Peter Ubel

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 Distinguished 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

Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Associate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Core Faculty Member, Duke-Margolis Center for Health Policy

Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1984

Carleton College

M.D. 1988

University of Minnesota, Twin Cities

Grants:

Cancer Treatment Disparities in the HIV Population: Exploring the Impact of HIV on Physician and Patient Decision-Making

Administered By
Radiation Oncology
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

Financial and Social Behavioral Economic Incentives to Increase Physical Activity in Adolescents and Young Adults for Cardiovascular Health

Administered By
Duke Clinical Research Institute
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

HIV cure studies: risk, risk perception, and ethics

Administered By
Institutes and Provost's Academic Units
Awarded By
Harvard University
Role
Principal Investigator
Start Date
End Date

Integrating Costs Into Shared Decision-Making for Heart Failure with Reduced Ejection Fraction

Administered By
Institutes and Provost's Academic Units
Awarded By
Emory University
Role
Principal Investigator
Start Date
End Date

Exploring Ethical Dilemmas Facing Private Payers

Administered By
Institutes and Provost's Academic Units
Awarded By
Greenwall Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Definitely, Maybe: Helping Patients Make Decisions about Surgery When Prognosis Is Uncertain.

AbstractThe sudden onset of severe traumatic brain injury (sTBI) is an event suffered by millions of individuals each year. Regardless of this frequency in occurrence, accurate prognostication remains difficult to achieve among physicians. There are many variables that affect this prognosis. Physicians are expected to assess the clinical indications of the brain injury while considering other factors such as patient quality of life, patient preferences, and environmental context. However, this lack of certainty in prognosis can ultimately affect treatment recommendations and prompt clinical ethical issues at the bedside, as it leaves room for physician bias and interpretation. In this article, we introduce data on neurosurgeon values that may shed light on the process physicians and patients involved in sTBI undergo. In doing so, we highlight the many nuances in decision-making for patients suffering from sTBI and discuss potential solutions to better patient-physician or surrogate-physician interactions.
Authors
Mitchell, T; Abdelgadir, J; Oshotse, C; Ubel, PA; Williamson, T
MLA Citation
Mitchell, Taylor, et al. “Definitely, Maybe: Helping Patients Make Decisions about Surgery When Prognosis Is Uncertain.The Journal of Clinical Ethics, vol. 34, no. 2, Jan. 2023, pp. 169–74. Epmc, doi:10.1086/724770.
URI
https://scholars.duke.edu/individual/pub1582442
PMID
37229741
Source
epmc
Published In
The Journal of Clinical Ethics
Volume
34
Published Date
Start Page
169
End Page
174
DOI
10.1086/724770

Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss Out-of-Pocket Costs.

Background Out-of-pocket costs have significant implications for patients with heart failure and should ideally be incorporated into shared decision-making for clinical care. High out-of-pocket cost is one potential reason for the slow uptake of newer guideline-directed medical therapies for heart failure with reduced ejection fraction. This study aims to characterize patient-cardiologist discussions involving out-of-pocket costs associated with sacubitril/valsartan during the early postapproval period. Methods and Results We conducted content analysis on 222 deidentified transcripts of audio-recorded outpatient encounters taking place between 2015 and 2018 in which cardiologists (n=16) and their patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. In the 222 included encounters, 100 (45%) contained discussions about cost. Cost was discussed in a variety of contexts: when sacubitril/valsartan was initiated, not initiated, continued, and discontinued. Of the 97 cost conversations analyzed, the majority involved isolated discussions about insurance coverage (64/97 encounters; 66%) and few addressed specific out-of-pocket costs or affordability (28/97 encounters; 29%). Discussion of free samples of sacubitril/valsartan was common (52/97 encounters; 54%), often with no discussion of a longer-term plan for addressing cost. Conclusions Although cost conversations were somewhat common in patient-cardiologist encounters in which sacubitril/valsartan was discussed, these conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with a course of free sacubitril/valsartan samples without a plan to address the cost after the samples ran out.
Authors
Rao, BR; Akrobetu, DJ; Dickert, NW; Nguyen, T-V; Davis, JK; Campagna, A; Mitchell, AR; Sharma, A; Speight, CD; Barks, MC; Farley, S; Gutterman, S; Santanam, T; Ubel, PA
MLA Citation
Rao, Birju R., et al. “Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss Out-of-Pocket Costs.Journal of the American Heart Association, vol. 12, no. 7, Apr. 2023, p. e028278. Epmc, doi:10.1161/jaha.122.028278.
URI
https://scholars.duke.edu/individual/pub1570178
PMID
36974764
Source
epmc
Published In
Journal of the American Heart Association
Volume
12
Published Date
Start Page
e028278
DOI
10.1161/jaha.122.028278

Financial Pollution in the US Health Care System.

