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Program on Ethics and Decision Making

Welcome to the Program

The Program on Ethics and Decision Making in Critical Illness is led by Dr. Douglas White, a physician scientist at the University of Pittsburgh.

The practice of critical care medicine requires focused scholarly attention because it brings together several difficult aspects of modern medicine: dying patients, expensive technological care, and uncertainty about how best to deliver care consistent with patients' values and preferences.

Mission

Our overarching mission is to understand and improve how medical decisions are made for critically ill patients who cannot make decisions for themselves.

To accomplish this, we use approaches from decision sciences, bioethics, and health service research to design interventions that go beyond the standard "informed decision making" paradigm.  Specifically, we are developing interventions to overcome the emotional, psychological, and health-systems barriers to making decisions that genuinely respect patients as persons.

The program brings together health services researchers, decision scientists, philosophers, bioethicists, and clinicians in conducting numerous research projects funded by the NIH, charitable foundations, and UPMC.

In addition to our funded research projects, program investigators, post-doctoral fellows and students conduct a variety of internally supported research studies surrogate decision-making, including the development of decision aids and the use of simulation methods to study clinician-family communication.

In the News

"Conflicts on Prognosis Occur Over Half the Time Between Physicians and Surrogate Decision-Makers"

November 2016 – In this article from Medical Ethics Advisor focusing on the reasons behind the prognosis expectations of a patient's family versus their physician, Dr. White explains the conflict is not always due to a misunderstanding.

"An Elderly Parent May Struggle to Recover from a Stay in the ICU, But You Can Help," The Washington Post

October 2016 – In this Washington Post article on how to help elderly patients have a meaningful recovery from an ICU stay, Douglas White emphasizes the need for good communication and regular meetings with the doctors.

"Tough Talk: Difficult Conversations in the ICU and Beyond," PittMed Magazine

Summer 2016 – “'The same thing we do in medicine is what you do when you analyze a novel—you look for what’s there, what’s said,' says Douglas White, an MD, who holds the UPMC Chair of Ethics in Critical Care Medicine at Pitt. It’s the doctor’s job to examine the person’s character and consider, 'What is the patient complaining of? What are they not complaining of? How are they saying it? And what clues might we get as to what’s going on?'"

"What Doctors Know About How Bad It Is, and Won’t Say," The New York Times

July 1, 2016 – Dr. White's recent study on discordance ("Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients," published May 17 in JAMA) is referenced as an example of one of the communication breakdowns that can often prevent frank end-of-life discussions.

"Decision-Makers Hold Overly Optimistic Expectations for Critically Ill Patient Outcomes"

May 17, 2016 – Dr. White led a research team that found that more than half of surrogate decision-makers have significantly different estimates, compared to their doctor's, of the chances that their critically ill loved one will survive. Moreover, the research found, this discordance is most often due to the decision-maker holding fundamentally different and overly optimistic beliefs about the patient's prognosis. The findings were published on May 17 in the Journal of the American Medical Association, and were discussed in multiple media outlets including CBS News and the Los Angeles Times.

"Shared Decision Making in ICUs"

January 2016 – Dr. White co-chaired the writing committee for this policy statement from the College of Critical Care Medicine and the American Thoracic Society.

"Near the End, It’s Best to Be ‘Friended,’" The New York Times

September 25, 2015  Dr. White is quoted in this article about unrepresented patients and end-of-life decisions. The article references two of White's studies about the number of "unbefriended" patients in ICUs, and quotes White on the importance of having a surrogate who can represent a patient's wishes.

Religious Conversations in the ICU

August 31, 2015 – This JAMA Internal Medicine article about the responses to religious statements made by surrogate decision makers received significant media attention, including from TIME Magazine.

Resolving Conflicts in Treating Critically Ill Patients

July 15, 2015 – This multisociety statement, which provides recommendations for responding to requests for potentially inappropriate treatments in ICUs, was referenced by several media outlets including Medscape and HealthManagement.

