Surrogates often make decisions on behalf of critically ill patients.1 Surrogate comprehension of patient survival prognosis can affect these decisions: surrogate prognostic estimates of survival that are overly optimistic compared with clinician estimates are associated with increased use of life-sustaining treatments and reduced quality of life for dying patients.2,3 … Different prognostic estimates by surrogates…
In 2012, private equity firms purchased approximately 75 physician-owned practices; by 2021, that number had risen to almost 500. However, private equity acquisitions can also lead to ethically troubling consequences. For example, to maximize the return on their investments, private equity firms sometimes pressure clinicians to see more patients, perform more procedures on those patients,…
Patients increasingly rely on web-based physician reviews to choose a physician and share their experiences. However, the unstructured text of these written reviews presents a challenge for researchers seeking to make inferences about patients’ judgments. This study aims to train, test, and validate an advanced natural language processing algorithm for classifying the presence and valence of…
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. 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…
How have women mid- to senior-career clinician-scientists experienced gender throughout their careers? In this qualitative interview study among 31 women clinician-scientists, participants experienced the institution of academic medicine as a male-centric system misaligned with the needs of women and people with family caregiving responsibilities. They felt that women’s needs were underrecognized and unaccommodated even in…
Adolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied.
Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality.
Sometimes doing what’s right depends on anticipating how people will react when you do the right thing. Consider two aspects of challenge trial payments discussed by Lynch and colleagues (2021). The first is the importance of promoting public trust in challenge trial payments. Lynch and colleagues point out that even if there is not any actual ethical impropriety in challenge trial payments, the public might worry that payments are taking advantage of vulnerable research participants, either by paying them too much or too little. Such public concerns could negatively affect the ability to carry out such trials. Lynch and colleagues suggest that their framework for ethical payment in research can help justify payment amounts to the public. We agree with their framework, but believe that the framework on its own will not necessarily be enough to counter public perceptions around over or under payment.
Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble ambivalence means that we are not always recognizing what is really going on with a patient. Importantly, different kinds of “ambivalence” may call for different approaches. In this paper, we present a taxonomy of ambivalence-related phenomena, provide normative analysis of some of the effects of—and common responses to—such mental states, and sketch some practical strategies for addressing ambivalence. In applying lessons from the philosophical literature and decision theory, our aim is to provide ethicists and clinicians with the tools to better understand and effectively intervene in cases of ambivalence.