions be improved by drawing attention to focusing illusions or emotional adaptation?." J Exp Psychol Appl 11.2 (June 2005): 111-123.
PMID
15998183
Source
pubmed
Published In
Journal of Experimental Psychology: Applied
Volume
11
Issue
2
Publish Date
2005
Start Page
111
End Page
123
DOI
10.1037/1076-898X.11.2.111

What's time got to do with it? Inattention to duration in interpretation of survival graphs.

Reports of randomized clinical trials often use survival curves to summarize clinical outcomes over time and graphically demonstrate evidence of treatment effectiveness. Survival curves can also be used in patient communications to display how health risks accumulate over time. In a randomized survey experiment, administered online, we tested whether people viewing survival curves appropriately adjust their risk perceptions to account for the duration shown. Internet users (N= 864) were recruited from a demographically balanced U.S. panel. Participants read about a hypothetical disease and then viewed one of four survival graphs that displayed mortality risks with and without treatment. Survival graphs showed either a visually large or visually small difference between treatments and were labeled to represent either 5-year or 15-year risk statistics. Participants then provided ratings of disease seriousness, as well as treatment effectiveness for each possible treatment. Variations in ratings corresponded more with visual dissimilarity than with changes in the statistical risk exhibited, with participants perceiving somewhat greater disease seriousness and significant differences in treatment effectiveness in large visual difference graphs. We conclude that when people interpret survival curves, they often fail to sufficiently account for the timeframe represented and perceive more risk and larger differences when identical risks are displayed over longer periods of time. We recommend that all presentations of survival graphics, whether to patients, physicians, or scientists, emphasize duration information (e.g., in the title) and remind readers that attending to graph axis labels is the only way to pierce these visual illusions.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. "What's time got to do with it? Inattention to duration in interpretation of survival graphs." Risk Anal 25.3 (June 2005): 589-595.
PMID
16022692
Source
pubmed
Published In
Risk Analysis
Volume
25
Issue
3
Publish Date
2005
Start Page
589
End Page
595
DOI
10.1111/j.1539-6924.2005.00626.x

The use of life expectancy in cancer screening guidelines. Moving with caution from model-based evidence to evidence-based guidelines.

Authors
Lantz, PM; Ubel, PA
MLA Citation
Lantz, PM, and Ubel, PA. "The use of life expectancy in cancer screening guidelines. Moving with caution from model-based evidence to evidence-based guidelines." J Gen Intern Med 20.6 (June 2005): 552-553.
PMID
15987335
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
20
Issue
6
Publish Date
2005
Start Page
552
End Page
553
DOI
10.1111/j.1525-1497.2005.41012.x

How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey.

Counseling women about breast cancer risks has been found to decrease screening compliance. We investigated whether women's reactions to risk information are an artifact of requiring women to estimate the risk of breast cancer prior to receiving risk information. Three hundred and fifty-six women were randomized to either make or not make a risk estimate prior to receiving risk information. Outcome measures were participants' estimates of the average woman's breast cancer risk and their emotional response to the risk information. Women overestimated the lifetime risk of breast cancer (M = 46%). Women who made risk estimates felt more relieved about the risk and perceived the risk as being lower than women who did not make estimates (p's < 0.001). Asking people to estimate risks influenced their subsequent perceptions of the risk of breast cancer.

Authors
Fagerlin, A; Zikmund-Fisher, BJ; Ubel, PA
MLA Citation
Fagerlin, A, Zikmund-Fisher, BJ, and 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 57.3 (June 2005): 294-299.
PMID
15893211
Source
pubmed
Published In
Patient Education and Counseling
Volume
57
Issue
3
Publish Date
2005
Start Page
294
End Page
299
DOI
10.1016/j.pec.2004.08.007

Ignorance of hedonic adaptation to hemodialysis: a study using ecological momentary assessment.

Healthy people generally underestimate the self-reported well-being of people with disabilities and serious illnesses. The cause of this discrepancy is in dispute, and the present study provides evidence for 2 causes. First, healthy people fail to anticipate hedonic adaptation to poor health. Using an ecological momentary assessment measure of mood, the authors failed to find evidence that hemodialysis patients are less happy than healthy nonpatients are, suggesting that they have largely, if not completely, adapted to their condition. In a forecasting task, healthy people failed to anticipate this adaptation. Second, although controls understated their own mood in both an estimation task and a recall task, patients were quite accurate in both tasks. This relative negativity in controls' estimates of their own moods could also contribute to their underestimation of the moods and overall well-being of patients.

Authors
Riis, J; Loewenstein, G; Baron, J; Jepson, C; Fagerlin, A; Ubel, PA
MLA Citation
Riis, J, Loewenstein, G, Baron, J, Jepson, C, Fagerlin, A, and Ubel, PA. "Ignorance of hedonic adaptation to hemodialysis: a study using ecological momentary assessment." J Exp Psychol Gen 134.1 (February 2005): 3-9.
PMID
15702959
Source
pubmed
Published In
Journal of Experimental Psychology: General
Volume
134
Issue
1
Publish Date
2005
Start Page
3
End Page
9
DOI
10.1037/0096-3445.134.1.3

Commentary: How did we get into this mess?

© Cambridge University Press 2005.I have been aware of the close ties between physicians and the pharmaceutical industry since the day I began medical school in 1984 and received a free stethoscope from a kind-hearted pharmaceutical company. Later that year, I received an expensive medical school textbook from another company, and, over the next several years, I ate more than a few donuts provided by sales representatives who set up meeting areas within the hospital at which I was training. When I left medical school and began residency training, I began to realize that some people thought it was inappropriate for doctors to get too cozy with the pharmaceutical industry. The Mayo Clinic, where I trained, banned pharmaceutical representatives from its grounds, to reduce industry influence on its physicians. In response to this policy, pharmaceutical representatives from several companies got together and rented a large hall in a hotel across the street from the clinic, where they provided food and conversation to Mayo Clinic physicians every week; we all, staff and trainees alike, gladly trudged across the cold Minnesota streets to receive free food and copies of important research articles that the sales representatives thought we should know about. It is safe to say, then, that I have been aware of the close ties between physicians and industry for a long time. But until reading Dr. Kassirer's disturbing summary, I was unaware of the thoroughness of the pharmaceutical marketing network.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Commentary: How did we get into this mess?." Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy. January 1, 2005. 142-151.
Source
scopus
Publish Date
2005
Start Page
142
End Page
151
DOI
10.1017/CBO9780511610332.011

Emotions, decisions, and the limits of rationality: symposium introduction.

In this symposium, three speakers describe research that examines ways in which people's decision-making is affected by emotions. In his paper, Dr. Loewenstein describes research on the properties and effects of "projection bias," the tendency to allow one's immediate, often transient, preferences to influence decisions in the future when one's preferences will be predictable different. Over-shopping on an empty stomach or failing, when not addicted, to appreciate one's future helplessness in the face of drug craving, are examples. Dr. Schwarz focuses on how experiences that accompany the thought process can influence the ease of access to information or the fluency with which new information can be processed. These meta-cognitive experiences can affect decisions. For example, recalling many risk-increasing behaviors is more difficult than recalling only a few. Drawing on this difficulty, people who recall many risk-increasing behaviors infer that they are at lower risk than people who recall merely a few risk-increasing behaviors, in contrast to what the content of recall would suggest. Finally, Dr. Bodenhausen clarifies what is meant by stereotyping, considers how stereotypes might influence decision-making processes, and discuss why this influence often might not be very desirable. He then describes research about factors that amplify the biasing impact of stereotypes in decision making processes. The authors provide examples, discuss implications of their findings for medical decision-making, and describe strategies that we might employ to minimize or eliminate the biases that might be introduced into decision-making processes.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Emotions, decisions, and the limits of rationality: symposium introduction." Med Decis Making 25.1 (January 2005): 95-96.
PMID
15673586
Source
pubmed
Published In
Medical Decision Making
Volume
25
Issue
1
Publish Date
2005
Start Page
95
End Page
96
DOI
10.1177/0272989X04273143

In a mailed physician survey, questionnaire length had a threshold effect on response rate.

OBJECTIVE: To examine the association between questionnaire length and response rate in a mailed survey of generalist physicians randomly selected from the American Medical Association master file. STUDY DESIGN AND SETTING: In a pilot study, otherwise similar questionnaires of 30 different lengths (849 to 1,867 words) were mailed to 192 physicians in April 1999. In the main study, questionnaires of 16 different lengths (564 to 988 words) were mailed to 1,700 physicians between June 1999 and January 2000. RESULTS: In the pilot study, response rate decreased from 60% for questionnaires 849 words in length to 16.7% for questionnaires over 1,800 words in length. Logistic regression revealed an odds ratio of 0.887 (95%CI 0.813, 0.968; p=0.006) for word count, expressed in units of 100 words. In the main study, response rate varied between 51.5% and 71.4%. Logistic regression showed no association between response and word count (OR 0.988; 95%CI 0.896, 1.090; p=0.81). CONCLUSION: There appears to have been a threshold in these studies of approximately 1,000 words. Questionnaires above the threshold had lower response rates than those below it (38.0% vs. 59.4%).

Authors
Jepson, C; Asch, DA; Hershey, JC; Ubel, PA
MLA Citation
Jepson, C, Asch, DA, Hershey, JC, and Ubel, PA. "In a mailed physician survey, questionnaire length had a threshold effect on response rate." J Clin Epidemiol 58.1 (January 2005): 103-105.
PMID
15649678
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
58
Issue
1
Publish Date
2005
Start Page
103
End Page
105
DOI
10.1016/j.jclinepi.2004.06.004

Checking up on immigrants: A job for physicians?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Checking up on immigrants: A job for physicians?." Ethical Choices: Case Studies for Medical Practice Second Edition. Ed. L Snyder. Philadelphia: American College of Physicians, 2005.
Source
manual
Publish Date
2005

Medical study: aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby.

Although many have argued that assisted reproductive technologies ("ARTs") attract those with a desire to genetically engineer their offspring, this claim has yet to be verified. To address this question, we surveyed three groups: the general public, people enrolling in an in vitro fertilization ("IVF") program, and pregnant couples. We asked subject which traits they would select in their children if it were possible to use a magic wand to do so and to value genetic relatedness. In our sample, the potential parents who were using ARTs were less likely to express a desire to select traits in their offspring than were the general public, and just as likely as the pregnant couples, Those using ARTs , however, place greater importance on having genetically related children than the others. Thus, the widely held view that reproductive technology is utilized by those most likely to favor genetic engineering is falsified by out findings.

Authors
Gurmankin, AD; Ubel, PA; Banger, E; McGee, G
MLA Citation
Gurmankin, AD, Ubel, PA, Banger, E, and McGee, G. "Medical study: aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby." Albany law review 68.4 (2005): 1097-1111.
PMID
16094768
Source
scival
Published In
Albany law review
Volume
68
Issue
4
Publish Date
2005
Start Page
1097
End Page
1111

Do unmet expectations for specific tests, referrals, and new medications reduce patients' satisfaction?

BACKGROUND: Patient-centered care requires clinicians to recognize and act on patients' expectations. However, relatively little is known about the specific expectations patients bring to the primary care visit. OBJECTIVE: To describe the nature and prevalence of patients' specific expectations for tests, referrals, and new medications, and to examine the relationship between fulfillment of these expectations and patient satisfaction. DESIGN: Prospective cohort study. SETTING: VA general medicine clinic. PATIENTS/PARTICIPANTS: Two hundred fifty-three adult male outpatients seeing their primary care provider for a scheduled visit. MEASUREMENTS AND MAIN RESULTS: Fifty-six percent of patients reported at least 1 expectation for a test, referral, or new medication. Thirty-one percent had 1 expectation, while 25% had 2 or more expectations. Expectations were evenly distributed among tests, referrals, and new medications (37%, 30%, and 33%, respectively). Half of the patients who expressed an expectation did not receive one or more of the desired tests, referrals, or new medications. Nevertheless, satisfaction was very high (median of 1.5 for visit-specific satisfaction on a 1 to 5 scale, with 1 representing "excellent"). Satisfaction was not related to whether expectations were met or unmet, except that patients who did not receive desired medications reported lower satisfaction. CONCLUSIONS: Patients' expectations are varied and often vague. Clinicians trying to implement the values of patient-centered care must be prepared to elicit, identify, and address many expectations.

Authors
Peck, BM; Ubel, PA; Roter, DL; Goold, SD; Asch, DA; Jeffreys, AS; Grambow, SC; Tulsky, JA
MLA Citation
Peck, BM, Ubel, PA, Roter, DL, Goold, SD, Asch, DA, Jeffreys, AS, Grambow, SC, and Tulsky, JA. "Do unmet expectations for specific tests, referrals, and new medications reduce patients' satisfaction?." J Gen Intern Med 19.11 (November 2004): 1080-1087.
PMID
15566436
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
19
Issue
11
Publish Date
2004
Start Page
1080
End Page
1087
DOI
10.1111/j.1525-1497.2004.30436.x

Altruism, incentives, and organ donation: attitudes of the transplant community.

OBJECTIVES: This study investigated the attitudes of the transplant community toward the current policy of altruistic organ donation and 6 alternative policies offering incentives to the donor family. METHODS: Two hundred forty-nine transplant surgeons, 143 transplant coordinators, and 134 critical-care nurses rated the moral appropriateness and success of the current policy of altruistic donation, rated the moral appropriateness of the alternative policies, judged whether donation would increase or decrease under each alternative policy, and decided whether each alternative policy should be put into effect. RESULTS: All 3 professions believed the current policy of altruistic organ donation to be morally appropriate and most of the alternative policies to be morally appropriate or morally neutral. All 3 professions believed the current policy to be at best only moderately successful and judged most or all of the alternative policies to be likely to increase donation. All 3 professions favored implementing a policy offering donor recognition; approximately one half of the surgeons and one half of the coordinators also advocated implementing a policy offering 1500 US dollars toward funeral expenses. In all 3 professions, respondents' decisions to implement the alternative policies were more frequently related to those policies' moral appropriateness than to their likelihood of increasing organ donation. CONCLUSIONS: Specific incentives varied in their acceptability to the transplant community. Attitudes of the transplant community toward incentives were not in accord with published criticisms of incentives.

Authors
Jasper, JD; Nickerson, CAE; Ubel, PA; Asch, DA
MLA Citation
Jasper, JD, Nickerson, CAE, Ubel, PA, and Asch, DA. "Altruism, incentives, and organ donation: attitudes of the transplant community." Med Care 42.4 (April 2004): 378-386.
PMID
15076815
Source
pubmed
Published In
Medical Care
Volume
42
Issue
4
Publish Date
2004
Start Page
378
End Page
386

The costs of denying scarcity.

Authors
Alexander, GC; Werner, RM; Ubel, PA
MLA Citation
Alexander, GC, Werner, RM, and Ubel, PA. "The costs of denying scarcity." Arch Intern Med 164.6 (March 22, 2004): 593-596.
PMID
15037486
Source
pubmed
Published In
Archives of internal medicine
Volume
164
Issue
6
Publish Date
2004
Start Page
593
End Page
596
DOI
10.1001/archinte.164.6.593

"Is 28% good or bad?" Evaluability and preference reversals in health care decisions.

Choices of health care providers can become inconsistent when people lack sufficient context to assess the value of available information. In a series of surveys, general population samples were randomized to read descriptions of either 2 possible health care providers or a single provider. Some information about providers was easy to consider (e.g., travel time), but some was difficult to interpret without additional context (e.g., success rates). Ratings of the described health care providers varied significantly by whether options were evaluated independently or concurrently. For example, one fertility clinic (33% success rate, 15 min away) was rated higher than a 2nd (40% success rate, 45 min away) when each clinic was considered separately (7.1 v. 6.2, P = 0.046), but preferences reversed in joint evaluation (5.9 v. 6.7, P = 0.051). The results suggest that clinicians and developers of patient information materials alike should consider information evaluability when deciding how to present health care options to patients.

Authors
Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA
MLA Citation
Zikmund-Fisher, BJ, Fagerlin, A, and Ubel, PA. ""Is 28% good or bad?" Evaluability and preference reversals in health care decisions." Med Decis Making 24.2 (March 2004): 142-148.
PMID
15090100
Source
pubmed
Published In
Medical Decision Making
Volume
24
Issue
2
Publish Date
2004
Start Page
142
End Page
148
DOI
10.1177/0272989X04263154

Does competition for transplantable hearts encourage 'gaming' of the waiting list?

Transplant centers may "game" the severity of listed patients to increase their patients' likelihood of receiving transplantable organs. Recent lawsuits allege gaming at some centers, and listing policies were modified in 1999 to clarify listing criteria. We tested for gaming and its relationship to heart transplant center competition. We found that increased competition resulted in more patients listed in the most severe illness category (p < .01), consistent with the gaming hypothesis. Gaming was mitigated after the 1999 policy change (p > .05), which suggests that the new rules were effective. Continued monitoring is warranted, given prior gaming and recent accusations.

Authors
Scanlon, DP; Hollenbeak, CS; Lee, W; Loh, E; Ubel, PA
MLA Citation
Scanlon, DP, Hollenbeak, CS, Lee, W, Loh, E, and Ubel, PA. "Does competition for transplantable hearts encourage 'gaming' of the waiting list?." Health Aff (Millwood) 23.2 (March 2004): 191-198.
PMID
15046143
Source
pubmed
Published In
Health Affairs
Volume
23
Issue
2
Publish Date
2004
Start Page
191
End Page
198

The validity of person tradeoff measurements: randomized trial of computer elicitation versus face-to-face interview.

Can person tradeoff (PTO) value judgments be elicited by a computer, or is a face-to-face interview needed? The authors randomly assigned 95 subjects to interview or computer methods for the PTO, a valuation measure that is often difficult for subjects. They measured relative values of foot numbness, leg paralysis, and quadriplegia (all 3 pairs) at 2 reference group sizes (10 or 100). Relative values did not differ between computer and interview. Overall, 21% of responses were equality responses, 13% were high extreme values, and 5% violated ordinal criteria. The groups did not differ in these measures. The authors also assessed consistency across reference group size (10 v. 100). Although relative values were significantly lower for 100 than for 10, mode did not influence the size of this effect. Subjects made, on average, equally consistent judgments for the 3 comparisons. A computerized PTO elicitation protocol produced results of similar quality to that of a face-to-face interview.

Authors
Damschroder, LJ; Baron, J; Hershey, JC; Asch, DA; Jepson, C; Ubel, PA
MLA Citation
Damschroder, LJ, Baron, J, Hershey, JC, Asch, DA, Jepson, C, and Ubel, PA. "The validity of person tradeoff measurements: randomized trial of computer elicitation versus face-to-face interview." Med Decis Making 24.2 (March 2004): 170-180.
PMID
15090103
Source
pubmed
Published In
Medical Decision Making
Volume
24
Issue
2
Publish Date
2004
Start Page
170
End Page
180
DOI
10.1177/0272989X04263160

Elevator etiquette: When is communication too effective?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Elevator etiquette: When is communication too effective?." Communication for Doctors: How to improve patient care and minimize legal risks. Ed. D Woods. Radcliff Publishing, 2004. (Chapter)
Source
manual
Publish Date
2004

Racial/ethnic disparities in the treatment of localized/regional prostate cancer

Purpose: Racial/ethnic disparities in the utilization of definitive therapy for prostate cancer are well recognized in the United States. The effect of race on the use of contemporary definitive therapies, including brachytherapy, and the assessment of Hispanic men with regard to racial/ethnic disparity has not been fully characterized. Materials and Methods: We evaluated treatment patterns using Surveillance, Epidemiology and End Results registry data on 142,340 localized/regional stage cases between 1992 and 1999 in white, black and Hispanic American men. Definitive therapy was defined as radical prostatectomy, external beam radiation, brachytherapy or combinations thereof. Logistic regression models were constructed to determine the odds of receiving definitive treatment, adjusting for age, marital status, tumor grade, and Surveillance, Epidemiology and End Results site. Results: Black and Hispanic men were less likely to receive definitive therapy than white men (p <0.001). Higher tumor grade was associated with decreasing odds of definitive therapy for black and Hispanic men (p <0.001) compared to white men. The racial/ethnic disparities in the use of definitive therapy decreased between 1992 and 1999 with the greatest decrease in Hispanic men. Conclusions: Hispanic and black men were less likely than white men to receive definitive therapy. The disparity in the use of definitive therapy between 1992 and 1999 decreased significantly in Hispanic men, although a significant disparity in the use of definitive therapy persisted in black men. Our observation of an association between tumor grade and the racial/ethnic disparity in definitive therapy ties together relevant biological and social factors that may contribute to the observed racial/ethnic disparity in mortality.

Authors
Underwood, W; DeMonner, S; Ubel, P; Fagerlin, A; Sanda, MG; Wei, JT
MLA Citation
Underwood, W, DeMonner, S, Ubel, P, Fagerlin, A, Sanda, MG, and Wei, JT. "Racial/ethnic disparities in the treatment of localized/regional prostate cancer." Journal of Urology 171.4 (2004): 1504-1507.
PMID
15017208
Source
scival
Published In
Journal of Urology
Volume
171
Issue
4
Publish Date
2004
Start Page
1504
End Page
1507
DOI
10.1097/01.ju.0000118907.64125.e0

Lying to insurance companies: the desire to deceive among physicians and the public.