March 2, 2015 A Surgery Standard Under Fire, The New York Times

 

Program Members


Douglas B. White, MD, MAS – Program Director

Dr. White is Vice Chair and Professor in the Department of Critical Care Medicine, University of Pittsburgh. He received his medical degree from University of California, San Francisco in 1999 and completed a residency in Internal Medicine and a fellowship in Pulmonary and Critical Care Medicine at UCSF. While at UCSF, he also completed a Master’s degree in Epidemiology and Biostatistics and a fellowship in Bioethics under Bernard Lo. He joined the faculty at UCSF in 2005 as an Assistant Professor of Medicine and a Core Faculty of the Program on Medical Ethics. In 2009 he joined the faculty of the University of Pittsburgh in the Departments of Critical Care Medicine and Medicine. He is also a core faculty member in the Center for Bioethics and Health law at the University of Pittsburgh. 

 

Anne-Marie Shields, MSN, RN - Program Manager

Anne-Marie joined the Program on Ethics and Decision Making in April 2012 as the Program Manager. She earned her Master's Degree in Nursing Research at the University of Pittsburgh, School of Nursing in 2011. She has broad research experience, including overseeing and coordinating multi-site studies. She has extensive experience in the clinical setting as a nurse, and training as an advance care planning facilitator.

 

Faculty

Deepika Mohan, MD

Dr. Mohan joined the faculty in the University of Pittsburgh Departments of Critical Care Medicine and Surgery in 2009, after completing a residency in general surgery at Emory University and a fellowship in surgical critical care medicine at the University of Pittsburgh. She joined the Program on Ethics and Decision Making in 2009, and has subsequently pursued research in determinants of physician decision making, in particular the influence of intuitive judgments (heuristics) on decision making, and the implications for quality improvement efforts. Having received a 2015 NIH Director’s New Innovator Award from the National Institutes of Health, Mohan is now using serious games to develop and test a new intervention to recalibrate physician heuristics.

She joined the Program on Ethics and Decision Making in 2009 and her current projects include studying regionalization in trauma triage, time pressured decision making in trauma triage, and validating the use of vignettes to study physician decision making.

 

Emeritus

Leslie P. Scheunemann, MD MPH

Dr. Scheunemann is a Clinical Instructor in Pulmonary and Critical Care Medicine and Geriatrics. She is also a Post-Doctoral Scholar on an NIA-funded F32 entitled, “Communicating with Surrogate Decision Makers about Incapacitated ICU Patients' Values.” The main focus of her research is understanding and improving how ICU clinicians and families talk about patients’ values during treatment decisions about life support.  She attended medical school at the University of North Carolina at Chapel Hill, which was where she first recognized the difficulties clinicians and families have making decisions for ICU patients who cannot speak for themselves. Her interest in this problem grew during her residency in Internal Medicine and fellowship in Geriatric Medicine there.  She earned a Masters in Public Health from the Gillings School of Global Public Health in 2011.  Then, she moved to Pittsburgh to begin her clinical fellowship in pulmonary and critical care medicine.  She had been working with Dr. White for several years, and joined the Program on Ethics and Decision Making full time in February 2013. 

 

Jared Chiarchiaro, MD

Dr. Chiarchiaro joined the Program on Ethics and Decision Making in 2012.  He attended medical school at the University of Texas Medical Branch from 2005-2009 where he was first introduced to the intensive care unit and participated in research with the critically ill on implementation of early goal directed therapy for sepsis.  He completed internal medicine residency training at Duke University Hospital from 2009-2012 where he became interested in communication and decision making in patients with advanced, critical illness.  During his residency he was mentored by James Tulsky and completed work on trajectories of well-being in patients with advanced chronic illness after a stay in the ICU.  He completed his fellowship in Pulmonary and Critical Care Medicine and joined the faculty as Assistant Professor of Medicine in the Division of Pulmonary, Allergy and Critical Care Medicine in 2015. He is currently a KL2 multidisciplinary clinical research scholar. His research focus is on helping patients with advanced lung disease and their families prepare for future medical decision making. .

