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Effective Health Care Program

Supporting Shared Decisions When Clinical Evidence Is Low (Session III)

White Paper

This conference took place on September 13, 2011, in Gaithersburg, Maryland. Presenters and discussants explored the theory-based and practical approaches to patient-provider communication in order to offer the EHC Program guidance on developing resources and tools that support decisionmaking by patients and their health care providers.

This third session addresses supporting shared decisions when clinical evidence is low.

Presentations

Supporting Shared Decisions When Clinical Evidence is Low

Mary C. Politi, Ph.D., Presenter


Washington University School of Medicine in St. Louis, St. Louis, Missouri

Supporting Shared Decision Making When Clinical Evidence is Low

Clarence H. Braddock, III, M.D., M.P.H., Presenter


Stanford School of Medicine, Stanford, California

An Ethical Framework for Supporting Shared Decision Making When Clinical Evidence is Low

Laurence B. McCullough, Ph.D., Presenter


Baylor College of Medicine, Houston, Texas

Decision making when clinical evidence is limited: Palliative chemotherapy for cancer

Anthony L. Back, M.D., Presenter


University of Washington, Seattle, Washington

Discussant Presentation

Steven H. Woolf, M.D., M.P.H., Discussant


Virginia Commonwealth University, Richmond, Virginia

Discussant Presentation

Paul M. Haidet, M.D., M.P.H., Discussant


Penn State College of Medicine, Hershey, Pennsylvania

Biosketches

Anthony L. Back, M.D., is Professor of Medicine at the University of Washington in Seattle. He is Director of the Cancer Communication and Palliative Care Programs at the Seattle Cancer Care Alliance (SCCA) and Fred Hutchinson Cancer Research Center (FHCRC). He is a board-certified medical oncologist whose primary research interests are doctor-patient communication and palliative care, and he practices gastrointestinal oncology. Dr. Back was a Faculty Scholar on the Project on Death in America and is a member of the ASCO Communication Task Force. He is the Principal Investigator the Oncotalk Teach, communication skills training program for Medical Oncology fellows (R25 CA 119019), and is an investigator on other NIH-funded observational studies of doctor-patient communication about hope and information (R01 PI J.R. Curtis) and prognosis in hematologic malignancies (R01 P.I. Stephanie Lee).

Clarence H. Braddock, III, M.D., M.P.H., is Professor of Medicine and Associate Dean for Undergraduate and Graduate Medical Education at Stanford School of Medicine, Director of the Stanford Center for Medical Education Research and Innovation, and Director of Clinical Ethics at the Stanford Center for Biomedical Ethics. His research focus has been physician-patient communication and informed decision-making, having developed an assessment scale of the quality of informed decision making (IDM) in clinical practice and applied it in numerous published studies of informed decision making in a number of areas, such as office practice, intensive care units, orthopedic surgical practice, and preventive and screening services. His work has been influential in our empiric understanding of the gap between the ethical ideal of shared decision making and the reality of clinical practice. In addition, the IDM framework he developed has informed new approaches in medical education and assessment of clinical competence in interpersonal communication. His work in this area has extended into cultural competence, having led a national effort among eighteen medical schools to developing patient-centered curriculum in cultural competence and healthcare disparities.

Paul M. Haidet M.D., M.P.H., is the Director of Medical Education Research and a Professor of Medicine, Humanities, and Public Health Sciences at the Pennsylvania State University College of Medicine. Dr. Haidet received his medical degree from the Pennsylvania State University, and his masters in public health from Harvard University. Dr. Haidet's career has focused on relationships in medicine, including patient-physician, student-teacher, and individual-organization relationships. His work in these realms has been cited widely, and he is the recipient of several national awards, including the 2011 Master Scholar Award from the International Association of Medical Science Educators. Dr. Haidet serves as the current President of the American Academy on Communication in Healthcare, and is a deputy editor for the journal Medical Education. Most recently, Dr. Haidet has been exploring the intersections of jazz music and medicine, in an effort to improve the improvisational skills of physicians.

Laurence B. McCullough, Ph.D., is the inaugural holder of the Dalton Tomlin Chair in Medical Ethics and Health Policy (since May 2008) in the Center for Medical Ethics and Health Policy, Baylor College of Medicine (BCM), Houston, Texas, where is also Professor Medicine and Medical Ethics and a Faculty Associate of the Huffington Center on Aging (since 1988). He has also served as Associate Director for Education of the Center for Medical Ethics and Health Policy since 2004. He is Adjunct Professor of Ethics in Obstetrics and Gynecology and of Public Health at the Weill Medical College of Cornell University in New York City and Adjunct Professor of Philosophy at Rice University. He received an American Council of Learned Societies Fellowship for 1995-1996 and was elected a Fellow the Gerontological Society of America in 1997 and of the Hastings Center in 2003. He received his AB in Art History from Williams College (1969) and his PhD in Philosophy from the University of Texas at Austin (1975) and held a post-doctoral fellowship at The Hastings Center (1975-1976). He has held prior appointments on the medical and philosophy faculties at Texas A&M University (1976-1979) and Georgetown University (1979-1988), where he was a Senior Research Scholar in the Kennedy Institute of Ethics. Dr. McCullough is a past president of the Society for Health and Human Values (1987-88), now merged into the American Society for Bioethics and Humanities.