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26%versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22%versus 59%). The odds of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources.

Authors
Werner, RM; Alexander, GC; Fagerlin, A; Ubel, PA
MLA Citation
Werner, RM, Alexander, GC, Fagerlin, A, and Ubel, PA. "Lying to insurance companies: the desire to deceive among physicians and the public." Am J Bioeth 4.4 (2004): 53-59.
PMID
16192208
Source
pubmed
Published In
American Journal of Bioethics
Volume
4
Issue
4
Publish Date
2004
Start Page
53
End Page
59
DOI
10.1080/15265160490518566

Misperceptions about beta-blockers and diuretics: a national survey of primary care physicians.

BACKGROUND: Based on a series of clinical trials showing no difference in the effectiveness or tolerability of most major classes of antihypertensive medications, the Joint National Commission on High Blood Pressure Treatment recommends that physicians prescribe beta-blockers or diuretics as initial hypertensive therapy unless there are compelling indications for another type of medication. Nevertheless, many physicians continue to favor more expensive medications like angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers as first line agents. The persistent use of these agents raises questions as to whether physicians perceive ACE inhibitors and calcium channel blockers to be better than beta-blockers and diuretics. METHODS: We surveyed 1,200 primary care physicians in 1997, and another 500 primary care physicians in 2000, and asked them to estimate the relative effectiveness and side effects of 4 classes of medication in treating a hypothetical patient with uncomplicated hypertension: ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics. In addition, we asked them to indicate whether they ever provided free samples of hypertension medications to their patients. RESULTS: Perceptions of the relative effectiveness and side effects of the 4 classes of hypertension medications did not significantly change over the 3 years, nor did prescription recommendations. Physicians perceive that diuretics are less effective at lowering blood pressure than the other 3 classes (P <.001). They also perceive that beta-blockers are less tolerated than the other 3 classes (P <.001). In a multivariate model, perceptions of effectiveness and tolerability displayed significant associations with prescription preference independent of background variables. The only other variable to contribute significantly to the model was provision of free medication samples to patients. CONCLUSIONS: Despite numerous clinical trials showing no difference in the effectiveness or side-effect profiles of these 4 classes of drugs, most physicians believed that diuretics were less effective and beta-blockers were less tolerated than other medications. Moreover, their prescription practices were associated with their provision of free samples provided by pharmaceutical representatives, even after adjusting for other demographic characteristics. Efforts to increase physicians' prescribing of beta-blockers and diuretics may need to be directed at overcoming misunderstandings about the effectiveness and tolerability of these medicines.

Authors
Ubel, PA; Jepson, C; Asch, DA
MLA Citation
Ubel, PA, Jepson, C, and Asch, DA. "Misperceptions about beta-blockers and diuretics: a national survey of primary care physicians." J Gen Intern Med 18.12 (December 2003): 977-983.
PMID
14687255
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
18
Issue
12
Publish Date
2003
Start Page
977
End Page
983

When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?

BACKGROUND: For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians. OBJECTIVE: To assess the extent to which patients with type 2 diabetes agree with their primary care providers (PCPs) on diabetes treatment goals and strategies, the factors that predict agreement, and whether greater agreement is associated with better patient self-management of diabetes. DESIGN: One hundred twenty-seven pairs of patients and their PCPs in two health systems were surveyed about their top 3 diabetes treatment goals (desired outcomes) and strategies to meet those goals. Using several measures to evaluate agreement, we explored whether patient characteristics, such as education and attitudes toward treatment, and patient-provider interaction styles, such as shared decision making, were associated with greater agreement on treatment goals and strategies. We then examined whether agreement was associated with higher patient assessments of their diabetes care self-efficacy and self-management. RESULTS: Overall, agreement on top treatment goals and strategies was low (all kappa were less than 0.40). In multivariable analyses, however, patients with more education, greater belief in the efficacy of their diabetes treatment, and who shared in treatment decision making with their providers were more likely to agree with their providers on treatment goals or strategies. Similarly, physician reports of having discussed more content areas of diabetes self-care were associated with greater agreement on treatment strategies. In turn, greater agreement on treatment goals and strategies was associated both with higher patient diabetes care self-efficacy and assessments of their diabetes self-management. CONCLUSION: Although patients and their PCPs in general had poor agreement on goals and strategies for managing diabetes, agreement was associated with higher patient self-efficacy and assessments of their diabetes self-management. This supports the hypothesis that enhancing patient-provider agreement on both overall treatment goals and specific strategies to meet these goals may lead to improved patient outcomes.

Authors
Heisler, M; Vijan, S; Anderson, RM; Ubel, PA; Bernstein, SJ; Hofer, TP
MLA Citation
Heisler, M, Vijan, S, Anderson, RM, Ubel, PA, Bernstein, SJ, and Hofer, TP. "When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?." J Gen Intern Med 18.11 (November 2003): 893-902.
PMID
14687274
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
18
Issue
11
Publish Date
2003
Start Page
893
End Page
902

Effect of assessment method on the discrepancy between judgments of health disorders people have and do not have: a web study.

Three experiments on the World Wide Web asked subjects to rate the severity of common health disorders such as acne or arthritis. People who had a disorder ("Haves") tended to rate it as less severe than people who did not have it ("Not-haves"). Two explanations of this Have versus Not-have discrepancy were rejected. By one account, people change their reference point when they rate a disorder that they have. More precise reference points would, on this account, reduce the discrepancy, but, if anything, the discrepancy was larger. By another account, people who do not have the disorder focus on attributes that are most affected by it, and the discrepancy should decrease when people make ratings on several attributes. Again, if anything, the discrepancy increased when ratings were on separate attributes (combined by a weighted average). The discrepancy varied in size and direction across disorders. Subjects also thought that they would be less affected than others.

Authors
Baron, J; Asch, DA; Fagerlin, A; Jepson, C; Loewenstein, G; Riis, J; Stineman, MG; Ubel, PA
MLA Citation
Baron, J, Asch, DA, Fagerlin, A, Jepson, C, Loewenstein, G, Riis, J, Stineman, MG, and Ubel, PA. "Effect of assessment method on the discrepancy between judgments of health disorders people have and do not have: a web study." Med Decis Making 23.5 (September 2003): 422-434.
PMID
14570300
Source
pubmed
Published In
Medical Decision Making
Volume
23
Issue
5
Publish Date
2003
Start Page
422
End Page
434
DOI
10.1177/0272989X03257277

Public response to cost-quality tradeoffs in clinical decisions.

PURPOSE: To explore public attitudes toward the incorporation of cost-effectiveness analysis into clinical decisions. METHODS: The authors presented 781 jurors with a survey describing 1 of 6 clinical encounters in which a physician has to choose between cancer screening tests. They provided cost-effectiveness data for all tests, and in each scenario, the most effective test was more expensive. They instructed respondents to imagine that he or she was the physician in the scenario and asked them to choose which test to recommend and then explain their choice in an open-ended manner. The authors then qualitatively analyzed the responses by identifying themes and developed a coding scheme. Two authors separately coded the statements with high overall agreement (kappa = 0.76). Categories were not mutually exclusive. RESULTS: Overall, 410 respondents (55%) chose the most expensive option, and 332 respondents (45%) choose a less expensive option. Explanatory comments were given by 82% respondents. Respondents who chose the most expensive test focused on the increased benefit (without directly acknowledging the additional cost) (39%), a general belief that life is more important than money (22%), the significance of cancer risk for the patient in the scenario (20%), the belief that the benefit of the test was worth the additional cost (8%), and personal anecdotes/preferences (6%). Of the respondents who chose the less expensive test, 40% indicated that they did not believe that the patient in the scenario was at significant risk for cancer, 13% indicated that they thought the less expensive test was adequate or not meaningfully different from the more expensive test, 12% thought the cost of the test was not worth the additional benefit, 9% indicated that the test was too expensive (without mention of additional benefit), and 7% responded that resources were limited. CONCLUSIONS: Public response to cost-quality tradeoffs is mixed. Although some respondents justified their decision based on the cost-effectiveness information provided, many focused instead on specific features of the scenario or on general beliefs about whether cost should be incorporated into clinical decisions.

Authors
Beach, MC; Asch, DA; Jepson, C; Hershey, JC; Mohr, T; McMorrow, S; Ubel, PA
MLA Citation
Beach, MC, Asch, DA, Jepson, C, Hershey, JC, Mohr, T, McMorrow, S, and Ubel, PA. "Public response to cost-quality tradeoffs in clinical decisions." Med Decis Making 23.5 (September 2003): 369-378.
PMID
14570295
Source
pubmed
Published In
Medical Decision Making
Volume
23
Issue
5
Publish Date
2003
Start Page
369
End Page
378
DOI
10.1177/0272989X03256882

Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public.

There is often a discrepancy between quality of life estimates from patients and the general public. These discrepancies are of concern to the disability community, who worry that the public does not understand how valuable life can be for people with disabilities; policy planners, who must decide whose quality of life estimates to use in economic analysis; and practitioners and patients facing difficult medical decisions, who may have to worry that people have difficulty imagining unfamiliar health states. We outline several factors that may contribute to these discrepancies. Discrepancies might occur because patients and the public interpret health state descriptions differently--for example, making different assumptions about the recency of onset of the health state, or about the presence of comorbidities. Discrepancies might also arise if patients adapt to illness and the public does not predict this adaptation; because of response shift in how people use quality of life scales; because of a focusing illusion whereby people forget to consider obvious aspects of unfamiliar health states; because of contrast effects, whereby negative life events make people less bothered by less severe negative life events; and because of different vantage points, with patients viewing their illness in terms of the benefits that would result from regaining health, while the public views the illness in terms of the costs associated with losing good health. Decisions about whose values to measure for the purposes of economic analyses, and how to measure discrepancies, should take these potential contributing factors into account.

Authors
Ubel, PA; Loewenstein, G; Jepson, C
MLA Citation
Ubel, PA, Loewenstein, G, and Jepson, C. "Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public." Qual Life Res 12.6 (September 2003): 599-607.
PMID
14516169
Source
pubmed
Published In
Quality of Life Research
Volume
12
Issue
6
Publish Date
2003
Start Page
599
End Page
607

Setting organ allocation priorities: should we care what the public cares about?

OBJECTIVE: To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation. DESIGN: A qualitative study based upon the transcripts of four focus groups. SETTING: Derby, Derbyshire, UK. PARTICIPANTS: Twenty-two members of the public in the Derby locality, recruited to one of four focus groups through local community groups. MAIN OUTCOME MEASURES: The views of focus group members as to the importance (or otherwise) of several potential discriminating factors which could be used in the prioritization of patients on the waiting list for liver transplantation were ascertained. The factors included were expected posttransplantation prognosis, the age of the patient, whether the patient was personally responsible for their illness, the time spent on the waiting list, re-transplantation or primary transplant and the social background of the patient. RESULTS AND CONCLUSIONS: Group members explored the criteria from a number of perspectives, and made some unexpected linkages between the criteria and wider moral principles. They did not come to firm conclusions about the relative desirability of the criteria, but their approach was notably flexible and thoughtful, with the exception of a few instances where they appeared to resort to arguments based on what is 'obvious' and 'natural'. The results of these discussions suggest that members of the public would be able and willing to respond positively to a more open and consultative system of donor liver prioritization than exists presently within the UK.

Authors
Johri, M; Ubel, PA
MLA Citation
Johri, M, and Ubel, PA. "Setting organ allocation priorities: should we care what the public cares about?." Liver Transpl 9.8 (August 2003): 878-880.
PMID
12884205
Source
pubmed
Published In
Liver Transplantation
Volume
9
Issue
8
Publish Date
2003
Start Page
878
End Page
880
DOI
10.1053/jlts.2003.50154

What is the price of life and why doesn't it increase at the rate of inflation?

Authors
Ubel, PA; Hirth, RA; Chernew, ME; Fendrick, AM
MLA Citation
Ubel, PA, Hirth, RA, Chernew, ME, and Fendrick, AM. "What is the price of life and why doesn't it increase at the rate of inflation?." Arch Intern Med 163.14 (July 28, 2003): 1637-1641. (Review)
PMID
12885677
Source
pubmed
Published In
Archives of internal medicine
Volume
163
Issue
14
Publish Date
2003
Start Page
1637
End Page
1641
DOI
10.1001/archinte.163.14.1637

Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons.

OBJECTIVE: Rheumatoid arthritis (RA) is a common cause of debilitating hand deformities, but management of these deformities is controversial, characterized by large variations in the surgical rates of common RA hand procedures. We conducted a national survey evaluating potential differences in physicians' management of RA hand deformities. METHODS: We mailed a survey instrument to a random national sample of 500 rheumatologists and 500 hand surgeons in the US. We evaluated physicians' attitudes toward the other specialties' management of common RA hand deformities and toward the indications for performing rheumatoid hand surgery. RESULTS: We found 70% of rheumatologists consider hand surgeons deficient in understanding the medical options available for RA, while 73.6% of surgeons believe rheumatologists have insufficient knowledge of the surgical options for RA hand diseases. However, 66.9% of surgeons and 79.5% of rheumatologists had no exposure to the other specialty during training. The 2 physician groups disagree significantly on the indications for commonly performed RA hand procedures such as metacarpophalangeal joint arthroplasty (p < 0.001), small joint synovectomy (p < 0.001), and distal ulna resection (p = 0.001). When physicians do not agree with others' management of RA hand deformities, only 62.4% of surgeons and 61.9% of rheumatologists relay their concern to the other specialty. CONCLUSION: Rheumatologists and hand surgeons have minimal interdisciplinary training, communicate with each other infrequently, and significantly disagree on the indications for RA hand surgery. Research must focus on the surgical outcomes of RA hand procedures and on improving communication between rheumatologists and hand surgeons.

Authors
Alderman, AK; Ubel, PA; Kim, HM; Fox, DA; Chung, KC
MLA Citation
Alderman, AK, Ubel, PA, Kim, HM, Fox, DA, and Chung, KC. "Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons." J Rheumatol 30.7 (July 2003): 1464-1472.
PMID
12858442
Source
pubmed
Published In
The Journal of rheumatology
Volume
30
Issue
7
Publish Date
2003
Start Page
1464
End Page
1472

When money is saved by reducing healthcare costs, where do US primary care physicians think the money goes?

BACKGROUND: Physician willingness to reduce medical costs is mixed. Some physicians might be unwilling to reduce medical costs because they are concerned about where the savings would go. OBJECTIVE: To determine whether primary care physicians might be less willing to choose a less expensive, less effective cancer screening alternative if they believe that the money saved goes to insurance companies. DESIGN: Anonymous mailed survey. PARTICIPANTS: A total of 865 US primary care physicians. MAIN OUTCOME MEASURES: Responses to one of several clinical vignettes presenting a choice between a less expensive, less effective cancer screening option and a more expensive, more effective alternative and responses to where physicians thought the savings might go if they chose the cheaper alternative. RESULTS: Fifty-three percent of physicians chose the most expensive screening alternative. In aggregate, physicians responded that more of any money saved would go to the managers or owners of insurance companies than to increased clinical services or reduced insurance premiums. Physicians choosing the more expensive screening test were more likely to believe that money saved from choosing the less expensive test would go to insurance company profits and salaries rather than to increased clinical services or reduced premiums (P < .001). CONCLUSIONS: Although US primary care physicians vary in where they think money saved in healthcare goes, most believe that more of it goes to the salaries of insurance company executives and the profits of insurance company owners than to improved clinical services or reduced premiums. The more physicians believe that this is where the money goes, the less willing they are to reduce healthcare costs.

Authors
Asch, DA; Jepson, C; Hershey, JC; Baron, J; Ubel, PA
MLA Citation
Asch, DA, Jepson, C, Hershey, JC, Baron, J, and Ubel, PA. "When money is saved by reducing healthcare costs, where do US primary care physicians think the money goes?." Am J Manag Care 9.6 (June 2003): 438-442.
PMID
12816173
Source
pubmed
Published In
American Journal of Managed Care
Volume
9
Issue
6
Publish Date
2003
Start Page
438
End Page
442

The influence of cost-effectiveness information on physicians' cancer screening recommendations.

Physicians are increasingly faced with choices in which one screening strategy is both more effective and more expensive than another. One way to make such choices is to examine the cost-effectiveness of the more costly strategy over the less costly one. However, little is known about how cost-effectiveness information influences physicians' screening decisions. We surveyed 900 primary care US physicians, and presented each with a hypothetical cancer-screening scenario. We created three familiar screening scenarios, involving cervical, colon, and breast cancer. We also created three unfamiliar screening scenarios. Physicians were randomized to receive one of nine questionnaires, each containing one screening scenario. Three questionnaires posed one of the familiar screening scenarios without cost-effectiveness information, three posed one of the familiar scenarios with cost-effectiveness information, and three posed one of the unfamiliar scenarios with cost-effectiveness information. The cost-effectiveness information for familiar scenarios was drawn from the medical literature. The cost-effectiveness information for unfamiliar scenarios was fabricated to match that of a corresponding familiar scenario. In all questionnaires, physicians were asked what screening alternative they would recommend. A total of 560 physicians responded (65%). For familiar scenarios, providing cost-effectiveness information had at most a small influence on physicians' screening recommendations; it reduced the proportion of physicians recommending annual Pap smears (p=0.003), but did not significantly alter the aggressiveness of colon cancer and breast cancer screening (both p's<0.1). For all three unfamiliar scenarios, physicians were significantly less likely to recommend expensive screening strategies than in corresponding familiar scenarios (all p's<0.001). Physicians' written explanations revealed a number of factors that moderated the influence of cost-effectiveness information on their screening recommendations. Providing physicians with cost-effectiveness information had only a moderate influence on their screening recommendations for cervical, colon, and breast cancer. Significantly, fewer physicians recommended aggressive screening for unfamiliar cancers than for familiar ones, despite similar cost-effectiveness. Physicians are relatively reluctant to abandon common screening strategies, even when they learn that they are expensive, and are hesitant to adopt unfamiliar screening strategies, even when they learn that they are inexpensive.

Authors
Ubel, PA; Jepson, C; Baron, J; Hershey, JC; Asch, DA
MLA Citation
Ubel, PA, Jepson, C, Baron, J, Hershey, JC, and Asch, DA. "The influence of cost-effectiveness information on physicians' cancer screening recommendations." Soc Sci Med 56.8 (April 2003): 1727-1736.
PMID
12639589
Source
pubmed
Published In
Social Science & Medicine
Volume
56
Issue
8
Publish Date
2003
Start Page
1727
End Page
1736

Support for physician deception of insurance companies among a sample of Philadelphia residents.

BACKGROUND: Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice. OBJECTIVE: To assess public attitudes regarding physician deception of insurance companies. DESIGN: Cross-sectional survey using clinical vignettes. SETTING: Philadelphia County Courthouse, Philadelphia, Pennsylvania. PARTICIPANTS: Convenience sample of 700 prospective jurors. MEASUREMENTS: Participants were asked whether, in response to restriction of health care, a physician should 1) accept restriction, 2) appeal restriction, or 3) misrepresent a patient's condition to obtain the desired service. The proportion of respondents reporting that the physician should misrepresent a patient's condition was determined. RESULTS: 26% of respondents sanctioned deception, 70% supported appealing, and 4% supported accepting the insurance company decision. Among the 27% of respondents believing physicians have inadequate time to appeal coverage decisions, 50% sanctioned deception. CONCLUSIONS: Sanctioning of deception was substantial in this sample of prospective jurors. Preferences regarding insurance company deception are related to perceptions of physician workload and may further pressure physicians struggling to balance advocacy with honesty.

Authors
Alexander, GC; Werner, RM; Fagerlin, A; Ubel, PA
MLA Citation
Alexander, GC, Werner, RM, Fagerlin, A, and Ubel, PA. "Support for physician deception of insurance companies among a sample of Philadelphia residents." Ann Intern Med 138.6 (March 18, 2003): 472-475.
PMID
12639080
Source
pubmed
Published In
Annals of internal medicine
Volume
138
Issue
6
Publish Date
2003
Start Page
472
End Page
475

Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient.

OBJECTIVE: We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a pelvic examination while she is anesthetized. STUDY DESIGN: Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a pelvic examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. RESULTS: After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship (P =.01). CONCLUSION: To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform examinations only after patients have given consent explicitly.

Authors
Ubel, PA; Jepson, C; Silver-Isenstadt, A
MLA Citation
Ubel, PA, Jepson, C, and Silver-Isenstadt, A. "Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient." Am J Obstet Gynecol 188.2 (February 2003): 575-579.
PMID
12592274
Source
pubmed
Published In
American Journal of Obstetrics & Gynecology
Volume
188
Issue
2
Publish Date
2003
Start Page
575
End Page
579

Incremental and average cost-effectiveness ratios: will physicians make a distinction?