 

Fellows

Jennifer B. Seaman, PhD, RN

Jennifer is a post-doctoral fellow in the division of Pulmonary, Allergy and Critical Care Medicine. Her clinical background is in critical care, and her research interest is the integration of palliative care and end-of-life care into ICU practice.  Her post-doctoral mentors are Dr. Doug White and Dr. Bob Arnold. Jennifer was previously awarded a John A. Hartford Foundation, Building Academic Geriatric Nursing Scholarship, and an F-31 for her dissertation project, Patient-centered Outcomes and Use of Palliative Care among Seriously-ill and Non-surviving Mechanically Ventilated ICU Patients. While a PhD student in the School of Nursing, Jennifer completed a research practicum with Dr. White and the Program on Decision Making and Ethics developing intervention fidelity maintenance and monitoring for the Four Supports study. She joined the program full-time in January 2015.

 

Research Staff

Praewpannarai (Pearl) Buddadhumaruk, MS, RN

Pearl graduated summa cum laude from Carlow University in 2010 with a Bachelor of Science in Biology and mathematics minor. Before that, she had earned an Associate degree in Nursing from the Community College of Allegheny County in 2006 and worked as a registered nurse in a cardiothoracic surgical unit for a year. She received her Master of Science in Biostatistics from the University of Pittsburgh, Graduate School of Public Health in December 2012. Her Master’s thesis was a statistical genetic research focusing on locating candidate genes in the mother that are responsible for meiotic nondisjunction errors and subsequently lead to Down’s syndrome development in the baby.

Pearl joined the program in September of 2012 while she was a biostatistics graduate student. Currently, she serves as the biostatistician for all the projects in the Ethics and Decision Making program statistically analyzing the collected quantitative data.

 

Melissa L. Vendetti (McCullough), BS

Melissa joined the CRISMA Center’s Program on Ethics and Decision Making in 2013. As a Research Project Manager and collaborator with Duke University Medical Center, Melissa oversees multiple ongoing clinical research studies that involve improving surrogate decision-making and also reducing stress using a coping skills intervention for ICU patients and their families. She also lends support to several other ongoing clinical research projects with Dr. Douglas White. Melissa received her BS degree in Psychology in 2008 from Slippery Rock University and has been working with critically ill patients and their families since she began her clinical research career at Johns Hopkins University in 2009. She is currently enrolled in a MS degree program (Health, Physical Activity, and Chronic Disease) at the University of Pittsburgh and will graduate in 2016. Melissa’s research interests vary from critical illness to health promotion and disease prevention. In addition, she has a strong interest in how making only minor changes in behavior can have such positive impacts on numerous preventable chronic diseases throughout the lifespan.

 

Rachel Palkoska, BSN, RN

Rachel joined the Program on Ethics and Decision Making in 2014 as a Family Support Nurse. She received her Bachelor of Science in Nursing from Loyola University Chicago in 2012. Her clinical background includes both adult intensive care and pediatric intensive care. Currently, she is pursuing her Master’s Degree in Clinical Nurse Leadership from the University of Pittsburgh, School of Nursing. In the White program, she actively enrolls for ongoing research studies in the intensive care unit as well as managing research activities associated with "4 Supports."

 

Elke H. P. Brown, MD

Elke joined the Program on Ethics and Decision Making in November 2014. She received her medical degree from Catanduva Medical School in Sao Paulo, Brazil and completed a residency in Internal Medicine.  Upon completion of her residency, she spent the next 10 months at the University of California, San Diego as a research fellow in the osteoradiology section. She returned to Brazil and practiced as a physician for 3 years.  For the past 61/2 years, she was a post-doc and clinical researcher  in the department of Physical Medicine and Rehabilitation at the University of Pittsburgh. In the White Program, she is Project Manager of the PARTNER II R01; “Improving Patient and Family Centered Care in Advanced Critical Illness.”

 

Kristyn Felman, MPH, CPH, LSW

Kristyn joined the Program on Ethics and Decision Making in 2015 as a Family Support Specialist. She holds advanced degrees and licensure in both public health and social work and is an alum of the University of Pittsburgh’s Graduate School of Public Health.  She has over ten years of experience providing health education and decision-making support to families navigating the healthcare system.  Within the “4 Supports Study” she provides emotional support and education to study participants, manages research activities, and actively enrolls subjects in ongoing research.