MLA Citation
Wagner, Anita Katharina, et al. “Financial Pollution in the US Health Care System.Jama Health Forum, vol. 2, no. 3, Mar. 2021, p. e210195. Pubmed, doi:10.1001/jamahealthforum.2021.0195.
URI
https://scholars.duke.edu/individual/pub1553516
PMID
36218446
Source
pubmed
Published In
Jama Health Forum
Volume
2
Published Date
Start Page
e210195
DOI
10.1001/jamahealthforum.2021.0195

Improving Cancer Care for People Living With HIV: A Qualitative Study of Provider Knowledge, Attitudes, and Practice.

PURPOSE: Cancer is now the leading cause of non-AIDS death in the US population with HIV. People living with HIV (PLWH) are known to have lower cancer treatment rates and worse cancer outcomes. Disparate cancer treatment is driven by health system, patient, and clinician factors. Little attention has been given to the factors oncologists consider when making cancer treatment recommendations to PLWH. This study sought to examine oncologists' knowledge, attitudes, and practices that influence cancer treatment decision-making. METHODS AND MATERIALS: This study used qualitative methods to explore oncologists' treatment decision-making processes for PLWH and cancer. The sample included 25 radiation, medical, and surgical oncologists from 2 academic centers and 5 community practices. The interview domains were developed from the Andersen Healthcare Utilization Model, the Health Belief Model, and the PEN-3 Model, as well as our prior survey research. RESULTS: This study describes elements of cancer treatment decision-making for PLWH. Oncologists highlighted the need for formal HIV education to support cancer treatment. One main concern with patient-provider interactions pertained to maintaining patient confidentiality during clinical encounters. Lastly, the importance of multidisciplinary care among health care providers allowed oncologists to facilitate both cancer care and logistical support. CONCLUSIONS: As cancer becomes an increasingly common cause of death among PLWH, it is critical to understand the drivers of the observed disparities in cancer treatment. To our knowledge, this is the first qualitative study to describe oncologists' knowledge, attitudes, and practices toward patients who have a comorbid diagnosis of HIV and cancer. Several themes for future interventions emerge, including HIV training for cancer care providers, fostering interdisciplinary collaboration, enhancing HIV education for oncology learners and clinicians, and minimizing implicit bias.
Authors
Henry, V; Stephens, MJ; Galyean, P; Young, J; Zickmund, S; Knettel, BA; Bartlett, J; Watt, MH; Pollak, KI; Ubel, PA; Fagerlin, A; Suneja, G
MLA Citation
Henry, Valencia, et al. “Improving Cancer Care for People Living With HIV: A Qualitative Study of Provider Knowledge, Attitudes, and Practice.Int J Radiat Oncol Biol Phys, vol. 116, no. 1, May 2023, pp. 60–67. Pubmed, doi:10.1016/j.ijrobp.2023.01.045.
URI
https://scholars.duke.edu/individual/pub1565094
PMID
36724857
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
116
Published Date
Start Page
60
End Page
67
DOI
10.1016/j.ijrobp.2023.01.045

Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study.

<h4>Objective</h4>For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family-based treatment (FBT), the gold-standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration.<h4>Methods</h4>This proof-of-concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first-time hospitalization for medical stabilization of AN or atypical AN. Parents completed a battery of measures and a semistructured interview assessing the acceptability and feasibility of OSOG.<h4>Results</h4>Parents described the tool as credible and acceptable. Qualitative feedback highlighted common themes of caregiver burden, nutrition education, and acceptability of the tool.<h4>Discussion</h4>Results point to the need for more work in supporting parents in Phase I of FBT.<h4>Public significance</h4>Families are instrumental in supporting youth to recover from anorexia nervosa. During treatment, parents are charged with selecting and serving their adolescent's meals, often requiring them to change grocery shopping and food preparation habits to meet their child's high caloric needs. Parents reported feeling overwhelmed by this task and noted struggling with learning different approaches to nourish their adolescent during an already stressful time. Collaboratively with parents, we modified a tool to support parents in shifting thier shopping habits, which they reported as being a helpful springboard in the early phase of treatment.
Authors
Makara, A; Howe, H; Cooper, M; Heckert, K; Weiss, S; Kellom, K; Scharf, D; Ubel, P; Orloff, N; Timko, CA
MLA Citation
Makara, Amanda, et al. “Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study.The International Journal of Eating Disorders, vol. 56, no. 5, May 2023, pp. 1011–20. Epmc, doi:10.1002/eat.23902.
URI
https://scholars.duke.edu/individual/pub1565019
PMID
36737256
Source
epmc
Published In
The International Journal of Eating Disorders
Volume
56
Published Date
Start Page
1011
End Page
1020
DOI
10.1002/eat.23902