Physicians are increasingly asked to use cost-effectiveness information when evaluating alternative health care interventions. Little is known about how the way such information is presented can influence medical decision making. We presented physicians with hypothetical screening scenarios with multiple options, varying the type of cost-effectiveness ratios provided as well as whether the scenarios described cancer screening settings that were familiar or unfamiliar. Half the scenarios used average cost-effectiveness ratios, as commonly reported, calculating benefits and costs relative to a no-screening option. The other half used the preferred incremental cost-effectiveness ratios, with each option's benefits and costs calculated relative to the next best alternative. Relative to average cost-effectiveness ratios, incremental cost-effectiveness information significantly reduced preference for the most expensive screening strategies in two of three unfamiliar scenarios. No such difference was found for familiar scenarios, for which physicians likely have established practice patterns. These results suggest that, in unfamiliar settings, average cost-effectiveness ratios as reported in many analyses reported in the literature can hide the often high price for achieving incremental health care goals, potentially causing physicians to choose interventions with poor cost effectiveness.

Authors
Hershey, JC; Asch, DA; Jepson, C; Baron, J; Ubel, PA
MLA Citation
Hershey, JC, Asch, DA, Jepson, C, Baron, J, and Ubel, PA. "Incremental and average cost-effectiveness ratios: will physicians make a distinction?." Risk Anal 23.1 (February 2003): 81-89.
PMID
12635724
Source
pubmed
Published In
Risk Analysis
Volume
23
Issue
1
Publish Date
2003
Start Page
81
End Page
89

Effectiveness of rheumatoid hand surgery: contrasting perceptions of hand surgeons and rheumatologists.

PURPOSE: Surgical management of rheumatoid hand diseases is controversial with large variation in practice pattern in the U.S. The purpose of this study is to evaluate the attitudes of hand surgeons and rheumatologists toward the effectiveness of rheumatoid hand surgery. METHODS: We designed a survey instrument to examine physicians' opinions about the effectiveness of different surgical treatments for rheumatoid hand deformities. The self-administered survey was mailed to a national random sample of 500 members of the American Society for Surgery of the Hand and 500 members of the American College of Rheumatology. RESULTS: Of survey responders, 82.5% of hand surgeons versus 34.1% of rheumatologists believe metacarpophalangeal joint arthroplasty improves hand function; 93.2% and 54.6%, respectively, believe prophylactic extensor tenosynovectomy prevents tendon rupture; and 52.5% and 12.6%, respectively, believe small joint synovectomy delays joint destruction. CONCLUSIONS: Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, which highlights the disagreements between the 2 specialties about the management of this clinical problem.

Authors
Alderman, AK; Chung, KC; Kim, HM; Fox, DA; Ubel, PA
MLA Citation
Alderman, AK, Chung, KC, Kim, HM, Fox, DA, and Ubel, PA. "Effectiveness of rheumatoid hand surgery: contrasting perceptions of hand surgeons and rheumatologists." J Hand Surg Am 28.1 (January 2003): 3-11.
PMID
12563630
Source
pubmed
Published In
Journal of Hand Surgery (American Volume)
Volume
28
Issue
1
Publish Date
2003
Start Page
3
End Page
11
DOI
10.1053/jhsu.2003.50034

A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient [3] (multiple letters)

Authors
Coxe, MF; Ubel, PA; Silver-Isenstadt, A
MLA Citation
Coxe, MF, Ubel, PA, and Silver-Isenstadt, A. "A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient [3] (multiple letters)." American Journal of Obstetrics and Gynecology 189.6 (2003): 1808-1809.
PMID
14710123
Source
scival
Published In
American Journal of Obstetrics and Gynecology
Volume
189
Issue
6
Publish Date
2003
Start Page
1808
End Page
1809

Erratum: Physicians' willingness to participate in the process of lethal injection for capital punishment. Ann Intern Med (Lancet (2001) 135 (884-888))

Authors
Farber, NJ; Aboff, BM; Weiner, J; Davis, EB; Boyer, EG; Ubel, PA
MLA Citation
Farber, NJ, Aboff, BM, Weiner, J, Davis, EB, Boyer, EG, and Ubel, PA. "Erratum: Physicians' willingness to participate in the process of lethal injection for capital punishment. Ann Intern Med (Lancet (2001) 135 (884-888))." Lancet 362.9380 (2003): 334--.
Source
scival
Published In
Lancet
Volume
362
Issue
9380
Publish Date
2003
Start Page
334-
DOI
10.1016/S0140-6736(03)13993-1

Comments to 'a note on cost-value analysis'

Authors
Nord, E; Pinto, JL; Richardson, J; Menzel, P; Ubel, P
MLA Citation
Nord, E, Pinto, JL, Richardson, J, Menzel, P, and Ubel, P. "Comments to 'a note on cost-value analysis'." Health Economics 12.3 (2003): 251-253.
Source
scival
Published In
Health Economics
Volume
12
Issue
3
Publish Date
2003
Start Page
251
End Page
253
DOI
10.1002/hec.715

Responding to the immunoglobulin shortage: a case study.

In fall 1997, a shortage of intravenous immunoglobulin (IVIG) developed in the United States because of increased demand for the product, reduced supply, and product recalls. This shortage is a useful model for understanding how our health care system responds to scarcity. Although the U.S. government took steps to inform the medical community of the shortage, with few exceptions, the government did not respond to the shortage in a timely or effective manner. Instead, it took a relatively passive role, leaving IVIG manufacturers and distributors, health care institutions, and clinicians to fend for themselves. The shortage likely had an uneven impact on patients, based on the relative market strength of the health care institutions in which they received care and the individual patient's ability to absorb the increasing out-of-pocket costs of scarce IVIG. Market mechanisms have now largely alleviated the shortage and significantly reduced its detrimental impact on patients. However, future shortages of IVIG or other scarce medical products, such as vaccines and antibiotics, would benefit from more immediate and coordinated efforts not only to make sure that scarce health care resources are distributed in a just manner but also to identify and remedy the sources of health product supply problems.

Authors
Boulis, A; Goold, S; Ubel, PA
MLA Citation
Boulis, A, Goold, S, and Ubel, PA. "Responding to the immunoglobulin shortage: a case study." J Health Polit Policy Law 27.6 (December 2002): 977-999.
PMID
12556024
Source
pubmed
Published In
Journal of Health Politics, Policy and Law
Volume
27
Issue
6
Publish Date
2002
Start Page
977
End Page
999

Is information always a good thing? Helping patients make "good" decisions.

In most cases, patient preferences are crucial in making good health care decisions. For example, choices between chemotherapy and radiation treatment usually hinge on trade-offs that only patients can decide about. In recognition of the importance of patient preferences in clinical decisions, health services researchers have begun developing decision aids to help patients understand complex medical information. But these decision aids might lead to "bad choices"-choices that are inconsistent with people's stated preferences. In this paper, the author provides examples of how people make inconsistent medical decisions, and briefly discusses future directions for exploring ways of structuring information so that patients are less likely to make inconsistent choices.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Is information always a good thing? Helping patients make "good" decisions." Med Care 40.9 Suppl (September 2002): V39-V44.
PMID
12226584
Source
pubmed
Published In
Medical Care
Volume
40
Issue
9 Suppl
Publish Date
2002
Start Page
V39
End Page
V44
DOI
10.1097/01.MLR.0000023954.85887.69

Physicians' preferences for active-controlled versus placebo-controlled trials of new antihypertensive drugs.

OBJECTIVE: To evaluate physicians' preferences for referring patients to, and using information from, active-controlled trials (ACTs) versus placebo-controlled trials (PCTs) of new antihypertensive drugs. DESIGN AND SETTING: Nationwide mailed survey, with telephone contact of nonresponders to assess nonresponse bias. PARTICIPANTS: One thousand two hundred primary care physicians randomly selected from the American Medical Association's Master File. Of 1,154 physicians eligible to respond, 651 (56.4%) returned completed questionnaires. MEASUREMENTS AND MAIN RESULTS: We measured physicians' stated willingness to encourage hypertensive patients to enroll in ACTs and PCTs of new antihypertensive drugs, their views of the relative merits of ACTs versus PCTs, their stated willingness to prescribe new drugs tested in ACTs or PCTs, and their views regarding the overall justifiability of the 2 designs. Physicians were significantly more likely to indicate they would encourage their patients to enroll in ACTs than in PCTs (P <.0001). Physicians thought ACTs provided more valuable information for their practices, were more likely to lead to a public health benefit, offered enrolled patients greater opportunity for personal benefit, and were less likely to expose enrolled patients to unnecessary risks (all P <.0001). Physicians were more likely to prescribe new drugs that had been compared in ACTs (P <.0001), and viewed ACTs as a more justifiable method for testing new antihypertensive drugs (P <.0001). There was no evidence of nonresponse bias for these main results. CONCLUSIONS: Although PCTs remain the standard method for testing new antihypertensive drugs, physicians strongly prefer ACTs. Using ACTs to test new antihypertensive drugs may enhance the efficiency of patient recruitment and more strongly influence physicians' prescribing practices.

Authors
Halpern, SD; Ubel, PA; Berlin, JA; Townsend, RR; Asch, DA
MLA Citation
Halpern, SD, Ubel, PA, Berlin, JA, Townsend, RR, and Asch, DA. "Physicians' preferences for active-controlled versus placebo-controlled trials of new antihypertensive drugs." J Gen Intern Med 17.9 (September 2002): 689-695.
PMID
12220365
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
17
Issue
9
Publish Date
2002
Start Page
689
End Page
695

Exploring the role of order effects in person trade-off elicitations.

BACKGROUND: The person trade-off (PTO) has been advocated by some as an alternative measure for the purposes of cost-effectiveness analyses. However, the measurement properties of PTO elicitations are still being defined. METHODS: We presented subjects with two PTO scenarios. In the pre-existing paraplegia scenario, they were asked how many paraplegics' lives would have to be saved to be just as important as saving 100 'normal' people's lives. In the paraplegia onset scenario, they were asked how many patients who would experience the onset of paraplegia need to be saved to equal the benefit of saving 100 'normal' lives. We varied the order of the two scenarios across subjects to test whether PTO elicitations are susceptible to order effects. In addition, we varied whether subjects were required to provide a numerical response to the first elicitation. RESULTS: Subjects' PTO indifference points for the two scenarios varied dramatically depending on the order with which they received the scenarios, and according to whether the first elicitation required a numerical response. For those subjects providing numerical responses to both elicitations, median PTO responses varied by a factor of close to two in the pre-existing paraplegia scenario and by a factor of eight in the paraplegia onset scenario. However, the magnitude of the order effect was significantly reduced when subjects were not asked to provide a numerical response to the first PTO elicitation. CONCLUSION: PTO elicitations are susceptible to order effects. These order effects are partly due to numerical anchoring. However, other cognitive factors contribute to the order effect. Further research should clarify whether these order effects can be reduced.

Authors
Ubel, PA; Richardson, J; Baron, J
MLA Citation
Ubel, PA, Richardson, J, and Baron, J. "Exploring the role of order effects in person trade-off elicitations." Health Policy 61.2 (August 2002): 189-199.
PMID
12088891
Source
pubmed
Published In
Health Policy
Volume
61
Issue
2
Publish Date
2002
Start Page
189
End Page
199

Solid-organ transplantation in HIV-infected patients.

Authors
Halpern, SD; Ubel, PA; Caplan, AL
MLA Citation
Halpern, SD, Ubel, PA, and Caplan, AL. "Solid-organ transplantation in HIV-infected patients." N Engl J Med 347.4 (July 25, 2002): 284-287.
PMID
12140307
Source
pubmed
Published In
The New England journal of medicine
Volume
347
Issue
4
Publish Date
2002
Start Page
284
End Page
287
DOI
10.1056/NEJMsb020632

Interest in BRCA1/2 testing in a primary care population.

BACKGROUND: Mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 are found in less than 1/1,000 women in the general population. Experts and professional organizations recommend targeting testing to women with risk factors for carrying a mutation. Over the next decade, BRCA1/2 testing is likely to become substantially less expensive and to move into primary care practice where pretest counseling may be limited. METHODS: The objective of the study was to investigate the factors associated with interest in BRCA1/2 testing among primary care patients receiving only limited information about testing. The design was a cross-sectional mailed survey. The setting was a University-based health system in the metropolitan Philadelphia region. The participants were 400 adult women cared for in a faculty General Internal Medicine practice. RESULTS: Two hundred forty-two women (71%) completed surveys; 53% of respondents were aware of BRCA1/2 testing and 58% were interested in undergoing testing if it was both convenient and affordable. Thirty-one percent were both aware of and interested in testing. Awareness of testing was inversely associated with African-American race (OR 0.56, 95% CI 0.38-0.83) and positively associated with college education (OR 2.21, 95% CI 1.23-3.94). Interest in testing was inversely associated with a family history of breast cancer (OR 0.45, 95% CI 0.23-0.92) and increasing age (OR 0.97, 95% CI 0.95-0.99). The inverse association between family history and interest in testing persisted in the subgroup of women who were aware of testing (OR 0.55, 95% CI 0.30-0.98). CONCLUSIONS: Among a primary care population, African-American women are less aware of BRCA1/2 testing and, when provided only limited information about BRCA1/2 testing, women at lowest risk of carrying a mutation are most interested in undergoing BRCA1/2 testing. Challenges of moving BRCA1/2 testing into primary care practice include both limiting indiscriminate use by the "worried well" and, as proven cancer prevention strategies become available, ensuring access to all high-risk women regardless of race.

Authors
Armstrong, K; Weber, B; Ubel, PA; Guerra, C; Schwartz, JS
MLA Citation
Armstrong, K, Weber, B, Ubel, PA, Guerra, C, and Schwartz, JS. "Interest in BRCA1/2 testing in a primary care population." Prev Med 34.6 (June 2002): 590-595.
PMID
12052018
Source
pubmed
Published In
Preventive Medicine
Volume
34
Issue
6
Publish Date
2002
Start Page
590
End Page
595
DOI
10.1006/pmed.2002.1022

Fear of litigation may increase resuscitation of infants born near the limits of viability.

OBJECTIVES: To explore how fear of litigation influences neonatal treatment decisions. STUDY DESIGN: In a mailed survey, we presented a hypothetical vignette of a premature infant to 1000 neonatologists. We asked them to estimate prognosis, indicate appropriate intervention, and respond to parental treatment requests. Subjects were randomly assigned to receive one of two questionnaires, "litigious" or "nonlitigious," which differed only in the description of the infant's parents. RESULTS: The response rate was 63.0%. The vast majority of respondents deferred to parental requests rather than adhering to their best judgment. They deferred whether or not parents requested treatment and whether or not parents were described as litigious (P <.0001). Among those respondents who shifted their resuscitation opinion after parental introduction, respondents to the nonlitigious version were more likely to shift their opinion from "treat" to "do not treat" after parental requests to "use your best judgment" (P <.042). The influence of parental litigiousness was primarily seen among neonatologists who thought that the infant's prognosis was dismal (P <.044). CONCLUSIONS: There is a strong disposition among neonatologists toward respecting parental wishes. This disposition is stronger when neonatologists are given additional reason to be concerned about litigation.

Authors
Ballard, DW; Li, Y; Evans, J; Ballard, RA; Ubel, PA
MLA Citation
Ballard, DW, Li, Y, Evans, J, Ballard, RA, and Ubel, PA. "Fear of litigation may increase resuscitation of infants born near the limits of viability." J Pediatr 140.6 (June 2002): 713-718.
PMID
12072875
Source
pubmed
Published In
The Journal of Pediatrics
Volume
140
Issue
6
Publish Date
2002
Start Page
713
End Page
718
DOI
10.1067/mpd.2002.124184

The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?

BACKGROUND: Some physicians are willing to misrepresent clinical information to insurance companies to circumvent appeals processes. Whether characteristics of appeals processes affect the likelihood of misrepresentation is unknown. This study sought to determine the relationship between the likelihood of a successful appeal, appeals process length, and severity of the health condition and physicians' willingness to sanction deception. METHODS: A random sample of 1617 physicians was surveyed by mail to assess their willingness to accept an insurance company restriction, to appeal the restriction, or to misrepresent the facts to an insurance company to obtain coverage for a patient. RESULTS: Most respondents would appeal (77%) rather than accept (12%) or misrepresent (11%) regarding a restriction on medically necessary care. Physicians' decisions were related to the likelihood of a successful appeal (chi(2) = 7.56; P =.02), the appeals process length (chi(2) = 8.53; P =.01), and the severity of the medical condition (chi(2) = 71.10; P<.001). A small but significantly larger number of physicians chose to misrepresent the facts to an insurer as the appeals process became more cumbersome. Among physicians asked about severe angina, their decisions were particularly affected by the hassle associated with appealing, being more likely to choose to misrepresent the facts to the insurer than to appeal as the hassle increased. CONCLUSIONS: Physicians are more willing to sanction deception when the appeals process is longer, the likelihood of a successful appeal is lower, and the health condition is more severe. Changes in the difficulty of appeals processes may ease the tensions physicians face regarding patient advocacy and honesty.

Authors
Werner, RM; Alexander, GC; Fagerlin, A; Ubel, PA
MLA Citation
Werner, RM, Alexander, GC, Fagerlin, A, and Ubel, PA. "The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?." Arch Intern Med 162.10 (May 27, 2002): 1134-1139.
PMID
12020183
Source
pubmed
Published In
Archives of internal medicine
Volume
162
Issue
10
Publish Date
2002
Start Page
1134
End Page
1139

"What should I do, doc?": Some psychologic benefits of physician recommendations.

Authors
Ubel, PA
MLA Citation
Ubel, PA. ""What should I do, doc?": Some psychologic benefits of physician recommendations." Arch Intern Med 162.9 (May 13, 2002): 977-980.
PMID
11996605
Source
pubmed
Published In
Archives of internal medicine
Volume
162
Issue
9
Publish Date
2002
Start Page
977
End Page
980

The role of physicians' recommendations in medical treatment decisions.

BACKGROUND: A shift away from the medical paternalism of the past has occurred, and today, the law and ethics advocate that physicians share decision-making responsibility with their patients. It is unclear, however, what the appropriate role of physicians' recommendations ought to be in this new shared decision-making paradigm. One way to approach this question is to assess the influence of physicians' recommendations. OBJECTIVE: In this study, the authors examine the influence of physicians' recommendations on hypothetical treatment decisions. Do physicians' recommendations influence treatment decisions in scenarios where the decision that maximizes health is obvious and apparent to subjects? Do recommendations pull subjects away from the treatment choice that they otherwise prefer (based on their decision when unaware of the physicians' recommendation)? DESIGN: An experimental web questionnaire presented hypothetical medical treatment scenarios in which the treatment choice that maximized health was obvious. Across scenarios, the authors varied physicians' recommendations in 3 ways: (1) physicians' recommendations supporting what maximized health, (2) physicians' recommendations that went against what maximized health, and (3) no physicians' recommendation. The participants were 102 volunteers. RESULTS: Hypothetical treatment decisions were significantly influenced by physicians'recommendations (P < 0.0001), and physicians'recommendations against the decision that maximized health pulled subjects away from the treatment decision that they made when no recommendation was given (P < 0.0001). CONCLUSION: Physicians' recommendations can lead people to make decisions that go against what is best and against what they would otherwise prefer. Physicians must take care in making recommendations and should incorporate patient preferences into their recommendations.

Authors
Gurmankin, AD; Baron, J; Hershey, JC; Ubel, PA
MLA Citation
Gurmankin, AD, Baron, J, Hershey, JC, and Ubel, PA. "The role of physicians' recommendations in medical treatment decisions." Med Decis Making 22.3 (May 2002): 262-271.
PMID
12058783
Source
pubmed
Published In
Medical Decision Making
Volume
22
Issue
3
Publish Date
2002
Start Page
262
End Page
271
DOI
10.1177/0272989X0202200314

Effect of framing as gain versus loss on understanding and hypothetical treatment choices: survival and mortality curves.

BACKGROUND: Presentation of information using survival or mortality (i.e., incidence) curves offers a potentially powerful method of communication because such curves provide information about risk over time in a relatively simple graphic format. However, the effect of framing as survival versus mortality on understanding and treatment choice is not known. METHODS: In this study, 451 individuals awaiting jury duty at the Philadelphia City Courthouse were randomized to receive 1 of 3 questionnaires: (1) survival curves, (2) mortality curves, or (3) both survival and mortality curves. Each questionnaire included a brief description of a hypothetical treatment decision, survival curve graphs and/or mortality curve graphs presenting the outcome of the treatment, and questions measuring understanding of the information contained in the graphs and preference for undergoing treatment. After completing a brief practice exercise, participants were asked to answer questions assessing their ability to interpret single points on a curve and the difference between curves, and then to decide whether they would choose to undergo preventive surgery for 3 different scenarios in which the benefit of surgery varied. RESULTS: Participants who received only survival curves or who received both survival and mortality curves were significantly more accurate in answering questions about the information than participants who received only mortality curves (P < 0.05). For 2 of the 3 treatment presentations, participants who received only mortality curves were significantly less likely to prefer preventive surgery than participants who received survival curves only or both survival and mortality curves (P < 0.05). The effect of framing on understanding was greatest among participants with less than a college education and among non-Caucasian participants. CONCLUSION: Framing graphic risk information as chance of death over time results in lower levels of understanding and less interest in preventive surgery than framing as chance of survival over time.