 

 

Amanda Argenas

Amanda joined the Program on Ethics and Decision Making in 2015 as a Research Project Coordinator. She previously worked at University Hospitals Case Medical Center during her time as an undergraduate. Amanda also worked as an assistant coordinator in a Dermatology clinical trials unit where she assisted with daily research functions and managed online databases. She will be helping to manage multiple studies in the Program on Ethics and Decision Making.

 

Wendy Newdick

Wendy joined the Program on Ethics and Decision Making in 2015 as a Family Support Nurse. She received her Bachelor of Science of Nursing at the University of Pittsburgh in 2005. Her background is adult critical care, with experience in trauma. She is currently attending Waynesburg University in pursuit of a Master’s of Nursing Education. In the Program on Ethics and Decision Making, she enrolls and supports families in the “4 Supports” program.

 

 

Veronica Kozar

Dr Veronica Kozar is the Implementation Specialist for the PARTNER 2 research program. She will be working between the department of Critical Care Medicine and the Donald J Wolff, Jr. Center for Quality Improvement and Innovation at UPMC. Veronica gained experience working in ICU as a clinical social worker. She also served on a medical ethics consult service, responding to requests from health care professionals for consultation concerning clinical ethics. Veronica earned her PhD in Administrative and Policy Studies at the University of Pittsburgh in 2011.

 

Rachel San Pedro, LSW, RN

Rachel joined the Program on Ethics and Decision Making in 2017 as a Family Support Nurse and Research Project Manager. She received her diploma in nursing from the UPMC Shadyside School of Nursing in 2015, and has worked in brain injury rehab and psychiatry as a staff nurse. Prior to nursing, Rachel worked as a clinical social worker with a focus on mental health research. In the White program, she actively enrolls for ongoing research studies in the intensive care unit as well as managing research activities associated with "4 Supports."

 

Rachel Butler, MHA, MPH

Rachel joined the CRISMA Center's Program on Ethics and Decision Making in Critical Illness in February 2017. As a Clinical Research Coordinator, Rachel manages the University of Pittsburgh site operations for the Prediction of Functional Outcomes from Chronic Critical Illness (ProFOCCI) study and lends support to other ongoing clinical research projects in Dr. Douglas White's research program. Prior to her work with Dr. White's team, she was a Senior Research Coordinator for Dr. Amber Barnato's program in the Division of General Internal Medicine, Section of Decision Sciences and served as Executive Director of the ICU StoryWeb project. Rachel received her Master of Health Administration and Master of Public Health degrees from Indiana University in 2013. She is currently a part-time doctoral student in the Health Services Research and Policy program at the University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, with interests in health services research in the end-of-life domain, decision science, and bioethics. Additionally, she is a fellow in the Jewish Healthcare Foundation's 2017 Fellowship on Death and Dying. Rachel completed the Respecting Choices Last Steps(R) Advance Care Planning Facilitator training in 2014. Her passion for end-of-life care and conversations overflows into her "free" time; she is a co-organizer and facilitator for Death Café Pittsburgh, a hospice and grief support volunteer, and a member of the Coalition for Quality at the End-of-Life (CQEL).

 

Students

Alexandra Bursic, BA, BS

Alexandra joined Dr. White's program in February 2015 as a first year medical student at the University of Pittsburgh School of Medicine. She is working with Dr. White’s group to develop a tablet-based communication & decision support tool for surrogates of incapacitated patients in the ICU.  Before joining Dr. White’s research team, she worked as a research assistant in the Department of Physical Medicine & Rehabilitation and the School of Nursing at Pitt.  Alexandra graduated summa cum laude from the University of Pittsburgh, where she was a member of Phi Beta Kappa honorary society, with a Bachelor of Arts in philosophy and  Bachelor of Science in psychology in 2014.

Hannah Callahan

Hannah joined the Program on Ethics and Decision Making in 2015 as a Student Research Assistant. She is currently in her third year at the University of Pittsburgh studying biology, chemistry, and social work with plans to go into Genetic Counseling. In the White Program, she is adding program support to the multiple projects being run by the team.