Dr. McCullough has published more than 400 articles, case studies, and editorials in the peer-reviewed literature and 12 books. Medical Ethics: The Moral Responsibilities of Physicians, co-authored with Tom L. Beauchamp (Prentice-Hall, 1984), has been translated into Spanish (Barcelona, 1987) and Japanese (Tokyo, 1992). With Frank A. Chervenak, MD (Given Foundation Professor and Chairman of Obstetrics and Gynecology, Weill Medical College of Cornell University), he is co-author of Ethics in Obstetrics and Gynecology (Oxford University Press, 1994). He is co-editor with Nancy L. Wilson of BCM's Huffington Center on Aging of Long-Term Care Decisions: Ethical and Conceptual Dimensions (Johns Hopkins University Press, 1995). His Leibniz on Individuals and Individuation appeared in 1996 (Kluwer Academic Publishers). In 1998 his John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine and (as editor) John Gregory's Writings on Medical Ethics and the Philosophy of Medicine appeared (Kluwer), as well as Surgical Ethics (Oxford), co-edited with Baruch A. Brody and James W. Jones. He is also co-editor with Baruch A. Brody, Mark Rothstein, and Mary Anne Bobinski of Medical Ethics: Codes, Opinions, and Statements (Bureau of National Affairs 2000) and co-author with them of a companion volume commenting on these documents (BNA 2001). With James W. Jones and Bruce W. Richman he is co-author of The Ethics of Surgical Practice: Cases, Dilemmas, and Resolutions (Oxford University Press 2008). With Robert B. Baker of Union College (Schenectady, New York) Dr. McCullough is co-editor The Cambridge World History of Medical Ethics (Cambridge University Press 2009). He is also preparing a second edition of Ethics in Obstetrics and Gynecology with Drs. Chervenak and John Coverdale, Professor of Psychiatry at BCM, to appear 2011. In addition, Dr. McCullough has published 70 invited chapters in scholarly volumes in bioethics and medical humanities and 125 chapters in medical textbooks.

Mary C. Politi, Ph.D., is a clinical psychologist and an Assistant Professor in the Division of Public Health Sciences, Department of Surgery at Washington University in St. Louis. Dr. Politi’s research program focuses on using systematic methods to help patients work through the uncertainties of health decisions through developing and evaluating patient decision tools, examining techniques to aid patient-clinician discussions about health decisions, and exploring ways to improve communication about risks. Her research also investigates the influence of numeracy and health literacy on medical decision-making. Currently, Dr. Politi is a co-Director on Washington University’s Comparative Effectiveness Research Training program (KM1 CA156708), where she has helped to develop and implement mentored hands-on comparative effectiveness research training using research data, administrative data, and electronic health records. She is also involved in several funded projects (e.g. CIHR 212366; UL2010-4805) examining the implementation of shared decision making and risk prediction modeling into clinical practice. Dr. Politi’s current leadership roles include work with national organizations such as the Society for Behavioral Medicine and the Society for Medical Decision Making, and international groups such as the International Patient Decision Aids Standards Instrument (IPDASi) group. She was previously (2007 – 2010) awarded fellowships to attend the Dartmouth Summer Institute on Informed Patient Choice, and she also (2008-2009) served on the Uncertainty Working Group at the National Cancer Institute.

Steven H. Woolf, M.D., M.P.H., is Professor at the Departments of Family Medicine, Epidemiology and Community Health at Virginia Commonwealth University and is director of the Virginia Commonwealth University Center on Human Needs. He received his MD in 1984 from Emory University and underwent residency training in family medicine at Virginia Commonwealth University. Dr. Woolf is also a clinical epidemiologist and underwent training in preventive medicine and public health at Johns Hopkins University, where he received his MPH in 1987. He is board certified in family medicine, preventive medicine, and public health.

Dr. Woolf has published more than 150 articles in a career that has focused on evidence-based medicine and the development of evidence-based clinical practice guidelines, with a special focus on preventive medicine, cancer screening, quality improvement, and social justice. From 1987 to 2002, he served as science advisor to and then member of the United States Preventive Services Task Force. Dr. Woolf edited the first two editions of the Guide to Clinical Preventive Services and is author of Health Promotion and Disease Prevention in Clinical Practice. He is associate editor of the American Journal of Preventive Medicine and served as North American editor of the British Medical Journal. He has consulted widely on various matters of health policy with government agencies and professional organizations in the United States and Europe, and in 2001 was elected to the Institute of Medicine.