Authors
Armstrong, K; Schwartz, JS; Fitzgerald, G; Putt, M; Ubel, PA
MLA Citation
Armstrong, K, Schwartz, JS, Fitzgerald, G, Putt, M, and Ubel, PA. "Effect of framing as gain versus loss on understanding and hypothetical treatment choices: survival and mortality curves." Med Decis Making 22.1 (January 2002): 76-83.
PMID
11833668
Source
pubmed
Published In
Medical Decision Making
Volume
22
Issue
1
Publish Date
2002
Start Page
76
End Page
83
DOI
10.1177/0272989X0202200108

Organ transplantation in HIV-infected patients [3] (multiple letters)

Authors
Wright, CE; Bowers, VD; Halkic, N; Bally, F; Gillet, M; Krishnan, A; Molina, A; Forman, SJ; Halpern, SD; Ubel, PA; Caplan, AL
MLA Citation
Wright, CE, Bowers, VD, Halkic, N, Bally, F, Gillet, M, Krishnan, A, Molina, A, Forman, SJ, Halpern, SD, Ubel, PA, and Caplan, AL. "Organ transplantation in HIV-infected patients [3] (multiple letters)." New England Journal of Medicine 347.22 (2002): 1801-1803.
PMID
12462231
Source
scival
Published In
New England Journal of Medicine
Volume
347
Issue
22
Publish Date
2002
Start Page
1801
End Page
1803
DOI
10.1056/NEJM200211283472215

Randomized trial of $5 versus $10 monetary incentives, envelope size, and candy to increase physician response rates to mailed questionnaires

BACKGROUND. The validity of the results of mailed surveys is often threatened by nonresponse bias, which is made more likely when response rates are low. However, the effectiveness and cost-effectiveness of several strategies to increase response rates are uncertain. OBJECTIVES. To assess three strategies to increase response rates to mailed physician surveys: including a $10 versus a $5 cash incentive in the initial mailing, including a mint candy or not, and using a large versus small outgoing envelope. RESEARCH DESIGN AND SUBJECTS. Using a 2 × 2 × 2 factorial design, a randomized trial of these strategies was conducted in a survey of 1200 physicians randomly selected from the American Medical Association's Master File. RESULTS. Including a $10 incentive yielded a significantly higher response rate (60.5% vs. 52.8%) (P = 0.009). The mailing and incentive costs per completed response were $12.24 (95% CI, $11.75, $13.64) in the $5 group and $18.48 (95% CI, $17.77, $20.69) in the $10 group. Each additional response obtained in the $10 group came at an incremental cost of $61.26 (95% CI, $36.98, $200.80). Neither inclusion of a mint nor use of a large envelope influenced the response rate. CONCLUSIONS. Investigators may increase response rates by including more money in the initial questionnaire packet, but there may be diminishing returns to serial increments in incentives greater than $5. Including smaller incentives in more questionnaires may maximize total responses. © 2002 Lippincott Williams & Wilkins, Inc.

Authors
Halpern, SD; Ubel, PA; Berlin, JA; Asch, DA
MLA Citation
Halpern, SD, Ubel, PA, Berlin, JA, and Asch, DA. "Randomized trial of $5 versus $10 monetary incentives, envelope size, and candy to increase physician response rates to mailed questionnaires." Medical Care 40.9 (2002): 834-839.
PMID
12218773
Source
scival
Published In
Medical Care
Volume
40
Issue
9
Publish Date
2002
Start Page
834
End Page
839
DOI
10.1097/00005650-200209000-00012

Types of inconsistency in health-state utility judgments

In making judgments of health-related quality of life, respondents often compare the relative magnitude of two intervals between health states, such as the interval between normal health and blindness compared to that between normal health and death. We examined two ways of comparing such intervals: person-trade-off (PTO)-in which the judgment concerns matching numbers of people so that two changes are equivalent and direct judgment of the ratio. Both measures showed ratio inconsistency (a ratio that should be the product of two other ratios is too high) and superadditivity (two ratios that should add to 1 are too high). Some responses in both methods implied that two intervals which should have been different (because they shared a top or bottom point, but differed on the other point) were nevertheless viewed by subjects as being of equal size. These equality responses were more common when death was the bottom (worse end) of both intervals being compared (e.g., the interval between death and blindness is perceived as being the same size as the interval between death and normal health) than when any other condition was at the bottom or when the condition common to the two intervals was at the top. A second experiment indicated that subjects really do consider the intervals to be equal Our findings argue for giving subjects a chance to reflect on such apparent inconsistencies in practical utility elicitation. © 2002 Elsevier Science (USA). All rights reserved.

Authors
Baron, J; Ubel, PA
MLA Citation
Baron, J, and Ubel, PA. "Types of inconsistency in health-state utility judgments." Organizational Behavior and Human Decision Processes 89.2 (2002): 1100-1118.
Source
scival
Published In
Organizational Behavior and Human Decision Processes
Volume
89
Issue
2
Publish Date
2002
Start Page
1100
End Page
1118
DOI
10.1016/S0749-5978(02)00019-5

Physicians' willingness to participate in the process of lethal injection for capital punishment.

BACKGROUND: It has been found that physicians condone colleague involvement in capital punishment. Physicians' own willingness to participate has not been explored. OBJECTIVE: To examine physicians' willingness to be involved in cases of capital punishment. DESIGN: Survey exploring physicians' willingness to participate in 10 aspects of capital punishment by lethal injection, 8 of which are disallowed by the American Medical Association. SETTING: United States. PARTICIPANTS: 1000 randomly selected practicing physicians. MEASUREMENTS: Questions assessing willingness to be involved in and attitudes toward capital punishment. RESULTS: 41% of respondents indicated that they would perform at least one action disallowed by the American Medical Association; 25% would perform five or more disallowed actions. Perceived duty to society (P < 0.001), approval of the death penalty (P < 0.001), and approval of assisted suicide (P = 0.015) correlated with increased willingness to perform disallowed actions. Only 3% of respondents knew of any guidelines on this issue. CONCLUSIONS: Despite medical society policies, many physicians would be willing to be involved in the execution of adults. The medical profession needs to be better informed about the ethical issues involved in physician participation in capital punishment.

Authors
Farber, NJ; Aboff, BM; Weiner, J; Davis, EB; Boyer, EG; Ubel, PA
MLA Citation
Farber, NJ, Aboff, BM, Weiner, J, Davis, EB, Boyer, EG, and Ubel, PA. "Physicians' willingness to participate in the process of lethal injection for capital punishment." Ann Intern Med 135.10 (November 20, 2001): 884-888.
PMID
11712878
Source
pubmed
Published In
Annals of internal medicine
Volume
135
Issue
10
Publish Date
2001
Start Page
884
End Page
888

Between two worlds medical student perceptions of humor and slang in the hospital setting.

OBJECTIVE: Residents frequently use humor and slang at the expense of patients on the clinical wards. We studied how medical students react to and interpret the "appropriateness" of derogatory and cynical humor and slang in a clinical setting. DESIGN: Semistructured, in-depth interviews. SETTING: Informal meeting spaces. PARTICIPANTS: Thirty-three medical students. MEASUREMENTS: Qualitative content analysis of interview transcriptions. MAIN RESULTS: Students' descriptions of the humorous stories and their responses reveal that students are able to take the perspective of both outsiders and insiders in the medical culture. Students' responses to these stories show that they can identify the outsider's perspective both by seeing themselves in the outsider's role and by identifying with patients. Students can also see the insider's perspective, in that they identify with residents' frustrations and disappointments and therefore try to explain why residents use this kind of humor. Their participation in the humor and slang--often with reservations--further reveals their ability to identify with the perspective of an insider. CONCLUSIONS: Medical students describe a number of conflicting reactions to hospital humor that may enhance and exacerbate tensions that are already an inevitable part of training for many students. This phenomenon requires greater attention by medical educators.

Authors
Parsons, GN; Kinsman, SB; Bosk, CL; Sankar, P; Ubel, PA
MLA Citation
Parsons, GN, Kinsman, SB, Bosk, CL, Sankar, P, and Ubel, PA. "Between two worlds medical student perceptions of humor and slang in the hospital setting." J Gen Intern Med 16.8 (August 2001): 544-549.
PMID
11556931
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
16
Issue
8
Publish Date
2001
Start Page
544
End Page
549

The Author Responds: Putting Bedside Rationing Back into Perspective

Authors
Ubel, P
MLA Citation
Ubel, P. "The Author Responds: Putting Bedside Rationing Back into Perspective." HealthcarePapers 2.2 (July 15, 2001): 69-75.
Source
crossref
Published In
HealthcarePapers
Volume
2
Issue
2
Publish Date
2001
Start Page
69
End Page
75
DOI
10.12927/hcpap.2001.17461

Who will enroll? Predicting participation in a phase II AIDS vaccine trial.

BACKGROUND: The problems of underenrollment and selective enrollment may undermine AIDS vaccine trials. If prospective study subjects' stated willingness to participate (WTP) in hypothetical vaccine trials predicts future enrollment, then measuring WTP before recruitment may enhance the enrollment in, and ethics of, such trials. METHODS: We prospectively studied changes over an 18-month period in the stated WTP in, and knowledge of, a hypothetical AIDS vaccine trial among 610 Philadelphia residents at high risk for HIV infection. Of these people, 499 were subsequently recruited to participate in an actual, phase II AIDS vaccine trial. We used multivariable logistic regression and the area under the receiver-operating characteristic (ROC) curve to model predictors of actual enrollment. RESULTS: Actual enrollment rates were 8.3%, 6.8%, 15.8%, and 29.0% among those who had initially said they were "definitely not," "probably not," "probably," and "definitely" willing to participate, respectively (p =.006). The area under the ROC curve was 0.65, indicating a modest ability of stated WTP to differentiate those who enroll from those who do not. Knowledge of basic vaccine trial concepts, though unrelated to enrollment, increased over an 18-month period with repeated education sessions (p <.0001), whereas stated WTP declined over this same period (p <.0001). CONCLUSION: Although other factors not captured by stated WTP may also influence future enrollment, prospectively assessing stated WTP may augment the validity of the informed consent process, help prevent underenrollment, and clarify the population from which the study sample is drawn.

Authors
Halpern, SD; Metzger, DS; Berlin, JA; Ubel, PA
MLA Citation
Halpern, SD, Metzger, DS, Berlin, JA, and Ubel, PA. "Who will enroll? Predicting participation in a phase II AIDS vaccine trial." J Acquir Immune Defic Syndr 27.3 (July 1, 2001): 281-288.
PMID
11464149
Source
pubmed
Published In
Journal of Acquired Immune Deficiency Syndromes
Volume
27
Issue
3
Publish Date
2001
Start Page
281
End Page
288

Using survival curve comparisons to inform patient decision making can a practice exercise improve understanding?

BACKGROUND: Patients often face medical decisions that involve outcomes that occur and change over time. Survival curves are a promising communication tool for patient decision support because they present information about the probability of an outcome over time in a simple graphic format. However, previous studies of survival curves did not measure comprehension, used face-to-face explanations, and focused on a VA population. METHODS: In this study, 246 individuals awaiting jury duty at the Philadelphia County Courthouse were randomized to receive one of two questionnaires. The control group received a questionnaire describing two hypothetical treatments and a graph with two survival curves showing the outcomes of each treatment. The practice group received the same questionnaire preceded by a practice exercise asking questions about a graph containing a single curve. Subjects' ability to interpret survival from a curve and ability to calculate change in survival over time were measured. RESULTS: Understanding of survival at a single point in time from a graph containing two survival curves was high overall, and was improved by the use of a single curve practice exercise. With a practice exercise, subjects were over 80% accurate in interpreting survival at a single point in time. Understanding of changes in survival over time was lower overall, and was not improved by the use of a practice exercise. With or without a practice exercise, subjects were only 55% accurate in calculating changes in survival. CONCLUSION: The majority of the general public can interpret survival at a point in time from self-administered survival curves. This understanding is improved by a single curve practice exercise. However, a significant proportion of the general public cannot calculate change in survival over time. Further research is necessary to determine the effectiveness of survival curves in improving risk communication and patient decision making.

Authors
Armstrong, K; FitzGerald, G; Schwartz, JS; Ubel, PA
MLA Citation
Armstrong, K, FitzGerald, G, Schwartz, JS, and Ubel, PA. "Using survival curve comparisons to inform patient decision making can a practice exercise improve understanding?." J Gen Intern Med 16.7 (July 2001): 482-485.
PMID
11520387
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
16
Issue
7
Publish Date
2001
Start Page
482
End Page
485

Revising a priority list based on cost-effectiveness: the role of the prominence effect and distorted utility judgments.

BACKGROUND: People sometimes object to the results of cost-effectiveness analysis when the analysis produces a ranking of options based on both cost and benefit. We suggest 2 new reasons for these objections: the prominence effect, in which people attend mostly to a more prominent attrbute (benefit as opposed to cost), and distortion of utility judgments. METHOD: We simulated the production of a cost-effectiveness ranking list in 3 experiments using questionnaires on the World Wide Web. Subjects rated the utility of 16 health benefits using either rating scale or person trade-off elicitation methods. In some experiments, subjects were asked to rate the utility of the health benefits with attention also to the cost of achieving the benefits. In all experiments, at the end, subjects were shown a priority list based on their own utility judgments and were asked whether they wanted to move any of the health benefits up or down the list. RESULTS: In all experiments, subjects wanted to give higher priority to treatments with higher benefit, even when they also had higher cost. They thus wanted to give less weight to high cost (which would, by itself, lead to lower ranking) and more weight to benefit than the weight implied by their own prior judgments. The desire for revision was reduced when subjects made their utility judgments after indicating whether the utility was above or below the midpoint of the scale (a manipulation previously found to reduce distortion). CONCLUSION: The desire to change cost-effectiveness rankings is in part a preference reversal phenomenon that occurs because people attend mainly to the benefit of health interventions as opposed to cost, when they examine the ranking. People should be wary of tinkering with priority lists by examining the lists themselves.

Authors
Baron, J; Ubel, PA
MLA Citation
Baron, J, and Ubel, PA. "Revising a priority list based on cost-effectiveness: the role of the prominence effect and distorted utility judgments." Med Decis Making 21.4 (July 2001): 278-287.
PMID
11475384
Source
pubmed
Published In
Medical Decision Making
Volume
21
Issue
4
Publish Date
2001
Start Page
278
End Page
287
DOI
10.1177/0272989X0102100403

Allocation of transplantable organs: do people want to punish patients for causing their illness?

Some people believe patients with alcoholic cirrhosis should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) are personally responsible for causing their own illnesses, (2) have poor transplant prognoses, or (3) are unworthy because they have engaged in socially undesirable behavior. We explore the roles that social desirability and personal responsibility have in people's judgments about transplant allocation. We presented prospective jurors with 4 scenarios, asking them to distribute 100 transplantable organs among 2 groups of 100 patients each. In each scenario, 1 group of patients, but not the other, was described as having a history of unhealthy behavior (alcohol or cigarette use) associated with a poorer prognosis. In some scenarios, alcohol or cigarette use was said to cause the organ failure. In others, it only contributed to the patients' transplant prognosis. We also obtained self-reports of subjects' own smoking status. Subjects allocated significantly fewer than half the organs to those with unhealthy behaviors and worse prognoses (33%; P <.001), but the specific behavior (alcohol versus cigarette use) was not significantly associated with subjects' allocation choices. Significantly fewer organs were allocated to patients with behavior responsible for causing their diseases than to other patients (P <.0001). Subjects who never smoked discriminated the most and current smokers discriminated the least against patients with a history of unhealthy behavior (P <.0001). The public's transplantation allocation preferences are influenced by whether patients' behaviors are said to have caused their organ failure.

Authors
Ubel, PA; Jepson, C; Baron, J; Mohr, T; McMorrow, S; Asch, DA
MLA Citation
Ubel, PA, Jepson, C, Baron, J, Mohr, T, McMorrow, S, and Asch, DA. "Allocation of transplantable organs: do people want to punish patients for causing their illness?." Liver Transpl 7.7 (July 2001): 600-607.
PMID
11460227
Source
pubmed
Published In
Liver Transplantation
Volume
7
Issue
7
Publish Date
2001
Start Page
600
End Page
607
DOI
10.1053/jlts.2001.25361

Truth in the most optimistic way.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Truth in the most optimistic way." Ann Intern Med 134.12 (June 19, 2001): 1142-1143.
PMID
11412055
Source
pubmed
Published In
Annals of internal medicine
Volume
134
Issue
12
Publish Date
2001
Start Page
1142
End Page
1143

Do nonpatients underestimate the quality of life associated with chronic health conditions because of a focusing illusion?

BACKGROUND: A number of studies show that the general public often estimates that the quality of life (QOL) associated with various health conditions is worse than patients say it is. These studies raise the possibility that people overestimate the impact that unfamiliar health conditions will have on their quality of life. One possible reason people overestimate this is because they are susceptible to a focusing illusion--when asked to imagine themselves in unfamiliar circumstances, people overestimate the emotional impact of those features of their life that would change. METHODS: The authors surveyed members of the general public to test the hypothesis that their QOL ratings of hypothetical health conditions would be higher (indicating a better quality of life) after thinking about how the health condition would affect a broad range of life domains. Across 3 experiments, the authors varied the health conditions people were asked to consider (either paraplegia, below-the-knee amputation, or partial blindness), the life domains they were asked to consider, the response mode with which they evaluated how each health condition would affect each life domain, whether subjects rated the health condition before and after considering life domains or only after, and whether subjects rated their own current quality of life first. RESULTS: Across 3 experiments, using 10 different questionnaire versions, only 1 instance was found in which subjects' ratings were significantly higher after thinking about the effect of the health condition on life domains than before, and the magnitude of this increase was small. CONCLUSION: It could not be established that a focusing illusion contributes significantly to the discrepancy in QOL ratings of patients and nonpatients. Further research should explore other factors that could contribute to the discrepancy or other ways of testing for the influence of a focusing illusion.

Authors
Ubel, PA; Loewenstein, G; Hershey, J; Baron, J; Mohr, T; Asch, DA; Jepson, C
MLA Citation
Ubel, PA, Loewenstein, G, Hershey, J, Baron, J, Mohr, T, Asch, DA, and Jepson, C. "Do nonpatients underestimate the quality of life associated with chronic health conditions because of a focusing illusion?." Med Decis Making 21.3 (May 2001): 190-199.
PMID
11386626
Source
pubmed
Published In
Medical Decision Making
Volume
21
Issue
3
Publish Date
2001
Start Page
190
End Page
199
DOI
10.1177/0272989X0102100304

Preference for equity as a framing effect.

BACKGROUND: In previous studies, the authors found that most people, given a fixed budget, would rather offer a less effective screening test to 100% of a Medicaid population than a more effective test to 50% of the population. In a subsequent study, the authors found that the number of people preferring the less effective screening test was dramatically reduced when the percentage of Medicaid enrollees receiving it was less than 100. In this article, 2 new studies are reported that explore whether people's preferences for equity versus efficiency are susceptible to a framing effect. METHODS: In 2 studies, the authors presented subjects with multiple scenarios involving screening tests that vary in the proportion of people who could receive the tests within a budget constraint and the number of people whose lives each test would save. Across scenarios, the proportion of Medicaid enrollees who could receive each test was varied, as was the question of whether scenarios involved Medicaid enrollees from the same or a different state. In addition, the authors varied the order in which subjects received the scenarios. RESULTS: In the 1st study, people's preferences for equity over efficiency varied significantly depending on the way situations were framed. Preference for equity was stronger when the more widely distributed choice covered the entire population than when it covered only half the population (P < 0.001). In addition, people's preferences were susceptible to order effects, with preference for equity being significantly stronger when the 1st scenario received by subjects involved 1 screening test that could be offered to the entire population (P < 0.001). In the 2nd study, preferences for equity over efficiency diminished even when the different framings were descriptions of identical circumstances--preference for equity was significantly reduced when the population to be screened was framed broadly, in terms of the percentage of patients across 2 states who could receive testing rather than narrowly, in terms of the percentages of patients in 1 state who could receive testing (P = 0.04). CONCLUSION: Policy planners should be careful about accepting public preferences for equity over efficiency at face value, because such preferences can be dramatically influenced by framing effects and order effects.

Authors
Ubel, PA; Baron, J; Asch, DA
MLA Citation
Ubel, PA, Baron, J, and Asch, DA. "Preference for equity as a framing effect." Med Decis Making 21.3 (May 2001): 180-189.
PMID
11386625
Source
pubmed
Published In
Medical Decision Making
Volume
21
Issue
3
Publish Date
2001
Start Page
180
End Page
189
DOI
10.1177/0272989X0102100303

Money talks, patients walk?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Money talks, patients walk?." J Gen Intern Med 16.3 (March 2001): 204-205.
PMID
11318917
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
16
Issue
3
Publish Date
2001
Start Page
204
End Page
205

Rationing HIV medications: what do patients and the public think about allocation policies?