 

Tracy Campbell, BS

Tracy joined the Program on Ethics and Decision Making in August 2016 as a second year medical student at the University of Pittsburgh School of Medicine. She received her Bachelor of Science in Biology from Dickinson College in 2013. Prior to joining Dr. White’s group, she was a Cancer Research Training Award fellow at the National Cancer Institute Surgery Branch. Tracy is interested in palliative care and will be joining the PARTNER II research program for her Scholarly Research Project, under the mentorship of Dr. White.

 

Former Program Members

Rebecca Vanderwall, BS

Becca joined the Program on Ethics and Decision Making in August 2014 as a student researcher. She received a Bachelor of Science in Biology with a minor in Health Science from Northeastern University in 2014 and is currently enrolled in a dual Master’s degree program at the University of Pittsburgh Graduate School of Public Health in Genetic Counseling and Public Health Genetics.  For the White program, she is involved in enrolling patients and caregivers in an ICU Coping Skills Education Program study and assists with intervention fidelity monitoring of the “4 Supports” study.​

 

Natalie C. Ernecoff, MPH

Natalie joined the Program on Ethics and Decision Making in 2011 as a student researcher. She received a Bachelor of Science in Neuroscience and History & Philosophy of Science from the University of Pittsburgh in 2013. She continued her education and received a Master’s degree in behavioral and community health sciences from the  University of Pittsburgh, Graduate School of Public Health in 2014, where she studied aging and advance care planning. In the White program, she helped to create and analyze qualitative data sets, and she managed a project aimed to support surrogates in the ICU. Natalie is pursuing a PhD in Health Policy and Management in the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

 

Suzanne MacKenzie RN, BNSc, MPA

Suzanne joined the Program on Ethics and Decision Making in 2013 as a Familly Support Nurse and took on the role of Project Management for the "4 Supports Study" in January 2015. She received a Bachelor's Degree in Nursing Science and a Master's Degree in Public Administration from Queen's University in Ontario, Canada.  Her clinical background is primarily in mental health and addictions, with significant long-term care experience.  In the White program, she actively enrolled for ongoing research studies in the intensive care unit as well as managing research activities associated with "4 Supports."  Suzanne has relocated to the west coast and has accepted a hospital based clinical nursing position.

 

Kaitlin J. Shotsberger, BSN, RN

Kaitlin was a member of the Program on Ethics and Decision Making from 2011-2014 as a Clinical Research Coordinator. She received her Bachelor of Science in Nursing and her Master’s Degree in Clinical Nursing Leadership at the University of Pittsburgh, School of Nursing.  Her background is in critical care nursing.  During her time with the White program, she oversaw the progress of empirical projects and enrolled subjects in ongoing studies. She accepted a position as a Quality Analyst with a suburban Pittsburgh hospital.

 

 

Rachel Schuster, MD, MS

Dr. Schuster was a post-doctoral research fellow with the Program on Ethics and Decision Making in Critical Illness from 2011-2013. She graduated from New Mexico State University with a BS in Microbiology, before attending the University of New Mexico, School of Medicine. Dr. Schuster completed a residency in internal medicine at the University of Texas Medical Branch – Austin Program. During her fellowship in Pulmonary and Critical Care Medicine at the University of Pittsburgh, she conducted a study validating medical simulation as a method to study physician-surrogate conflict in ICUs and earned a MS in Clinical Research from the Pitt School of Medicine. She is currently a clinical assistant professor in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh, based at UPMC Shadyside Hospital.

 

Alyssa Majesko, MD

Dr. Alyssa Majesko is an Assistant Professor in the Division of Internal Medicine at Emory University with appointments in the Center for Palliative Care and the Center for Critical Care. She has recently joined the Emory faculty after completing her Critical Care Fellowship in the Program on Ethics and Decision Making at the University of Pittsburgh in June 2011. She is board certified in Internal Medicine and Board Eligible for Critical Care and Palliative Care.

She has an interest in improving communication between patients and caregivers in the ICU. She has been trained to teach communication and has facilitated a range of communication skills courses for medical students to ICU fellows.