BACKGROUND: New medications for treating HIV/AIDS are effective, but expensive, and funding shortfalls have led many state AIDS Drug Assistance Programs (ADAPs) to ration these drugs. Little is known about the views of those most directly affected by rationing policies. This study explores attitudes of patients with HIV and the general public toward specific rationing strategies. METHODS: A Likert-style, self-administered questionnaire about rationing expensive HIV medications in the context of a budget shortfall was administered to patients with HIV and shopping mall patrons in central Pennsylvania. Subjects were asked how much they agreed or disagreed with seven drug rationing policies. RESULTS: In all, 100 patients and 101 shoppers completed the survey (response rate = 89%). A majority in both groups "strongly" or "somewhat" disagreed with six of the seven rationing policies described, and patients more strongly disagreed with the policies than did the public. The five policies actually used by state ADAPs (first come first serve, limiting expensive medicines, limiting new patient enrollment, giving the expensive medicines to the sickest, using a spending cap) lacked support in either group. CONCLUSIONS: HIV drug rationing policies currently in use do not reflect the preferences of patients and the public. Integrating the views of those affected by the rationing decisions would raise difficult challenges to current programs.

Authors
Green, MJ; Fong, S; Mauger, DT; Ubel, PA
MLA Citation
Green, MJ, Fong, S, Mauger, DT, and Ubel, PA. "Rationing HIV medications: what do patients and the public think about allocation policies?." J Acquir Immune Defic Syndr 26.1 (January 1, 2001): 56-62.
PMID
11176269
Source
pubmed
Published In
Journal of Acquired Immune Deficiency Syndromes
Volume
26
Issue
1
Publish Date
2001
Start Page
56
End Page
62

Measuring patient expectations: does the instrument affect satisfaction or expectations?

BACKGROUND: Fulfillment of patients' expectations may influence health care utilization, affect patient satisfaction, and be used to indicate quality of care. Several different instruments have been used to measure expectations, yet little is known about how different assessment methods affect outcomes. OBJECTIVE: The object of the study was to determine whether different measurement instruments elicit different numbers and types of expectations and different levels of patient satisfaction. DESIGN: Patients waiting to see their physician were randomly assigned to receive 1 of 2 commonly used instruments assessing expectations or were assigned to a third (control) group that was not asked about expectations. After the visit, patients in all 3 groups were asked about their satisfaction and services they received. SUBJECTS: The study subjects were 290 male, primary care outpatients in a VA general medicine clinic. MEASURES: A "short" instrument asked about 3 general expectations for tests, referrals, and new medications, while a "long" instrument nested similar questions within a more detailed list. Wording also differed between the 2 instruments. The short instrument asked patients what they wanted; the long instrument asked patients what they thought was necessary for the physician to do. Satisfaction was measured with a visit-specific questionnaire and a more general assessment of physician interpersonal skills. RESULTS: Patients receiving the long instrument were more likely to express expectations for tests (83% vs. 28%, P <0.001), referrals (40% vs. 18%, P <0.001), and new medications (45% vs. 28%, P <0.001). The groups differed in the number of unmet expectations: 40% of the long instrument group reported at least 1 unmet expectation compared with 19% of the short instrument group (P <0.001). Satisfaction was similar among the 3 groups. CONCLUSIONS: These different instruments elicit different numbers of expectations but do not affect patient satisfaction.

Authors
Peck, BM; Asch, DA; Goold, SD; Roter, DL; Ubel, PA; McIntyre, LM; Abbott, KH; Hoff, JA; Koropchak, CM; Tulsky, JA
MLA Citation
Peck, BM, Asch, DA, Goold, SD, Roter, DL, Ubel, PA, McIntyre, LM, Abbott, KH, Hoff, JA, Koropchak, CM, and Tulsky, JA. "Measuring patient expectations: does the instrument affect satisfaction or expectations?." Med Care 39.1 (January 2001): 100-108.
PMID
11176547
Source
pubmed
Published In
Medical Care
Volume
39
Issue
1
Publish Date
2001
Start Page
100
End Page
108

Barriers to influenza immunization in a low-income urban population.

BACKGROUND: Although influenza immunization significantly reduces mortality from influenza, over one third of elderly Americans are not immunized each year. Low rates of immunization are particularly concerning among African-American low-income populations. Preliminary interviews suggested that fear of undisclosed ingredients in the influenza vaccine may impede vaccine acceptance in this vulnerable population. OBJECTIVES: To assess the role of concern about vaccine contents and other factors in the use of influenza immunization among a predominantly African-American low-income urban population. METHODS: Cross-sectional, health-system-population-based, telephone survey of a random sample of West Philadelphia residents aged > or =65 years. RESULTS: Of 659 eligible individuals, 486 (73.8%) were successfully interviewed. Concern about undisclosed shot contents was reported by 132 (20%) respondents and was inversely associated with vaccine receipt (OR 0. 49, 95% CI 0.26-0.91). This association was similar among African Americans and Caucasians. In addition, receipt of influenza vaccine was inversely associated with belief that immunization is inconvenient (OR 0.14, 95% CI 0.05-0.36), belief that immunization is painful (OR 0.21, 95% CI 0.08-0.54), and history of previous side effects (OR 0.33, 95% CI 0.18-0.60), and positively associated with physician recommendation (OR 3.22, 95% CI 1.76-5.93). CONCLUSIONS: In a low-income urban population, concern about undisclosed vaccine contents appears to impede acceptance of influenza immunization among both African Americans and Caucasians. Directly addressing this concern offers a new approach to increasing immunization in this vulnerable population.

Authors
Armstrong, K; Berlin, M; Schwartz, JS; Propert, K; Ubel, PA
MLA Citation
Armstrong, K, Berlin, M, Schwartz, JS, Propert, K, and Ubel, PA. "Barriers to influenza immunization in a low-income urban population." Am J Prev Med 20.1 (January 2001): 21-25.
PMID
11137770
Source
pubmed
Published In
American Journal of Preventive Medicine
Volume
20
Issue
1
Publish Date
2001
Start Page
21
End Page
25

The inclusion of patient testimonials in decision aids: effects on treatment choices.

BACKGROUND: Decision aids often provide statistical information and patient testimonials to guide treatment choices. This raises the possibility that the testimonials will overwhelm the statistical information. METHODS: Prospective jurors in Philadelphia County were presented with hypothetical statistical information about the percentage of angina patients who benefit from angioplasty and bypass surgery (50% and 75%, respectively). They were also given written testimonials from hypothetical patients who had benefited or not benefited from each of the two treatments. The numbers of patients benefiting and not benefiting were varied to be either proportionate to the statistical information or disproportionate. In study 1, all participants received 1 testimonial from a patient who had benefited from angioplasty and 1 from a patient who had not. Participants receiving the proportionate questionnaire version were also given 3 testimonials from patients who benefited from bypass surgery and 1 from a patient who did not, coinciding with the hypothetical statistical information. In contrast, participants receiving the disproportionate questionnaire version received only 1 testimonial from a patient who benefited from surgery and 1 from a patient who did not. In study 2, all participants received 2 examples of patients who benefited from angioplasty and 2 who did not. Participants with the proportionate questionnaire version received the same testimonials regarding surgery as in study 1. Those receiving the disproportionate questionnaire version received 2 testimonials from patients who benefited from bypass and 2 from patients who did not. Finally, a separate set of participants in study 2 received a questionnaire with no testimonials. RESULTS: In study 1, 30% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 44% of those receiving the proportionate questionnaire (P = 0.002 by chi2). In study 2, 34% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 37% of those receiving the proportionate questionnaire (P = 0.59 by chi2). Of those receiving no patient testimonials, 58% chose bypass surgery. CONCLUSIONS: The inclusion of written patient testimonials significantly influenced hypothetical treatment choices. Efforts to make the mix of positive versus negative testimonials proportionate to statistical information may, under some circumstances, affect choices in ways that cannot automatically be assumed to be optimal.

Authors
Ubel, PA; Jepson, C; Baron, J
MLA Citation
Ubel, PA, Jepson, C, and Baron, J. "The inclusion of patient testimonials in decision aids: effects on treatment choices." Med Decis Making 21.1 (January 2001): 60-68.
PMID
11206948
Source
pubmed
Published In
Medical Decision Making
Volume
21
Issue
1
Publish Date
2001
Start Page
60
End Page
68
DOI
10.1177/0272989X0102100108

Analog scale, magnitude estimation, and person trade-off as measures of health utility: Biases and their correction

Subjects judged the disutility of health conditions (e.g. blindness) using one of them (e.g. blindness+deafness) as a standard, using three elicitation methods: analog scale (AS, how bad is blindness compared to blindness+deafness?); magnitude estimation (ME, blindness+deafness is how many times as bad as blindness?); and person trade-off (PTO, how many people cured of blindness is as good as 10 people cured of blindness + deafness?). ME disutilities of the less bad condition were smallest, and AS was highest. Interleaving PTO with ME made PTO more like ME. AS disutilities were inconsistent with direct judgments of differences between pairs of conditions. ME and PTO judgments were internally inconsistent: e.g. the disutility of one-eye-blindness relative to blindness+deafness was larger than predicted from comparison of each to blindness. Consistency training reduced inconsistency, increased agreement between AS and PTO, and transferred from one method to the other. The results support the use of consistency checks in utility elicitation. Copyright © 2001 John Wiley & Sons, Ltd.

Authors
Baron, J; Wu, Z; Brennan, DJ; Weeks, C; Ubel, PA
MLA Citation
Baron, J, Wu, Z, Brennan, DJ, Weeks, C, and Ubel, PA. "Analog scale, magnitude estimation, and person trade-off as measures of health utility: Biases and their correction." Journal of Behavioral Decision Making 14.1 (2001): 17-34.
Source
scival
Published In
Journal of Behavioral Decision Making
Volume
14
Issue
1
Publish Date
2001
Start Page
17
End Page
34

Physicians' attitudes about involvement in lethal injection for capital punishment [4] (multiple letters)

Authors
Wirt, DP; Bailey, WC; Bowers, WJ; Farber, NJ; Davis, EB; Weiner, J; Jordan, J; Boyer, EG; Ubel, PA
MLA Citation
Wirt, DP, Bailey, WC, Bowers, WJ, Farber, NJ, Davis, EB, Weiner, J, Jordan, J, Boyer, EG, and Ubel, PA. "Physicians' attitudes about involvement in lethal injection for capital punishment [4] (multiple letters)." Archives of Internal Medicine 161.10 (2001): 1353-1354.
PMID
11371272
Source
scival
Published In
Archives of Internal Medicine
Volume
161
Issue
10
Publish Date
2001
Start Page
1353
End Page
1354

Physicians, thou shalt ration: the necessary role of bedside rationing in controlling healthcare costs.

Physicians are often asked to be "gatekeepers," determining their patients' access to medical therapies and technologies. At the same time, most physicians have been taught that they should act as patient advocates, pursuing patients' best interests regardless of cost. This paper reviews moral arguments ethicists have made for and against "bedside rationing." It argues that healthcare rationing is appropriate in order to help control healthcare costs, and that rationing decisions made at the bedside by physicians must be part of the rationing system. A system that attempts to control costs by mandating an elaborate set of rules would be burdensome, and many physicians would find ways

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Physicians, thou shalt ration: the necessary role of bedside rationing in controlling healthcare costs." Healthc Pap 2.2 (2001): 10-21.
PMID
12811141
Source
pubmed
Published In
HealthcarePapers
Volume
2
Issue
2
Publish Date
2001
Start Page
10
End Page
21

Finding a place for public preferences in liver allocation decisions.

Over the last decade there have been major advances in all aspects of liver transplantation with the consequence that the number of patients who could benefit from the procedure is increasing. As a result, the number of patients listed for liver transplantation is growing while the donor pool is remaining constant or even falling. The effect of this donor shortage is seen clearly both in Europe and in North America. For example, in North America data from UNOS shows that between 1988 and 1997 the number of cadaveric donor liver transplants rose from 1,713 to 4,100. The number of patients waiting for transplant rose over the same time from 616 to 9,647. This shortage of organs has tragic consequences. Although the proportion of patients dying on the waiting list is falling, the number of patients dying on the liver transplant waiting list increased from 196 to 1,129 over this same period of time.

Authors
Neuberger, J; Ubel, PA
MLA Citation
Neuberger, J, and Ubel, PA. "Finding a place for public preferences in liver allocation decisions." Transplantation 70.10 (November 27, 2000): 1411-1413. (Review)
PMID
11118080
Source
pubmed
Published In
Transplantation
Volume
70
Issue
10
Publish Date
2000
Start Page
1411
End Page
1413

Physicians' attitudes about involvement in lethal injection for capital punishment.

BACKGROUND: Physicians could play various roles in carrying out capital punishment via lethal injection. Medical societies like the American Medical Association (AMA) and American College of Physicians have established which roles are acceptable and which are disallowed. No one has explored physicians' attitudes toward their potential roles in this process. METHODS: We surveyed physicians about how acceptable it was for physicians to engage in 8 actions disallowed by the AMA and 4 allowed actions involving lethal injection. Questions assessing attitudes toward capital punishment and assisted suicide were included. The impact of attitudinal and demographic variables on the number of disallowed actions deemed acceptable was analyzed via analysis of variance and multiple logistic regression analysis. RESULTS: Four hundred eighty-two physicians (51%) returned questionnaires. Eighty percent indicated that at least 1 of the disallowed actions was acceptable, 53% indicated that 5 or more were acceptable, and 34% approved all 8 disallowed actions. The percentage of respondents approving of disallowed actions varied from 43% for injecting lethal drugs to 74% for determining when death occurred. All 4 allowed actions were deemed acceptable by the majority of respondents. Favoring the death penalty (P<.001) and the acceptance of assisted suicide (P<.001) were associated with an increased number of disallowed actions that were deemed acceptable. CONCLUSIONS: Despite medical society policies, the majority of physicians surveyed approved of most disallowed actions involving capital punishment, indicating that they believed it is acceptable in some circumstances for physicians to kill individuals against their wishes. It is possible that the lack of stigmatization by colleagues allows physicians to engage in such practices. Arch Intern Med. 2000;160:2912-2916

Authors
Farber, N; Davis, EB; Weiner, J; Jordan, J; Boyer, EG; Ubel, PA
MLA Citation
Farber, N, Davis, EB, Weiner, J, Jordan, J, Boyer, EG, and Ubel, PA. "Physicians' attitudes about involvement in lethal injection for capital punishment." Arch Intern Med 160.19 (October 23, 2000): 2912-2916.
PMID
11041897
Source
pubmed
Published In
Archives of internal medicine
Volume
160
Issue
19
Publish Date
2000
Start Page
2912
End Page
2916

The nature and prevalence of patient expectations in a VA general medicine clinic.

Authors
Tulsky, JA; Peck, BM; Ubel, PA; Roter, DL; Goold, SD; Asch, DA; Shearin, AL; Grambow, SC; Koropchak, CM
MLA Citation
Tulsky, JA, Peck, BM, Ubel, PA, Roter, DL, Goold, SD, Asch, DA, Shearin, AL, Grambow, SC, and Koropchak, CM. "The nature and prevalence of patient expectations in a VA general medicine clinic." JOURNAL OF GENERAL INTERNAL MEDICINE 15 (October 2000): 7-7.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
15
Publish Date
2000
Start Page
7
End Page
7
DOI
10.1046/j.1525-1497.2000.15200-29.x

Pennsylvania's voluntary benefits program: evaluating an innovative proposal for increasing organ donation.

Authors
Ubel, PA; Bryce, CL; Siminoff, LA; Caplan, AL; Arnold, RM
MLA Citation
Ubel, PA, Bryce, CL, Siminoff, LA, Caplan, AL, and Arnold, RM. "Pennsylvania's voluntary benefits program: evaluating an innovative proposal for increasing organ donation." Health Aff (Millwood) 19.5 (September 2000): 206-211.
PMID
10992670
Source
pubmed
Published In
Health Affairs
Volume
19
Issue
5
Publish Date
2000
Start Page
206
End Page
211

Improving value measurement in cost-effectiveness analysis.

OBJECTIVE: Before cost-effectiveness analysis (CEA) can fulfill its promise as a tool to guide health care allocation decisions, the method of incorporating societal values into CEA may need to be improved. DESIGN: The study design was a declarative exposition of potential fallacies in the theoretical underpinnings of CEA. Two values held by many people-preferences for giving priority to severely ill patients and preferences to avoid discrimination against people who have limited treatment potential because of disability or chronic illness-that are not currently incorporated into CEA are discussed. CONCLUSIONS: Traditional CEA, through the measurement of quality-adjusted life years (QALYs), is constrained because of a "QALY trap." If, for example, saving the life of a person with paraplegia is equally valuable as saving the life of a person without paraplegia, then current QALY methods force us to conclude that curing paraplegia brings no benefit. Basing cost-effectiveness measurement on societal values rather than QALYs may allow us to better capture public rationing preferences, thereby escaping the QALY trap. CEA can accommodate a wider range of such societal values about fairness in its measurements by amending its methodology.

Authors
Ubel, PA; Nord, E; Gold, M; Menzel, P; Prades, JL; Richardson, J
MLA Citation
Ubel, PA, Nord, E, Gold, M, Menzel, P, Prades, JL, and Richardson, J. "Improving value measurement in cost-effectiveness analysis." Med Care 38.9 (September 2000): 892-901.
PMID
10982111
Source
pubmed
Published In
Medical Care
Volume
38
Issue
9
Publish Date
2000
Start Page
892
End Page
901

Lying to each other: when internal medicine residents use deception with their colleagues.

BACKGROUND: While lying is morally problematic, physicians have been known to use deception with their patients and with third parties. Little is known, however, about the use of deception between physicians. OBJECTIVES: To determine the likelihood that resident physicians say they would deceive other physicians in various circumstances and to examine how variations in circumstances affect the likelihood of using deception. METHODS: Two versions of a confidential survey using vignettes were randomly distributed to all internal medicine residents at 4 teaching hospitals in 1998. Survey versions differed by introducing slight variations to each vignette in ways we hypothesized would influence respondents' willingness to deceive. The likelihood that residents say they would use deception in response to each vignette was compared between versions. RESULTS: Three hundred thirty surveys were distributed (response rate, 67%). Of those who responded, 36% indicated they were likely to use deception to avoid exchanging call, 15% would misrepresent a diagnosis in a medical record to protect patient privacy, 14% would fabricate a laboratory value to an attending physician, 6% would substitute their own urine in a drug test to protect a colleague, and 5% would lie about checking a patient's stool for blood to cover up a medical mistake. For some of the scenarios, the likelihood of deceiving was influenced by variations in the vignettes. CONCLUSIONS: A substantial percentage of internal medicine residents report they would deceive a colleague in various circumstances, and the likelihood of using deception depends on the context. While lying about clinical issues is not common, it is troubling when it occurs at any time. Medical educators should be aware of circumstances in which residents are likely to deceive, and discuss ways to eliminate incentives to lie.

Authors
Green, MJ; Farber, NJ; Ubel, PA; Mauger, DT; Aboff, BM; Sosman, JM; Arnold, RM
MLA Citation
Green, MJ, Farber, NJ, Ubel, PA, Mauger, DT, Aboff, BM, Sosman, JM, and Arnold, RM. "Lying to each other: when internal medicine residents use deception with their colleagues." Arch Intern Med 160.15 (August 14, 2000): 2317-2323.
PMID
10927729
Source
pubmed
Published In
Archives of internal medicine
Volume
160
Issue
15
Publish Date
2000
Start Page
2317
End Page
2323

Beliefs about breast cancer risk and use of postmenopausal hormone replacement therapy.

BACKGROUND: Postmenopausal hormone replacement therapy (HRT) decreases the risks of coronary heart disease and osteoporosis, but increases the risk of breast cancer. Although only 20-30% of postmenopausal women in the United States take HRT, the relationship between breast cancer risk perception and use of HRT is not known. OBJECTIVE: To assess the impact of belief that HRT increases breast cancer risk and high perceived risk of breast cancer on the use of HRT. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: 189 randomly selected postmenopausal women from a general internal medicine practice in the Philadelphia area. MAIN RESULTS: Of the 268 women (67%) who returned surveys, 189 were postmenopausal; 70 (37%) were currently using HRT and 21 (11 %) had previously used HRT. Respondents' mean age was 59.6 years; 64% were Caucasian, and 33% had completed college. Fifty-nine women (33%) thought HRT increased the risk of breast cancer, 22 (12%) thought it did not, and 100 (55%) were unsure. Mean perceived lifetime risk of breast cancer was 31% (range 0%-100%). After multivariate adjustment, current use of HRT was inversely associated with age (OR 0.96 for each one-year increase, 95% CI 0.940.98), and positively associated with Caucasian race (OR 2.73, 95% CI 1.40-5.32). Use of HRT was not associated with belief that HRT increases the risk of breast cancer, breast cancer risk perception, or perceived severity of breast cancer. CONCLUSIONS: Belief that HRT increases the risk of breast cancer and high perceptions of breast cancer risk may not be important barriers to use of HRT. Efforts to improve decision making about HRT should focus on previously established barriers, such as perceptions of menopause and lack of physician discussion, rather than misconceptions about breast cancer risk.

Authors
Armstrong, K; Popik, S; Guerra, C; Ubel, PA
MLA Citation
Armstrong, K, Popik, S, Guerra, C, and Ubel, PA. "Beliefs about breast cancer risk and use of postmenopausal hormone replacement therapy." Med Decis Making 20.3 (July 2000): 308-313.
PMID
10929853
Source
pubmed
Published In
Medical Decision Making
Volume
20
Issue
3
Publish Date
2000
Start Page
308
End Page
313
DOI
10.1177/0272989X0002000307

Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors.