Dr. Majesko also has an interest in research and completed a Masters in Clinical Research. She is currently investigating hospice utilization among ICU patients and outcomes of family-centered care in the ICU.

 

Apoorv Narang, BT

Apoorv is earning a master's degree from CMU's Human-Computer Interaction Institute. He has a BT in Computer Science and Engineering from IIIT-Delhi. He is a co-founder of the startup, Backpack, which is a modern, mobile-first learning platform for college instructors. Apoorv is working with Doug on the design of a tablet-based communication & decision support tool for surrogates of incapacitated patients in the ICU.

 

 

Louise Vongphrachanh, BA

Louise is earning a master's degree from CMU's Human-Computer Interaction Institute. She has a BA in Informatics from the University of Michigan. She spent two years working in startups as a UX Designer and Developer in San Francisco. Louise is working with Doug on the design of a tablet-based communication & decision support tool for surrogates of incapacitated patients in the ICU.

 

 

 

Collaborators

Wendy Gabrielle Anderson, MD, MS

Derek C. Angus, MD, MPH, FRCP

Robert M. Arnold, MD

Amber E. Barnato, MD, MPH, MS

Cindy Bryce, PhD

Shannon Carson, MD

Elizabeth Chaitin, DHCE, MSW

Christopher E. Cox, MD, MHA, MPH

Farr A. Curlin, MD

J. Randall Curtis, MD, MPH

Cynthia Gries, MD

Scott D. Halpern, MD, PhD, MBE

Mary Beth Happ, PhD, RN, FAAN

Catherine L. Hough, MD, MSC

Jeremy M. Kahn, MD, MS

Charles Seth Landefeld, MD

Bernard Lo, MD

Susan Martin

Kelly N. Michelson, MD, MPH

Cynthia Paner, MSN

Michael W. Peterson, MD

Carrie Pidro, BS

Thaddeus Pope

Yael Schenker, MD, MS

Mi-Kyung Song, PhD, RN, FAAN

Jay S. Steingrub, MD

Mark R. Wicclair, PhD

Donald D. Wolff, Jr. Center for Quality, Safety, and Innovation

 

Current Research Projects

 

Prediction of Functional Outcomes from Chronic Critical Illness

Principal Investigator: Shannon Carson, MD

Co-Investigator: Douglas White, MD, MAS

Funding Source: NIH/NINR 1R01-NR016459

The purpose of the study is to 1) establish clinical determinants of poor cognitive and physical functional outcome in CCI patients, and 2) provide a new tool to more effectively inform decision making earlier in the course of ICU care. We hypothesize that multiple premorbid and acute factors measured early in the course of CCI will have strong independent associations with functional recovery. We further hypothesize that social and economic factors are associated with long-term functional outcomes independent of the acute clinical problems.

 

Family Support Intervention in Intensive Care Units: A randomized trial to improve surrogate decision-making for critically ill elders

Principal Investigator: Douglas B. White, MD, MAS

Funding Source: National Institute on Aging - R01AG045176

The goal of this study is to conduct a multicenter efficacy trial of the Four Supports Intervention among 400 critically ill older adults to reduce their long term symptoms of depression and anxiety. The Four Supports Intervention is a multifaceted intervention in which a specially trained nurse intensively provides four types of support to surrogates in coordination with the clinical team: emotional support, communication support, decision support, and anticipatory grief support.  The central hypothesis is that by intensively supporting surrogates in this highly stressful circumstance, the Four Supports Intervention will improve key elements of decision making, decrease long-term psychological distress among surrogates, and achieve more patient-centered care near the end of life.