BACKGROUND: Black patients undergo coronary artery bypass grafting and percutaneous transluminal coronary angioplasty less often than white patients. It is unclear how racial differences in clinical factors contribute to this variation. METHODS: A retrospective cohort study was performed of 666 male patients (326 blacks and 340 whites), admitted to 1 of 6 Veterans Affairs hospitals from October 1, 1989, to September 30, 1995, with acute myocardial infarction or unstable angina who underwent cardiac catheterization. The primary comparison was whether racial differences in percutaneous transluminal coronary angioplasty and coronary artery bypass grafting rates persisted after stratifying by clinical appropriateness of the procedure, measured by the appropriateness scale developed by the RAND Corporation, Santa Monica, Calif. RESULTS: Whites more often than blacks underwent a revascularization procedure (47% vs 28%). There was substantial variation in black-white odds ratios within different appropriateness categories. Blacks were significantly less likely to undergo percutaneous transluminal coronary angioplasty (odds ratio, 0.30; 95% confidence interval, 0.14-0.63 [P<.01]) when the indication was rated "equivocal." Similarly, blacks were less likely to undergo coronary artery bypass grafting (odds ratio, 0.44; 95% confidence interval, 0.23-0.86 [P<.01]) when only coronary artery bypass grafting was indicated as "appropriate and necessary." Differences in comorbidity or use of cigarettes or alcohol did not explain these variations. Using administrative data from the Veterans Health Administration, we found no differences in 1-year (5.2% vs 7.4%) and 5-year (23.3% vs 26.2%) mortality for blacks vs whites. CONCLUSION: Among patients with acute myocardial infarction or unstable angina, variation in clinical factors using RAND appropriateness criteria for procedures explained some, but not all, racial differences in coronary revascularization use.

Authors
Conigliaro, J; Whittle, J; Good, CB; Hanusa, BH; Passman, LJ; Lofgren, RP; Allman, R; Ubel, PA; O'Connor, M; Macpherson, DS
MLA Citation
Conigliaro, J, Whittle, J, Good, CB, Hanusa, BH, Passman, LJ, Lofgren, RP, Allman, R, Ubel, PA, O'Connor, M, and Macpherson, DS. "Understanding racial variation in the use of coronary revascularization procedures: the role of clinical factors." Arch Intern Med 160.9 (May 8, 2000): 1329-1335.
PMID
10809037
Source
pubmed
Published In
Archives of internal medicine
Volume
160
Issue
9
Publish Date
2000
Start Page
1329
End Page
1335

Are preferences for equity over efficiency in health care allocation "all or nothing"?

BACKGROUND: In a previous study we showed that within a budget constraint, most people would rather offer a less effective screening test to 100% of a Medicaid population, thereby saving 1,000 lives, than a more effective test to 50% of the population, thereby saving 1,100 lives. We present here a study exploring whether this preference for equity over efficiency persists when neither test can be offered to the entire population. METHODS: Members of Physicians' Online and prospective jurors at the Philadelphia County Courthouse randomly received 1 of 3 questionnaires (Q1, Q2, or Q3) describing a limited budget to screen Medicaid enrollees for colon cancer. In all questionnaires, test 1 was said to save 1,000 lives, and test 2, a more effective and more expensive test, was said to save 1,100. In Q1, test 1 was offered to 100% and test 2 to 50% of the population. In Q2, the 2 tests could be offered to 50% and 25%, respectively; in Q3, to 90% and 40%, respectively. Respondents indicated which test they recommended and provided justification. RESULTS: The majority of physicians (59%) and the general public (56%) receiving Q1 favored the less effective screening test However, of those receiving Q2, only 26% of physicians and 27% of the general public recommended the less effective screening test. And of those receiving Q3, only 38% of physicians and 28% of the general public recommended the less effective test. Justifications for these recommendations were based largely on concerns for equality of treatment among those who chose the less effective test and concerns for saving the most lives among those who preferred the more effective test. CONCLUSIONS: Although most respondents show a preference for equity over efficiency when equity means that 100% of a population can receive a service, many fewer respondents maintain this preference when equity is no longer absolute. This result suggests that the preference for equity is sometimes "all or none."

Authors
Ubel, PA; Baron, J; Nash, B; Asch, DA
MLA Citation
Ubel, PA, Baron, J, Nash, B, and Asch, DA. "Are preferences for equity over efficiency in health care allocation "all or nothing"?." Med Care 38.4 (April 2000): 366-373.
PMID
10752968
Source
pubmed
Published In
Medical Care
Volume
38
Issue
4
Publish Date
2000
Start Page
366
End Page
373

Spiritual values in the setting of health care priorities.

Authors
Coyle, BR; Ubel, PA
MLA Citation
Coyle, BR, and Ubel, PA. "Spiritual values in the setting of health care priorities." Kennedy Inst Ethics J 10.1 (March 2000): 107-108. (Letter)
PMID
11658152
Source
pubmed
Published In
Kennedy Institute of Ethics Journal
Volume
10
Issue
1
Publish Date
2000
Start Page
107
End Page
108

Societal value, the person trade-off, and the dilemma of whose values to measure for cost-effectiveness analysis.

In a previous paper, it was argued that Societal Value measurement through person trade-off (PTO) elicitation offers a way to include the values of both general public and patients into cost-effectiveness analysis (CEA). It was said that patients' values could be used to estimate the effect that various health care dimensions have on health-related utility and that public values could be used to estimate the Societal Value of these changes in utility. However, this previous proposal still creates opportunities for the public to misvalue the benefit of health care interventions because of bias or misunderstanding about what the health-related utility really is of various illnesses or disabilities. A procedure that combines patient and public values into CEA to partially correct for this bias is suggested in this paper. In addition, it is pointed out that, although Societal Value measurement offers a role for distinctly public preferences in CEA, it still does not answer the question of whose utilities ought to be included in CEA.

Authors
Ubel, PA; Richardson, J; Menzel, P
MLA Citation
Ubel, PA, Richardson, J, and Menzel, P. "Societal value, the person trade-off, and the dilemma of whose values to measure for cost-effectiveness analysis." Health Econ 9.2 (March 2000): 127-136.
PMID
10721014
Source
pubmed
Published In
Health Economics
Volume
9
Issue
2
Publish Date
2000
Start Page
127
End Page
136

Accounting for fairness in health care

Authors
Ubel, PA; Cohen, JP; Asch, DA
MLA Citation
Ubel, PA, Cohen, JP, and Asch, DA. "Accounting for fairness in health care." The Social Economics of Healthcare. London: Routledge Press, 2000.
Source
manual
Publish Date
2000

Bioethics and medical decision making: What can they learn from each other?

Authors
Ubel, PA; Cohen, JP; Asch, DA
MLA Citation
Ubel, PA, Cohen, JP, and Asch, DA. "Bioethics and medical decision making: What can they learn from each other?." Decision Making in Health Care. Cambridge University Press, 2000.
Source
manual
Publish Date
2000

Are patients willing to participate in medical education?

Authors
Ubel, PA; Silver-Isenstadt, A
MLA Citation
Ubel, PA, and Silver-Isenstadt, A. "Are patients willing to participate in medical education?." J Clin Ethics 11.3 (2000): 230-235.
PMID
11127637
Source
pubmed
Published In
The Journal of clinical ethics
Volume
11
Issue
3
Publish Date
2000
Start Page
230
End Page
235

Decision psychology and health preferences: Further explorations of medical decisions for individuals and for groups

Background. Important discrepancies between clinical practice and health policy may be related to the ways in which physicians and others make decisions about individuals and groups. Previous research has found that physicians and laypersons asked to consider an individual patient generally make different decisions than those asked to consider a group of comparable patients, but this discrepancy has not been observed in more recent studies. This study was designed to explore possible reasons for these findings. Methods. Prospective jurors (N = 1,013) each made a recommendation regarding a risky treatment for an incurable blood condition. Perspective (individual vs group) was crossed with uncertainty frame (probability vs frequency) and response wording (original vs revised) in a 2 x 2 x 2 between-participants design. Results. When the strength of participants' recommendations was considered, the effects of perspective, uncertainty frame, and response wording were not statistically significant. When recommendations were dichotomized, participants in the revised-response-wording conditions were more likely to recommend treatment to the group than to the individual. Conclusions. These results conflict with previous findings for this scenario and suggest that reported differences between decisions for individuals and decisions for groups are not robust.

Authors
DeKay, ML; Nickerson, CAE; Ubel, PA; Hershey, JC; Spranca, MD; Asch, DA
MLA Citation
DeKay, ML, Nickerson, CAE, Ubel, PA, Hershey, JC, Spranca, MD, and Asch, DA. "Decision psychology and health preferences: Further explorations of medical decisions for individuals and for groups." Medical Decision Making 20.1 (2000): 39-44.
PMID
10638535
Source
scival
Published In
Medical Decision Making
Volume
20
Issue
1
Publish Date
2000
Start Page
39
End Page
44

Physicians' duties in an era of cost containment: advocacy or betrayal?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Physicians' duties in an era of cost containment: advocacy or betrayal?." JAMA 282.17 (November 3, 1999): 1675-.
PMID
10553798
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
282
Issue
17
Publish Date
1999
Start Page
1675

Dose response: intelligent rationing by physicians is the first step to a health-care system that society can afford.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Dose response: intelligent rationing by physicians is the first step to a health-care system that society can afford." Sciences (New York) 39.6 (November 1999): 18-23.
PMID
15584152
Source
pubmed
Published In
The Sciences
Volume
39
Issue
6
Publish Date
1999
Start Page
18
End Page
23

Educational content and the effectiveness of influenza vaccination reminders.

OBJECTIVE: To determine if a mailed patient education brochure (addressing demonstrated reasons for vaccination refusal) would result in a higher rate of influenza vaccination than a mailed postcard reminder without educational content. DESIGN: Randomized, controlled trial. SETTING: Urban, predominantly African-American, low-income community. PARTICIPANTS: There were 740 community-dwelling individuals aged 65 years and older in the study. MEASUREMENTS: Receipt of influenza vaccination and beliefs about influenza and influenza vaccination were measured by telephone survey self-report. MAIN RESULTS: We successfully contacted 202 individuals (69.9%) who received the postcard reminder and 229 individuals (71.1%) who received the educational brochure. People receiving the educational brochure were more likely to report influenza vaccination during the previous vaccination season than those who received the postcard reminder (66.4% vs 56.9%, p =.04). They also reported more interest in influenza vaccination in the coming year. (66.5% vs 57.1%, p =.05). CONCLUSIONS: A mailed educational brochure is more effective than a simple reminder in increasing influenza vaccination rates among inner-city, elderly patients.

Authors
Armstrong, K; Berlin, M; Schwartz, JS; Propert, K; Ubel, PA
MLA Citation
Armstrong, K, Berlin, M, Schwartz, JS, Propert, K, and Ubel, PA. "Educational content and the effectiveness of influenza vaccination reminders." J Gen Intern Med 14.11 (November 1999): 695-698.
PMID
10571718
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
14
Issue
11
Publish Date
1999
Start Page
695
End Page
698

How stable are people's preferences for giving priority to severely ill patients?

BACKGROUND: Previous studies have suggested that people favor allocating resources to severely ill patients even when they benefit less from treatment than do less severely ill patients. This study explores the stability of people's preferences for treating severely ill patients. METHODS: This study surveyed prospective jurors in Philadelphia and asked them to decide how they would allocate scarce health care resources between a severely ill group of patients who would improve a little with treatment and moderately ill patients who would improve considerably with treatment. Subjects were randomized to receive one of six questionnaire versions, which altered the wording of the scenarios and altered whether subjects were given an explicit option of dividing resources evenly between the two groups of patients. RESULTS: Four hundred and seventy nine subjects completed surveys. The preference subjects placed on allocating resources to severely ill patients depended on relatively minor wording changes in the scenarios. In addition, when given the explicit option of dividing resources evenly between the two groups of patients, the majority of subjects chose to do so. CONCLUSION: People's preferences for allocating resources to severely ill patients can be significantly decreased by subtle wording changes in scenarios. However, this study adds to evidence suggesting that many people place priority on allocating resources to severely ill patients, even when they would benefit less from treatment than others.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "How stable are people's preferences for giving priority to severely ill patients?." Soc Sci Med 49.7 (October 1999): 895-903.
PMID
10468394
Source
pubmed
Published In
Social Science & Medicine
Volume
49
Issue
7
Publish Date
1999
Start Page
895
End Page
903

The challenge of measuring community values in ways appropriate for setting health care priorities.

The move from a notion that community values ought to play a role in health care decision making to the creation of health care policies that in some way reflect such values is a challenging one. No single method will adequately measure community values in a way appropriate for setting health care priorities. Consequently, multiple methods to measure community values should be employed, thereby allowing the strengths and weaknesses of the various methods to complement each other. A preliminary research agenda to bring together empirical research on community values with more traditional research on health care ethics is outlined, with the goal of identifying and measuring acceptable community values that are relatively consistent across measurement methods and, ultimately, developing ways to incorporate these values into health care priority decision making.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The challenge of measuring community values in ways appropriate for setting health care priorities." Kennedy Inst Ethics J 9.3 (September 1999): 263-284.
PMID
11657717
Source
pubmed
Published In
Kennedy Institute of Ethics Journal
Volume
9
Issue
3
Publish Date
1999
Start Page
263
End Page
284

Erosion in medical students' attitudes about telling patients they are students.

OBJECTIVE: To study the attitudes of preclinical and clinical medical students toward the importance of telling patients they are students, and to compare their attitudes with those of patients. METHODS: We conducted a cross-sectional survey of medical students from five Philadelphia medical schools, and a longitudinal follow-up in one medical school, to assess the importance students place on telling patients they are medical students before interacting with them. We asked similar questions of 100 general medical outpatients from two academically affiliated hospitals. MAIN RESULTS: In total, 2,603 students (58%) responded to the cross-sectional survey, 74 (50%) responded to the longitudinal survey, and 100 patients responded to our interview survey (94% response rate). In the cross-sectional survey, there were negligible differences in the importance that patients and medical students placed on informing alert patients that they are interacting with students in nonsurgical settings. In surgical settings involving anesthetized patients, patients placed significantly more importance on being informed of students' roles in their surgery than did students, and preclinical students placed more importance on this than did clinical students. Results from the cross-sectional survey were supported by the longitudinal survey, in which fourth-year medical students placed significantly less importance on informing patients of their student status than the same cohort had done 2 years previously. CONCLUSIONS: Medical students place less importance on informing patients about their student status than patients desire, especially in surgical settings in which the patient is to be anesthetized. Medical students already having completed a clinical rotation stray further from patient ideals than preclinical medical students. These findings suggest that, as medical students advance in their training, they suffer an erosion in their attitudes about telling patients they are students.

Authors
Silver-Isenstadt, A; Ubel, PA
MLA Citation
Silver-Isenstadt, A, and Ubel, PA. "Erosion in medical students' attitudes about telling patients they are students." J Gen Intern Med 14.8 (August 1999): 481-487.
PMID
10491232
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
14
Issue
8
Publish Date
1999
Start Page
481
End Page
487

Social responsibility, personal responsibility, and prognosis in public judgments about transplant allocation.

Authors
Ubel, PA; Baron, J; Asch, DA
MLA Citation
Ubel, PA, Baron, J, and Asch, DA. "Social responsibility, personal responsibility, and prognosis in public judgments about transplant allocation." Bioethics 13.1 (January 1999): 57-68.
PMID
11657059
Source
pubmed
Published In
Bioethics
Volume
13
Issue
1
Publish Date
1999
Start Page
57
End Page
68

Advocating for patients under managed care: Case commentary

Authors
Ubel, PA; Parsons, GN
MLA Citation
Ubel, PA, and Parsons, GN. "Advocating for patients under managed care: Case commentary." Ethical Challenges in Managed Care: A Casebook. Ed. KG Gervais, R Priester, DE Vawter, KK Otte, and MM Solberg. Georgetown University Press, 1999.
Source
manual
Publish Date
1999

Toward a broader view of values in cost-effectiveness analysis of health

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.

Authors
Menzel, P; Gold, MR; Nord, E; Pinto-Prades, J-L; Richardson, J; Ubel, P
MLA Citation
Menzel, P, Gold, MR, Nord, E, Pinto-Prades, J-L, Richardson, J, and Ubel, P. "Toward a broader view of values in cost-effectiveness analysis of health." Hasting Center Report 29.3 (1999): 7-15.
PMID
10420299
Source
scival
Published In
The Hastings Center report
Volume
29
Issue
3
Publish Date
1999
Start Page
7
End Page
15

Life-saving treatments and disabilities. Are all QALYs created equal?

OBJECTIVES: Decision-makers and the general public are often reluctant to adopt policy recommendations based exclusively upon cost-utility analyses. One possible reason explored here is that patients' previous health state before experiencing the onset of an acute life-threatening illness may influence the value of saving those patients' lives. METHODS: We surveyed members of the general public to see the relative importance of saving patients' lives when some patients could be returned to perfect health and others would live the remainder of their years with paraplegia. Among this latter group, some were described as having pre-existing paraplegia. Others were described as having as having the onset of paraplegia. The relative importance of saving each of these lives was measured using the person trade-off method. RESULTS: Six hundred five subjects completed questionnaires, and 250 met pre-established consistency criteria and were included in the final analysis. Overall, subjects placed equal importance on saving the lives of people with pre-existing paraplegia versus those who could be returned to perfect health because they did not have pre-existing paraplegia. In contrast, respondents gave lower priority to patients who would experience the onset of paraplegia after having their lives saved, especially if their paraplegia was avoidable with an alternative treatment. CONCLUSION: People do not think that all quality-adjusted life-years are created equal. Instead, the value that people place on treatment programs depends on patients' state of health before developing life-threatening illnesses, and on whether alternative treatments are available that provide better health outcomes for the patients. These results may explain, in part, public discomfort over basing health care priorities on cost-utility analysis.

Authors
Ubel, PA; Richardson, J; Prades, JL
MLA Citation
Ubel, PA, Richardson, J, and Prades, JL. "Life-saving treatments and disabilities. Are all QALYs created equal?." Int J Technol Assess Health Care 15.4 (1999): 738-748.
PMID
10645115
Source
pubmed
Published In
International Journal of Technology Assessment in Health Care
Volume
15
Issue
4
Publish Date
1999
Start Page
738
End Page
748

Geographic favoritism in liver transplantation [1] (multiple letters)

Authors
Turcotte, JG; Jr, FRB; Stratta, RJ; Gaber, AO; Vera, SR; Markowitz, JS; Finder, SG; Rabkin, JM; Ubel, PA; Ubel, PA; Caplan, AL
MLA Citation
Turcotte, JG, Jr, FRB, Stratta, RJ, Gaber, AO, Vera, SR, Markowitz, JS, Finder, SG, Rabkin, JM, Ubel, PA, Ubel, PA, and Caplan, AL. "Geographic favoritism in liver transplantation [1] (multiple letters)." New England Journal of Medicine 340.12 (1999): 963-965.
PMID
10094640
Source
scival
Published In
The New England journal of medicine
Volume
340
Issue
12
Publish Date
1999
Start Page
963
End Page
965
DOI
10.1056/NEJM199903253401213

Incorporating societal concerns for fairness in numerical valuations of health programmes

The paper addresses some limitations of the QALY approach and outlines a valuation procedure that may overcome these limitations. In particular, we focus on the following issues: the distinction between assessing individual utility and assessing societal value of health care; the need to incorporate concerns for severity of illness as an independent factor in a numerical model of societal valuations of health outcomes; similarly, the need to incorporate reluctance to discriminate against patients that happen to have lesser potentials for health than others; and finally, the need to combine measurements of health-related quality of life obtained from actual patients (or former patients) with measurements of distributive preferences in the general population when estimating societal value. We show how equity weights may serve to incorporate concerns for severity and potentials for health in QALY calculations. We also suggest that for chronically ill or disabled people a life year gained should count as one and no less than one as long as the year is considered preferable to being dead by the person concerned. We call our approach 'cost-value analysis'.

Authors
Nord, E; Pinto, JL; Richardson, J; Menzel, P; Ubel, P
MLA Citation
Nord, E, Pinto, JL, Richardson, J, Menzel, P, and Ubel, P. "Incorporating societal concerns for fairness in numerical valuations of health programmes." Health Economics 8.1 (1999): 25-39.
PMID
10082141
Source
scival
Published In
Health Economics
Volume
8
Issue
1
Publish Date
1999
Start Page
25
End Page
39

Geographic favoritism in liver transplantation--unfortunate or unfair?

Authors
Ubel, PA; Caplan, AL
MLA Citation
Ubel, PA, and Caplan, AL. "Geographic favoritism in liver transplantation--unfortunate or unfair?." N Engl J Med 339.18 (October 29, 1998): 1322-1325.
PMID
9791151
Source
pubmed
Published In
The New England journal of medicine
Volume
339
Issue
18
Publish Date
1998
Start Page
1322
End Page
1325
DOI
10.1056/NEJM199810293391811

Encourage qualitative research to improve students' clinical skills!