PARTNER II: Improving Patient and Family Centered Care in Advanced Critical Illness

Principal Investigator: Douglas B. White, MD, MAS

Funding Source: NIH/NINR - R01NR014663

PARTNER II is a comparative effectiveness trial with the overarching goal of this research project to ensure patient-centered decisions about the use of intensive treatments for patients with advanced critical illness. In a prior project, we developed the PARTNER program (PAiring Re-engineered ICU Teams with Nurse-driven Education and OutReach), a 4-facet, team-based intervention that re-engineers how surrogates are supported in ICUs, including: 1) changing care “defaults” to ensure clinician-family meetings within 48 hours of enrollment and frequently thereafter; 2) protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician-family meetings, 3) increased use of palliative care services for patients with a poor prognosis; and 4) structured communication at care transitions about patient’s health care preferences and goals. We expect to achieve the following project goals:1. To increase the patient-centeredness of end-of-life decisions, and to increase the quality of clinician-family communication.2. To decrease the psychological burden on family members acting as surrogates.3. Lower costs: To reduce total health care costs by increasing the use of palliative care and hospice services and decreasing unwanted readmissions near the end of life.

 

Improving Patient and Family Centered Care in Advanced Critical Illness

Principal Investigator: Douglas B. White, MD, MAS

Funding Source:   Support for this project is provided by Stephen Shapiro, UPMC Chief Medical and Scientific Officer

The overall purpose of this research study is to assess health care quality and health outcomes following a Quality Improvement Initiative of a protocolized, team-based intervention to improve patient and family centered care in patients with advanced critical illness (PARTNER).The PARTNER program targets a high-risk population, combines multiple evidence-based practices into a novel team-based intervention, and transforms the healthcare workforce through training existing clinicians in advanced, team-based communication protocols. The specific goals of this project are:
1.To increase the patient-centeredness of end-of-life decisions, and to increase the quality of clinician-family communication.
2.To decrease the psychological burden on family members acting as surrogates.
3.To reduce total health care costs by ensuring that patients who would not choose prolonged intensive treatment instead are offered the use of palliative care and hospice services near the end of life.

 

Developing a Communication and Shared Decision Making Tool to Prepare Family Members in ICUs for the Role of Surrogate Decision Makers

Principal Investigator: Douglas B. White, MD, MAS

Funding Source: NIH/NIA R21-AG050252-01

The purpose of this project is to find ways to  improve the quality of  Surrogate Decision Makers in the ICU by developing and deploying a web based Communication and Decision Support (CDS) tool and a reliable care process to Integrate the tool into routine practice.

 

Communicating with Surrogate Decision Makers About Incapacitated ICU Patients’ Values

Principal Investigator: Leslie P. Scheunemann, MD & Douglas B. White, MD, MAS

Funding Source:   National Heart, Lung, and Blood Institute (NHLBI) - T32HL007820 and National Institutes on Aging (NIA) – F32AG047806-01A1 - pending funding,

One important barrier to patient-centered decision-making for patients with acute respiratory failure is that clinicians do not consistently elicit and incorporate patients’ values when communicating with the patient’s surrogate decision-makers. The goal of this project is to develop three research tools for future interventions to improve this problem: 1. 1) a high-fidelity simulation, which is a laboratory for studying and intervening on how clinicians elicit and incorporate incapacitated patients’ values into life support decisions; 2) consensus from a diverse group of stakeholders about which communication skills for physicians to use to elicit patients’ values and preferences are most important for interventions to target; and 3) a checklist outcome measure to quantify intervention effectiveness.

 

User-centered Design of a New Advance Care Planning Tool for Advanced Lung Disease

Principal Investigator: Jared  Chiarchiaro, MD & Douglas B. White, MD, MAS

Funding Source:  Pulmonary T32 HL007563-26

The goal of this project is to create a web-based, multimedia, interactive advance care planning tool for patients with advanced lung disease and their families that can be further developed to improve patient-related and clinical outcomes.

 

Improving Psychological Distress Among Critical Illness Survivors and Their Informal Caregivers

Principal Investigator: Christopher E. Cox, MD

Funding Source: Patient Centered Outcomes Research Institute (PCORI) - Funding Award 195

The purpose of this randomized trial is to reduce distress and improve quality of life for the ICU survivor-informal caregiver (family) dyad. Dyads will be randomized to receive one of two 6-week, telephone-based interventions: an ICU survivor-specific coping skills training (CST) program or a critical illness educational program. Both programs were developed with patient input and are promising interventions for this high risk group.