Authors
Parsons, GN; Kinsman, SB; Ubel, PA
MLA Citation
Parsons, GN, Kinsman, SB, and Ubel, PA. "Encourage qualitative research to improve students' clinical skills!." Acad Med 73.9 (September 1998): 933-934.
PMID
9759093
Source
pubmed
Published In
Academic Medicine
Volume
73
Issue
9
Publish Date
1998
Start Page
933
End Page
934

Physicians' experiences with patient-initiated health insurance fraud.

Authors
Farber, NJ; Berger, MS; Davis, EB; Weiner, J; Boyer, EG; Ubel, PA
MLA Citation
Farber, NJ, Berger, MS, Davis, EB, Weiner, J, Boyer, EG, and Ubel, PA. "Physicians' experiences with patient-initiated health insurance fraud." Del Med J 70.7 (July 1998): 329-334.
PMID
9707803
Source
pubmed
Published In
Delaware Medical Journal
Volume
70
Issue
7
Publish Date
1998
Start Page
329
End Page
334

Public preferences for prevention versus cure: what if an ounce of prevention is worth only an ounce of cure?

BACKGROUND: The belief that small preventive efforts bring large benefits may explain why many people say they value prevention above all other types of health care. However, it often takes a great deal of preventive medicine to prevent a bad outcome. This study explores whether people value prevention or cure more when each brings the same magnitude of benefit and examines whether preferences for prevention or cure vary according to the severity of the disability of the patients who can receive the preventive or curative intervention. METHODS: 289 prospective jurors were presented with a policy dilemma involving how best to allocate funds to benefit people with varying levels of disability. Each project was said to influence the functional ability of 100 nursing home residents, either by improving their level of function or by preventing their level of function from declining. RESULTS: When given a choice between preventive and curative interventions, more subjects preferred the preventive intervention (37% vs 21%, p=0.002). However, when the strength of people's preferences was taken into account, the preference for preventive interventions was not statistically significant (p=0.135). With both preventive and curative interventions, the subjects preferred helping patients with more severe disabilities (p < 0.005 for both comparisons). This preference for helping more severely disabled patients did not differ for prevention and cure (p=0.663). CONCLUSION: When the magnitude of benefit was held constant, the subjects slightly preferred prevention over cure. In addition, they preferred directing limited resources toward those with greater disabilities, regardless of whether those resources were targeted toward prevention or cure. These findings suggest that previously stated preferences for prevention over cure may result from a belief that small efforts at prevention will be repaid by large reductions in the later need for cure.

Authors
Ubel, PA; Spranca, MD; Dekay, ML; Hershey, JC; Asch, DA
MLA Citation
Ubel, PA, Spranca, MD, Dekay, ML, Hershey, JC, and Asch, DA. "Public preferences for prevention versus cure: what if an ounce of prevention is worth only an ounce of cure?." Med Decis Making 18.2 (April 1998): 141-148.
PMID
9566447
Source
pubmed
Published In
Medical Decision Making
Volume
18
Issue
2
Publish Date
1998
Start Page
141
End Page
148
DOI
10.1177/0272989X9801800202

'Rationing' health care. Not all definitions are created equal.

Authors
Ubel, PA; Goold, SD
MLA Citation
Ubel, PA, and Goold, SD. "'Rationing' health care. Not all definitions are created equal." Arch Intern Med 158.3 (February 9, 1998): 209-214. (Review)
PMID
9472199
Source
pubmed
Published In
Archives of internal medicine
Volume
158
Issue
3
Publish Date
1998
Start Page
209
End Page
214

Value measurement in cost-utility analysis: explaining the discrepancy between rating scale and person trade-off elicitations.

Previous studies have shown a discrepancy between common utility elicitation methods, such as rating scale (RS) elicitations, and person trade-off (PTO) elicitations. This discrepancy has generally been felt to be due to the fact that RS elicitations ask people to compare conditions to each other in terms of numbers on a visual rating scale, while PTO elicitations ask people to think in terms of numbers of people needing to be treated. However, there are three other cognitive differences between PTO and RS elicitations that might contribute to the discrepancy: In PTO elicitations, as opposed to RS elicitations: (1) people are asked to think about how conditions affect people other than themselves; (2) people are asked to think about the benefit of treating conditions; and (3) people are asked to chose who to treat among patients with different conditions. In this study, we attempt to determine whether any of three cognitive differences contribute to the discrepancy between RS and PTO utility elicitations. We randomized prospective jurors to receive one of several survey versions in which we manipulated the RS and PTO elicitations to reduce the differences between them, while preserving their underlying structure. In the RS-self survey, we asked subjects to rate a health condition on a scale from 0 to 100 as if they had the condition. In the RS-other survey, we asked people to rate the health condition as if someone else had it. In the RS-cure survey, we asked subjects to rate the benefits of curing someone else of the health condition. In the PTO-comparison survey, we asked people to determine equivalent numbers of people needing to be cured of two conditions in order to produce equal benefits. In the PTO-choice survey, we presented people with a budget constraint and asked them to determine equivalent numbers of people needing to be cured of two conditions to help decide which group should be treated within the budget constraint. Two hundred and twenty two subjects completed surveys. Median utilities for health conditions were higher in the two PTO elicitations than in the three RS elicitations. There were no differences in utilities across the two PTO surveys, nor across the three RS surveys. In addition, the PTO elicitations allowed people to make finer distinctions among non-life threatening conditions than did the RS elicitations. The discrepancy between RS and PTO elicitations cannot be explained by shifting subjects attentions from themselves to others, nor from conditions to the benefit of treating conditions. Instead, the discrepancy occurs because of the general format of RS and PTO elicitations.

Authors
Ubel, PA; Loewenstein, G; Scanlon, D; Kamlet, M
MLA Citation
Ubel, PA, Loewenstein, G, Scanlon, D, and Kamlet, M. "Value measurement in cost-utility analysis: explaining the discrepancy between rating scale and person trade-off elicitations." Health Policy 43.1 (January 1998): 33-44.
PMID
10178799
Source
pubmed
Published In
Health Policy
Volume
43
Issue
1
Publish Date
1998
Start Page
33
End Page
44

Does bedside rationing violate patients' best interests? An exploration of "moral hazard".

Authors
Ubel, PA; Goold, S
MLA Citation
Ubel, PA, and Goold, S. "Does bedside rationing violate patients' best interests? An exploration of "moral hazard"." Am J Med 104.1 (January 1998): 64-68. (Review)
PMID
9528721
Source
pubmed
Published In
The American Journal of Medicine
Volume
104
Issue
1
Publish Date
1998
Start Page
64
End Page
68

Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives.

OBJECTIVES: The effects of incentive size on physicians' response rates to a mail survey were determined. METHODS: One thousand US primary care physicians were assigned randomly to receive a survey with either a $5 bill or a $2 bill as an incentive. For each of the two incentive groups, the overall response rate for three mailing waves, the total cost, and the total cost per usable response were measured. RESULTS: The response rate among those receiving the $5 bill (61%) was 32% higher than the response rate among those receiving the $2 bill (46%); overall costs were slightly higher in the $5 group, but the cost per response for each group was similar ($15.46 versus $14.93). For the same cost, a higher response rate could have been achieved in the $2 group if costs saved from foregoing the third mailing were instead used to increase the incentive for a portion of the subjects. CONCLUSIONS: A $5 bill incentive yielded a higher response rate among the physicians in this study than did a $2 bill incentive. Moreover, the powerful effect of the incentive size, combined with the consequent decline in the costs of subsequent mailing waves, suggests that resources in a fixed survey budget are allocated more efficiently to increasing the initial incentive rather than to providing a third wave to nonresponders.

Authors
Asch, DA; Christakis, NA; Ubel, PA
MLA Citation
Asch, DA, Christakis, NA, and Ubel, PA. "Conducting physician mail surveys on a limited budget. A randomized trial comparing $2 bill versus $5 bill incentives." Med Care 36.1 (January 1998): 95-99.
PMID
9431335
Source
pubmed
Published In
Medical Care
Volume
36
Issue
1
Publish Date
1998
Start Page
95
End Page
99

Does bedside rationing violate patients' best interests? An exploration of 'moral hazard' [5] (multiple letters)

Authors
DiNubile, MJ; Ubel, PA
MLA Citation
DiNubile, MJ, and Ubel, PA. "Does bedside rationing violate patients' best interests? An exploration of 'moral hazard' [5] (multiple letters)." American Journal of Medicine 105.4 (1998): 360-361.
PMID
9809705
Source
scival
Published In
The American Journal of Medicine
Volume
105
Issue
4
Publish Date
1998
Start Page
360
End Page
361

How preliminary data affect people's stated willingness to enter a hypothetical randomized controlled trial.

PURPOSE: To explore how preliminary trial data affect the general public's stated willingness to enter a randomized clinical trial. METHODS: We asked 165 prospective jurors to imagine that their physicians wanted them to enroll in a clinical trial. We then presented them with scenarios portraying preliminary trial results--for example, 9 out of 10 patients get better with drug A and 5 out of 10 get better with drug B--and asked after each scenario, whether they would choose to be part of the trial. We designed the scenarios to test how stated willingness to enter the trial would be influenced by: 1) the difference in effectiveness of the 2 treatments based on the patients enrolled thus far; and 2) by the chance that the difference in effectiveness was random (i.e., the P value). The subjects' willingness to enter the trial at various decision points was analyzed using logistic regression. RESULTS: Fewer subjects were willing to enter the trial as preliminary data indicated either an increasing difference in the effectiveness of the two treatments or an increasing statistical significance of that difference. For example 75% of subjects were willing to enter the research trial before any preliminary data were presented, but this number fell to 49% when subjects were presented with preliminary data showing that 9 out of 10 patients improved with one treatment and 5 out of 10 with the other. Multivariable logistic regression revealed that higher P values (odds ratio = 4.29; P < 0.001; 95% CI: 2.22-8.28) and smaller differences in effectiveness (odds ratio = 0.02; P < 0.001; 95% CI: 0.00-0.07) implicit in preliminary data presented to subjects made subjects less likely to agree to enter clinical trials. After adjustment for other relevant variables, male gender was associated with increased willingness to enter the trial. CONCLUSION: A subjects' willingness to enter the hypothetical trial was influenced by preliminary data. Fewer subjects were willing to enter the trial as the differences in benefit between 2 treatment groups increased. However, the majority of subjects were willing to enter the hypothetical trial even when preliminary evidence strongly favored one treatment over another. Given the importance of informed consent in entering patients in clinical trials, these results should be confirmed in actual trial settings.

Authors
Ubel, PA; Merz, JF; Shea, J; Asch, DA
MLA Citation
Ubel, PA, Merz, JF, Shea, J, and Asch, DA. "How preliminary data affect people's stated willingness to enter a hypothetical randomized controlled trial." J Investig Med 45.9 (December 1997): 561-566.
PMID
9444883
Source
pubmed
Published In
Journal of Investigative Medicine
Volume
45
Issue
9
Publish Date
1997
Start Page
561
End Page
566

Medical student name tags: identification or obfuscation?

OBJECTIVE: To explore how U.S. medical students doing clinical rotations are physically identified to patients via their name tags, and how patients interpret the educational status conveyed by those name tags. MEASUREMENTS AND MAIN RESULTS: A letter was sent to the dean of students at all 141 medical school campuses in the United States, requesting a photocopy of the name tag distributed to third-year students on clinical rotations. We then surveyed a convenience sample of 100 general medicine outpatients at the Hospital of the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center and presented them with examples of four ways medical students were identified on name tags we received: "medical student," "student physician," "student doctor," and "MD student." Patients were then asked to rank these, and three other identifiers ("faculty physician," "resident physician," and "house staff"), from least experienced to most experienced. Patients were told that some of the identifiers might denote the same level of experience. Fifty-three percent of the medical school name tags we received identified the medical student as "medical student," 11% as "student," 6% as "student physician," 2% as "student doctor," and 1% as "MD student." Four percent of name tags had only the student's name, and 18% had only the student's name and university affiliation. Patients thought that the four student descriptors ("medical student," "student physician," "student doctor," and "MD student") on medical student name tags indicated less experience than the other three descriptors. However, of the four student descriptors, patients thought "medical student" indicated less experience than the other three (p < .0001). CONCLUSIONS: There is great variation in how medical schools identify medical students on the name tags used during their clinical rotations. These different ways of identifying medical students are not interpreted as being identical to many patients.

Authors
Silver-Isenstadt, A; Ubel, PA
MLA Citation
Silver-Isenstadt, A, and Ubel, PA. "Medical student name tags: identification or obfuscation?." J Gen Intern Med 12.11 (November 1997): 669-671.
PMID
9383134
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
12
Issue
11
Publish Date
1997
Start Page
669
End Page
671

Kidney transplant candidates' views of the transplant allocation system.

OBJECTIVES: The point system used to distribute scarce transplantable kidneys places great emphasis on antigen matching. This contributes to increased waiting times for African Americans, who have a disproportionate share of rare antigens. We conducted a pilot study to explore the understanding and attitudes of kidney transplant candidates toward the way the transplant allocation system trades off between antigen matching and waiting time. MEASUREMENTS AND MAIN RESULTS: We performed semi-structured interviews of a convenience sample of 33 patients awaiting transplants in Philadelphia and its surrounding suburbs. Patients had a number of misconceptions about the transplant allocation system. Many incorrectly thought, for example, that quality of life and financial status influence which patients on the waiting list receive available organs. Despite these and other misconceptions, the majority of patients thought the allocation system was fair. However, many African Americans thought the system was biased against them because of their race. After hearing about how the transplant system factors antigen matching and waiting time into organ allocation, the majority of subjects still felt the system was fair. After hearing that the emphasis on antigen matching causes African Americans to wait twice as long as whites, a larger number of subjects thought the system was unfair. Nevertheless, few thought the system should be changed. Even African American patients who felt the system was unfair still approved of the emphasis on antigen matching out of a desire to have a successful kidney transplant. CONCLUSIONS: We found that most of the interviewed patients awaiting kidney transplant thought the system should continue to emphasize antigen matching. Although attitudes toward the allocation system differed by race, with African American patients more suspicious of the system, the importance patients placed on antigen matching did not appear to differ by race.

Authors
Louis, ON; Sankar, P; Ubel, PA
MLA Citation
Louis, ON, Sankar, P, and Ubel, PA. "Kidney transplant candidates' views of the transplant allocation system." J Gen Intern Med 12.8 (August 1997): 478-484.
PMID
9276653
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
12
Issue
8
Publish Date
1997
Start Page
478
End Page
484

The role of community values in setting healthcare priorities. Ethically and financially viable, or merely a "modest proposal?".

Authors
Ubel, PA
MLA Citation
Ubel, PA. "The role of community values in setting healthcare priorities. Ethically and financially viable, or merely a "modest proposal?"." MLO Med Lab Obs 29.7 (July 1997): 90-93.
PMID
10170110
Source
pubmed
Published In
Medical Laboratory Observer
Volume
29
Issue
7
Publish Date
1997
Start Page
90
End Page
93

Rationing by any other name.

Authors
Asch, DA; Ubel, PA
MLA Citation
Asch, DA, and Ubel, PA. "Rationing by any other name." N Engl J Med 336.23 (June 5, 1997): 1668-1671.
PMID
9171071
Source
pubmed
Published In
The New England journal of medicine
Volume
336
Issue
23
Publish Date
1997
Start Page
1668
End Page
1671
DOI
10.1056/NEJM199706053362309

Transplantation in alcoholics: separating prognosis and responsibility from social biases.

The general public does not favor transplanting livers into patients with alcoholic cirrhosis. This opinion may reflect a sense that we should not distribute scarce resources to people who are personally responsible for their illness. It may also reflect a sense that alcoholism is socially undesirable, and therefore alcoholics should not receive transplants. This article argues that these positions do not hold up under scrutiny. The only reason to give alcoholic patients lower priority for transplantation is if subgroups of alcoholics can be shown to have unacceptably poor transplant prognoses. However, giving these alcoholics lower priority is justifiable only if it is part of a larger policy that distributes livers on the basis of prognosis. In the meantime, there is no justification for giving lower priority to alcoholics for available livers.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Transplantation in alcoholics: separating prognosis and responsibility from social biases." Liver Transpl Surg 3.3 (May 1997): 343-346.
PMID
9346761
Source
pubmed
Published In
Liver Transplantation
Volume
3
Issue
3
Publish Date
1997
Start Page
343
End Page
346

Confidentiality and health insurance fraud.

BACKGROUND: Health insurance fraud committed by patients may be an increasing problem given the number of underinsured and uninsured people in the United States. Physicians recognizing acts of health insurance fraud perpetrated by patients face an ethical dilemma: should they disclose the incident to the insurance company, or protect patient confidentiality? OBJECTIVE: To explore physicians' attitudes toward the reporting of patient-initiated health insurance fraud. METHODS: Three hundred seven physician members of the American College of Physicians returned a mailed questionnaire that presented 6 case vignettes (3 variables) of patients who used a relative's insurance to obtain health care in the past. For each vignette, respondents were asked whether the treating physician should report insurance fraud to the health insurance carrier. RESULTS: Sixty-three respondents (20.7%) indicated that physicians should report all the patients presented in the vignettes, while 45 (14.8%) indicated none should be reported; the rest indicated that the decisions to-report should be based on the characteristics presented, with acute vs terminal illness (P < .001), history of fraud (P < .001), and wealth of the patient (P < .001) all causing physicians to be more likely to report the patient to the health insurance carrier. Multivariate analysis demonstrated that type of practice (P = .04) and respondents' experiences with insurance fraud (P = .03) had significant effects on the willingness to report patients. CONCLUSIONS: Physicians are divided about whether to report patients who have committed insurance fraud. Their decisions to report insurance fraud are influenced by their attitudes and demographic features, as well as by patient factors.

Authors
Farber, NJ; Berger, MS; Davis, EB; Weiner, J; Boyer, EG; Ubel, PA
MLA Citation
Farber, NJ, Berger, MS, Davis, EB, Weiner, J, Boyer, EG, and Ubel, PA. "Confidentiality and health insurance fraud." Arch Intern Med 157.5 (March 10, 1997): 501-504.
PMID
9066453
Source
pubmed
Published In
Archives of internal medicine
Volume
157
Issue
5
Publish Date
1997
Start Page
501
End Page
504

The role of decision analysis in informed consent: choosing between intuition and systematicity.

An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. In this paper we evaluate the relative importance of intuition and systematicity in informed consent. We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.

Authors
Ubel, PA; Loewenstein, G
MLA Citation
Ubel, PA, and Loewenstein, G. "The role of decision analysis in informed consent: choosing between intuition and systematicity." Soc Sci Med 44.5 (March 1997): 647-656.
PMID
9032832
Source
pubmed
Published In
Social Science & Medicine
Volume
44
Issue
5
Publish Date
1997
Start Page
647
End Page
656

Recognizing bedside rationing: clear cases and tough calls.

Under increasing pressure to contain medical costs, physicians find themselves wondering whether it is ever proper to ration health care at the bedside. Opinion about this is divided, but one thing is clear; Whether physicians should ration at the bedside or not, they ought to be able to recognize when they are doing so. This paper describes three conditions that must be met for a physician's action to quality as bedside rationing. The physician must 1) withhold, withdraw, or fail to recommend a service that, in the physician's best clinical judgment, is in the patient's best medical interests; 2) act primarily to promote the financial interests of someone other than the patient (including an organization, society at large, and the physician himself or herself); and 3) have control over the use of the beneficial service. This paper presents a series of cases that illustrate and elaborate on the importance of these three conditions. Physicians can use these conditions to identify instances of bedside rationing; leaders of the medical profession, ethicists, and policymakers can use them as a starting point for discussions about when, if ever, physicians should ration at the bedside.

Authors
Ubel, PA; Goold, S
MLA Citation
Ubel, PA, and Goold, S. "Recognizing bedside rationing: clear cases and tough calls." Ann Intern Med 126.1 (January 1, 1997): 74-80. (Review)
PMID
8992926
Source
pubmed
Published In
Annals of internal medicine
Volume
126
Issue
1
Publish Date
1997
Start Page
74
End Page
80

Managed care organizations should not disclose their physicians' financial incentives.

Authors
Noone, GC; Ubel, PA
MLA Citation
Noone, GC, and Ubel, PA. "Managed care organizations should not disclose their physicians' financial incentives." Am J Manag Care 3.1 (January 1997): 159-160.
PMID
10169247
Source
pubmed
Published In
American Journal of Managed Care
Volume
3
Issue
1
Publish Date
1997
Start Page
159
End Page
160

Rationing by any other name [7] (multiple letters)

Authors
Love, SM; Tuckfelt, M; Nicklin, D; Durand, AM; Katz, SJ; Asch, DA; Ubel, PA
MLA Citation
Love, SM, Tuckfelt, M, Nicklin, D, Durand, AM, Katz, SJ, Asch, DA, and Ubel, PA. "Rationing by any other name [7] (multiple letters)." New England Journal of Medicine 337.19 (1997): 1395-1396.
PMID
9380099
Source
scival
Published In
New England Journal of Medicine
Volume
337
Issue
19
Publish Date
1997
Start Page
1395
End Page
1396
DOI
10.1056/NEJM199711063371918

Semantic and moral debates about hastening death: a survey of bioethicists.

Authors
Ubel, PA; Asch, DA
MLA Citation
Ubel, PA, and Asch, DA. "Semantic and moral debates about hastening death: a survey of bioethicists." J Clin Ethics 8.3 (1997): 242-249.
PMID
9436082
Source
pubmed
Published In
The Journal of clinical ethics
Volume
8
Issue
3
Publish Date
1997
Start Page
242
End Page
249

Helping physicians recognize bedside rationing [9] (multiple letters)

Authors
Freedman, LR; Galanos, AN; Ubel, PA; Goold, S
MLA Citation
Freedman, LR, Galanos, AN, Ubel, PA, and Goold, S. "Helping physicians recognize bedside rationing [9] (multiple letters)." Annals of Internal Medicine 126.11 (1997): 921-922.
Source
scival
Published In
Annals of Internal Medicine
Volume
126
Issue
11
Publish Date
1997
Start Page
921
End Page
922

Physicians who report health insurance fraud and their practice type: Health maintenance organization vs fee-for-service (multiple letters)

Authors
Salom, IL; Farber, NJ; Berger, MS; Davis, EB; Weiner, J; Boyer, EG; Ubel, PA
MLA Citation
Salom, IL, Farber, NJ, Berger, MS, Davis, EB, Weiner, J, Boyer, EG, and Ubel, PA. "Physicians who report health insurance fraud and their practice type: Health maintenance organization vs fee-for-service (multiple letters)." Archives of Internal Medicine 157.19 (1997): 2270--.
PMID
9343004
Source
scival
Published In
Archives of internal medicine
Volume
157
Issue
19
Publish Date
1997
Start Page
2270-

Public preferences for efficiency and racial equity in kidney transplant allocation decisions.

Authors
Ubel, PA; DeKay, M; Baron, J; Asch, DA
MLA Citation
Ubel, PA, DeKay, M, Baron, J, and Asch, DA. "Public preferences for efficiency and racial equity in kidney transplant allocation decisions." Transplant Proc 28.5 (October 1996): 2997-3002.
PMID
8908149
Source
pubmed
Published In
Transplantation Proceedings
Volume
28
Issue
5
Publish Date
1996
Start Page
2997
End Page
3002

Public perceptions of the importance of prognosis in allocating transplantable livers to children.

BACKGROUND: The system to allocate scarce transplantable livers has been criticized for not giving enough weight to the prognoses of the patients receiving the transplants, but little research has been done looking at how the public weights the relative importances of efficacy and equity in distributing the organs. METHODS: This study was an experimental survey of prospective jurors asked to distribute transplantable livers among transplant candidates grouped according to their prognoses. The relative prognoses of the transplant candidates were varied across survey versions. RESULTS: As the prognostic difference between transplant groups increased, the subjects became less likely to distribute the organs equally between them (p < 0.005). However, the subjects' willingness to base allocation on prognosis was moderated by a number of factors, including their understanding of how to use prognostic information and their attitudes toward using prognostic information for individuals versus groups. Thus, even when the relative prognoses of transplant groups differed by 60%, less than a fourth of the subjects were willing to give all the organs to the better-prognosis group. CONCLUSION: Many subjects feel that prognosis is an important consideration in allocating scarce livers. However, few are willing to base allocation purely on maximizing survival. Policies that base allocations purely on outcomes will violate the values of a significant portion of the public.

Authors
Ubel, PA; Loewenstein, G
MLA Citation
Ubel, PA, and Loewenstein, G. "Public perceptions of the importance of prognosis in allocating transplantable livers to children." Med Decis Making 16.3 (July 1996): 234-241.
PMID
8818121
Source
pubmed
Published In
Medical Decision Making
Volume
16
Issue
3
Publish Date
1996
Start Page
234
End Page
241
DOI
10.1177/0272989X9601600307

Informed consent. From bodily invasion to the seemingly mundane.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Informed consent. From bodily invasion to the seemingly mundane." Arch Intern Med 156.12 (June 24, 1996): 1262-1263.
PMID
8651833
Source
pubmed
Published In
Archives of internal medicine
Volume
156
Issue
12
Publish Date
1996
Start Page
1262
End Page
1263

Safety of dapsone as Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with allergy to trimethoprim/sulfamethoxazole.

OBJECTIVE: To assess the safety of dapsone prophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with prior intolerance to trimethoprim/sulfamethoxazole (TMP/SMX). METHODS: We conducted a retrospective study in the categorical human immunodeficiency virus out-patient program of a university hospital. Patients who had filled prescriptions for dapsone at our pharmacy between January 1991 and April 1994 were evaluated and 75 patients were found eligible for analysis. RESULTS: The overall incidence of adverse events (AE) in our study cohort was 39%. The most common AEs were anemia (23%) and rash (16%). However, after critical evaluation of each case, only 3 cases of anemia (4%) and 2 cases of rash (3%) were judged to be "likely related" to dapsone. Only 5/75 patients (7%) developed the same intolerance to dapsone as previously experienced on TMP/SMX, and none of these cases was viewed as "likely related" to dapsone. A dapsone regimen of 100 mg qd and a prior episode of PCP were associated with a higher incidence of AEs. Eight cases of PCP occurred in spite of dapsone prophylaxis for an incidence of 7 cases per 1,000 patient-months. Seven of the cases of PCP occurred in patients who were receiving secondary prophylaxis. CONCLUSIONS: Given the low incidence of AEs judged to be "likely related" to dapsone, this drug is a reasonable choice for PCP prophylaxis in patients with prior AEs to TMP/SMX.

Authors
Beumont, MG; Graziani, A; Ubel, PA; MacGregor, RR
MLA Citation
Beumont, MG, Graziani, A, Ubel, PA, and MacGregor, RR. "Safety of dapsone as Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with allergy to trimethoprim/sulfamethoxazole." Am J Med 100.6 (June 1996): 611-616.
PMID
8678080
Source
pubmed
Published In
The American Journal of Medicine
Volume
100
Issue
6
Publish Date
1996
Start Page
611
End Page
616

Cost-effectiveness analysis in a setting of budget constraints--is it equitable?

BACKGROUND: One of the promises of cost-effective analysis is that it can demonstrate how to maximize health benefits attainable within a specific limited budget. Many people argue, however, that when there are budget limitations, the use of cost-effectiveness analysis leads to health care policies that are inequitable. METHODS: We asked prospective jurors, medical ethicists, and experts in medical decision making to choose between two screening tests for a population at low risk for colon cancer. One test was more cost effective than the other but because of budget constraints was too expensive to be given to everyone in the population. With the use of the more effective test for only half the population, 1100 lives could be saved at the same cost as that of saving 1000 lives with the use of the less effective test for the entire population. RESULTS: Fifty-six percent of the prospective jurors, 53 percent of the medical ethicists, and 41 percent of the experts in medical decision making recommended offering the less effective screening test to everyone, even though 100 more lives would have been saved by offering the more expensive test to only a portion of the population. Most of the study participants justified this recommendation on the basis of equity. A smaller number stated either that it was not politically feasible to offer a test to only half the population or that the additional benefit of the more expensive test (100 more lives saved) was too small to justify offering it to only a portion of the public. CONCLUSIONS: People place greater importance on equity than is reflected by cost-effectiveness analysis. Even many experts in medical decision making -- those often responsible for conducting cost-effectiveness analyses -- expressed discomfort with some of its implications. Basing health care priorities on cost effectiveness may not be possible without incorporating explicit considerations of equity into cost-effectiveness analyses or the process used to develop health care policies on the basis of such analyses.

Authors
Ubel, PA; DeKay, ML; Baron, J; Asch, DA
MLA Citation
Ubel, PA, DeKay, ML, Baron, J, and Asch, DA. "Cost-effectiveness analysis in a setting of budget constraints--is it equitable?." N Engl J Med 334.18 (May 2, 1996): 1174-1177.
PMID
8602185
Source
pubmed
Published In
The New England journal of medicine
Volume
334
Issue
18
Publish Date
1996
Start Page
1174
End Page
1177
DOI
10.1056/NEJM199605023341807

Distributing scarce livers: the moral reasoning of the general public.

The transplant system has been criticized for not paying enough attention to efficiency in distributing scarce organs. But little research has been done to see how the general public views tradeoffs between efficiency and equity. We surveyed members of the general public to see how they would distribute organs among patients with varying chances of benefiting from them. In addition, we asked subjects to explain their decisions and to tell us about any other information they would have liked in order to make the decisions. We found that the public places a very high value on giving everyone a chance at receiving scarce resources, even if that means a significant decrease in the chance that available organs will save people's lives. Our results raise important questions about whether the aims of outcomes research and cost-effective studies agree with the values of the general public.

Authors
Ubel, PA; Loewenstein, G
MLA Citation
Ubel, PA, and Loewenstein, G. "Distributing scarce livers: the moral reasoning of the general public." Soc Sci Med 42.7 (April 1996): 1049-1055.
PMID
8730910
Source
pubmed
Published In
Social Science & Medicine
Volume
42
Issue
7
Publish Date
1996
Start Page
1049
End Page
1055

Individual utilities are inconsistent with rationing choices: A partial explanation of why Oregon's cost-effectiveness list failed.

OBJECTIVE: To test whether cost-effectiveness analysis and present methods of eliciting health condition "utilities" capture the public's values for health care rationing. DESIGN: Two surveys of economics students. The first survey measured their utilities for three states of health, using either analog scale, standard gamble, or time tradeoff. The second survey measured their preferences, in paired rationing choices of the health states from the first survey and also compared with treatment of acutely fatal appendicitis. The rationing choices each subject faced were individualized according to his or her utility responses, so that the subject should have been indifferent between the two conditions in each rationing choice. RESULTS: The analog-scale elicitation method produced significantly lower utilities than the time-tradeoff and standard-gamble methods for two of the three conditions (p < 0.001). Compared with the rationing choices, all three utility-elicitation methods placed less value on the importance of saving lives and treating more severely ill people compared with less severely ill ones (p < 0.0001). The subjects' rationing choices indicated that they placed values on treating severely ill people that were tenfold to one-hundred-thousand-fold greater than would have been predicted by their utility responses. However, the subjects' rationing choices showed internal inconsistency, as, for example, treatments that were indicated to be ten times more beneficial in one scenario were valued as one hundred times more beneficial in other scenarios. CONCLUSIONS: The subjects soundly rejected the rationing choices derived from their utility responses. This suggests that people's answers to utility elicitations cannot be easily translated into social policy. However, person-tradeoff elicitations, like those given in our rationing survey, cannot be substituted for established methods of utility elicitation until they can be performed in ways that yield acceptable internal consistency.

Authors
Ubel, PA; Loewenstein, G; Scanlon, D; Kamlet, M
MLA Citation
Ubel, PA, Loewenstein, G, Scanlon, D, and Kamlet, M. "Individual utilities are inconsistent with rationing choices: A partial explanation of why Oregon's cost-effectiveness list failed." Med Decis Making 16.2 (April 1996): 108-116.
PMID
8778528
Source
pubmed
Published In
Medical Decision Making
Volume
16
Issue
2
Publish Date
1996
Start Page
108
End Page
116
DOI
10.1177/0272989X9601600202

Can We Continue to Afford Organ Transplants in an Era of Managed Care?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Can We Continue to Afford Organ Transplants in an Era of Managed Care?." American Journal of Managed Care 2 (1996): 293-297.
Source
manual
Published In
American Journal of Managed Care
Volume
2
Publish Date
1996
Start Page
293
End Page
297

The public's preference for bedside rationing [2]

Authors
Hall, MA; Ubel, P; Arnold, R
MLA Citation
Hall, MA, Ubel, P, and Arnold, R. "The public's preference for bedside rationing [2]." Archives of Internal Medicine 156.12 (1996): 1353-1354.
PMID
8651847
Source
scival
Published In
Archives of internal medicine
Volume
156
Issue
12
Publish Date
1996
Start Page
1353
End Page
1354
DOI
10.1001/archinte.156.12.1353

Cost-effectiveness analysis and budget constraints

Authors
McCombs, JS; Schwaber, MJ; Reichman, J; Brezis, M; Ubel, PA; Asch, DA; Baron, J; Patton, MF
MLA Citation
McCombs, JS, Schwaber, MJ, Reichman, J, Brezis, M, Ubel, PA, Asch, DA, Baron, J, and Patton, MF. "Cost-effectiveness analysis and budget constraints." New England Journal of Medicine 335.19 (1996): 1465-1466.
PMID
8927085
Source
scival
Published In
New England Journal of Medicine
Volume
335
Issue
19
Publish Date
1996
Start Page
1465
End Page
1466
DOI
10.1056/NEJM199611073351914

Acceptance of external funds by physician organizations: issues and policy options.

Authors
Ubel, PA; Arnold, RM; Gramelspacher, GP; Hoppe, RB; Landefeld, CS; Levinson, W; Tierney, W; Tolle, SW
MLA Citation
Ubel, PA, Arnold, RM, Gramelspacher, GP, Hoppe, RB, Landefeld, CS, Levinson, W, Tierney, W, and Tolle, SW. "Acceptance of external funds by physician organizations: issues and policy options." J Gen Intern Med 10.11 (November 1995): 624-630.
PMID
8583265
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
10
Issue
11
Publish Date
1995
Start Page
624
End Page
630

The efficacy and equity of retransplantation: an experimental survey of public attitudes.

PURPOSE: To measure the relative importance people place on prognosis and retransplantation status in allocating scarce transplantable livers. METHODS: 138 subjects were asked to distribute scarce livers amongst transplant candidates with either a 70% chance or a 30% chance of surviving if transplanted. In one group of subjects, the prognostic difference was based on the presence or absence of a 'blood marker.' In the other group, the prognostic difference was based on whether candidates had been previously transplanted or not, with retransplant candidates having a 30% chance of surviving if transplanted. RESULTS: Subjects answering the retransplantation survey gave a higher percentage of organs to the better prognostic group than subjects answering the blood marker survey, with a mean of 71.6% versus 65.0%, although this difference fell just short of statistical significance (P = 0.0581). Retransplantation survey respondents were significantly less likely to want to ignore prognostic information than were blood marker respondents (P = 0.026). Subjects in both survey groups were equally unwilling to abandon the poor prognostic group, with only 18% in each group choosing to give all the available organs to the better prognostic group. CONCLUSIONS: Respondents reacted more strongly to prognostic differences when they were due to retransplant status than to the results of a blood test. However, most people were not solely interested in the aggregate medical benefit brought by different allocation systems, but were also interested in the amount of benefit brought to the worst off.

Authors
Ubel, PA; Loewenstein, G
MLA Citation
Ubel, PA, and Loewenstein, G. "The efficacy and equity of retransplantation: an experimental survey of public attitudes." Health Policy 34.2 (November 1995): 145-151.
PMID
10153483
Source
pubmed
Published In
Health Policy
Volume
34
Issue
2
Publish Date
1995
Start Page
145
End Page
151

The unbearable rightness of bedside rationing. Physician duties in a climate of cost containment.

A local internist is in the process of ordering an intravenous pyelogram for a patient she suspects of having kidney problems, when a medical student shadowing her in clinic interrupts. The student wants to know why the physician is not ordering a low-osmolality contrast agent for the patient, having read that they are less likely to cause serious side effects than high-osmolality contrast agents. The physician realizes that the medical student is correct, but rejects the suggestion, telling the student that "low-osmolality contrast agents are the standard of care for low-risk patients."

Authors
Ubel, PA; Arnold, RM
MLA Citation
Ubel, PA, and Arnold, RM. "The unbearable rightness of bedside rationing. Physician duties in a climate of cost containment." Arch Intern Med 155.17 (September 25, 1995): 1837-1842.
PMID
7677549
Source
pubmed
Published In
Archives of internal medicine
Volume
155
Issue
17
Publish Date
1995
Start Page
1837
End Page
1842

Elevator talk: observational study of inappropriate comments in a public space.

OBJECTIVES: We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. METHODS: Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. RESULTS: We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. CONCLUSION: Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.

Authors
Ubel, PA; Zell, MM; Miller, DJ; Fischer, GS; Peters-Stefani, D; Arnold, RM
MLA Citation
Ubel, PA, Zell, MM, Miller, DJ, Fischer, GS, Peters-Stefani, D, and Arnold, RM. "Elevator talk: observational study of inappropriate comments in a public space." Am J Med 99.2 (August 1995): 190-194.
PMID
7625424
Source
pubmed
Published In
The American Journal of Medicine
Volume
99
Issue
2
Publish Date
1995
Start Page
190
End Page
194

Doctor talk: technology and modern conversation.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Doctor talk: technology and modern conversation." Am J Med 98.6 (June 1995): 587-588.
PMID
7778575
Source
pubmed
Published In
The American Journal of Medicine
Volume
98
Issue
6
Publish Date
1995
Start Page
587
End Page
588

Fever: blessing or curse?

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Fever: blessing or curse?." Ann Intern Med 121.12 (December 15, 1994): 982-. (Letter)
PMID
7978728
Source
pubmed
Published In
Annals of internal medicine
Volume
121
Issue
12
Publish Date
1994
Start Page
982

The euthanasia debate and empirical evidence: separating burdens to others from one's own quality of life.

Authors
Ubel, PA; Arnold, RM
MLA Citation
Ubel, PA, and Arnold, RM. "The euthanasia debate and empirical evidence: separating burdens to others from one's own quality of life." J Clin Ethics 5.2 (1994): 155-158.
PMID
7919490
Source
pubmed
Published In
The Journal of clinical ethics
Volume
5
Issue
2
Publish Date
1994
Start Page
155
End Page
158

Retransplantation of scarce organs: The ethical lessons [1]

Authors
Zinberg, JM; McMasters, R; Ubel, P; Arnold, R; Caplan, A
MLA Citation
Zinberg, JM, McMasters, R, Ubel, P, Arnold, R, and Caplan, A. "Retransplantation of scarce organs: The ethical lessons [1]." Journal of the American Medical Association 271.15 (1994): 1157-1158.
Source
scival
Published In
Journal of the American Medical Association
Volume
271
Issue
15
Publish Date
1994
Start Page
1157
End Page
1158

Rationing failure. The ethical lessons of the retransplantation of scarce vital organs.

Because of a shortage of transplantable livers and hearts, the transplant community has had to decide--by who gets an organ--who lives or dies. Despite this shortage, whether one has previously received a transplant is not used as a criterion to distribute organs. The existing allocation system distributes 10% to 20% of available hearts and livers to retransplant patients. This article examines three differences between primary transplantation and retransplantation that may affect the priority that retransplant candidates should receive in vying for organs: (1) the special obligations that transplant teams have not to abandon patients on whom they have already performed a transplant, (2) the fairness of allowing individuals to get multiple transplants while some die awaiting their first, and (3) the difference in efficacy between primary transplantation and retransplantation. Only this last difference holds up to critical analysis. Our moral duty to direct scarce, lifesaving resources to those likely to benefit from them, suggests that, all other things equal, primary transplant candidates should receive priority because their mortality after transplantation is lower. Consistency also demands that previous transplant history be taken into account, as we already allocate organs according to ABO blood group matching, a factor that affects transplant outcome approximately the same amount as a previous transplantation. We therefore conclude that the system should be revised so that primary transplant candidates have a better chance of receiving organs than retransplant candidates.

Authors
Ubel, PA; Arnold, RM; Caplan, AL
MLA Citation
Ubel, PA, Arnold, RM, and Caplan, AL. "Rationing failure. The ethical lessons of the retransplantation of scarce vital organs." JAMA 270.20 (November 24, 1993): 2469-2474.
PMID
8230624
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
270
Issue
20
Publish Date
1993
Start Page
2469
End Page
2474

Assisted suicide and the case of Dr. Quill and Diane.

Authors
Ubel, PA
MLA Citation
Ubel, PA. "Assisted suicide and the case of Dr. Quill and Diane." Issues Law Med 8.4 (1993): 487-502.
PMID
8463075
Source
pubmed
Published In
Issues in law & medicine
Volume
8
Issue
4
Publish Date
1993
Start Page
487
End Page
502

Hedonic adaptation and the role of decision and experience utility in public policy

Many economists are becoming supportive of 'soft' paternalistic interventions that help people to avoid common decision errors without curtailing individual autonomy. To identify when such interventions could be beneficial, and to assess their success, requires a welfare criterion. However, traditional preference or choice-based criteria cannot serve this function because they assume that whatever people choose makes them better off. An alternative criterion that bases welfare on happiness rather than choice avoids this problem but has several of its own drawbacks. Most notably, people often adapt to serious chronic health conditions, and exhibit high levels of happiness, even though both those with and those without the condition agree that it is much preferable to be healthy. After reviewing different lines of research that shed light on the pros and cons of these alternative welfare criteria, we argue that no simple criterion based on either concept can surmount these problems. Instead, evaluations of welfare will inevitably have to be informed by a combination of both approaches, patched together in a fashion that depends on the specific context. © 2008.

Authors
Loewenstein, G; Ubel, PA
MLA Citation
Loewenstein, G, and Ubel, PA. "Hedonic adaptation and the role of decision and experience utility in public policy." Journal of Public Economics.
Source
scival
Published In
Journal of Public Economics
DOI
10.1016/j.jpubeco.2007.12.011
Show More