 

Improving Decision Making for Patients with Prolonged Mechanical Ventilation

Principal Investigator: Christopher E. Cox

Funding Source:  National Institues of Health - R01 HL109823

This is a multicenter, randomized, controlled trial (RCT) comparing the efficacy of a tablet computer-based decision aid to usual care control in improving the quality of the decision making process for surrogates of incapacitated prolonged mechanical ventilation (PMV) patients, and their ICU physicians and nurses.

 

Current Policy Involvement

Ethics in the Intensive Care Unit: Responding to Requests for Futile or Inappropriate Therapies

These recommendations can be used to help frame local and national policy on responding to requests for futile or inappropriate therapies.

Clinicians are sometimes faced with requests to provide treatments for patients in the intensive care unit (ICU) that they judge to be ill-advised. They often arise due to poor communication regarding prognosis and treatment goals between the treating team and the patient and/or his or her surrogates. Less commonly, such requests may arise because of disagreements between the clinicians, the patient, and/or his or her surrogates about what the goals of care should be in light of a serious medical situation.  Issues related to requests for futile or potentially inappropriate therapies in the ICU were reviewed, terms defined, and recommendations made on how to handle these difficult situations.

 

Would Accommodating Some Conscientious Objections by Physicians Promote Quality in Medical Care?

These recommendations can be used to help frame local and national policy on Conscientious Objections by Physicians.

Moral pluralism is a valuable aspect of a free society but sometimes creates conflicts in medical care when individual physicians object to providing certain legal but morally controversial services, such as abortion, physician-assisted suicide (where it is legal), and palliative sedation to unconsciousness. The notion that protecting physicians' consciences benefits physicians at the expense of patients has created an overly simplistic dialogue about conscience in medicine. Viewing the issue from a societal perspective and conceptualizing medical quality as a public good allow a more robust understanding of the relationship between CBR and quality medical care. Policies that allow some CBRs while also ensuring patients' access to the requested services may yield better overall medical quality by fostering a diverse workforce that possesses integrity, sensitivity to patients' needs, and respect for diversity. This analysis is necessary for a genuine public discussion about how to handle moral pluralism among patients and physicians. The societal perspective should be incorporated into efforts to develop a comprehensive framework for when CBRs should and should not be accommodated.

 

Research Seminar on Ethics and Decision Making

Our Research Seminar on Ethics and Decision Making is held bi-weekly throughout the academic calendar year.  Guest presenters share their research on an array of topics which include decision sciences, bioethics, and health service research.

When: Every other Friday, 10 to 11 a.m.

Where: Conference Room 615 Scaife Hall, University of Pittsburgh Department of Critical Care Medicine

 

Research Seminar Calendar*

*Updates coming soon

2016-2017 Date

Speaker

Talk Title

September 9th

Rachel Pace

Improving surrogate decision making through augmented advance directives

September 23rd

Deepika Mohan

Testing the efficacy of a videogame intervention to recalibrate physician heuristics in trauma triage

October 7th

Janel Hanmer

Predicting and communicating risk of clinical deterioration on inpatient general medicine teaching teams

October 21st

Amber Barnato

Cancelled due to the Science 2016 conference

November 4th

Stephen Broomell

An Expert Elicitation to Characterize Environmental Cues that Signal a Tornado

November 18th

Jennifer Seaman Ensuring Timely Interdisciplinary Family Meetings in the ICU: Barriers and Facilitators Point to Novel Intervention Components

December 2nd

Julie Donohue

Social network analysis of physician adoption of new prescription drugs

December 16th

Alex Davis

An overview of probabilistic models of discrete choice

January 17th

Peter Ubel

Cnacelled

January 27th

Robert Arnold

Can A Death-Predicting Algorithm Improve Care

February 10th

Rachel Rodenbach

Promoting End of Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists

February 24th

Laura Petrillo

Identifying, measuring, and supporting what is important to patients in medical decisions

March 10th

Cancelled-Pitt Holiday

 

March 22nd

Karen Steinhauser

 

April 7th

Jesse Soodalter

 

April 21st

 

 

May 5th

Ellen Peters

 

May 19th

Cancelled-ATS

                                

June 2nd

Yael Schenker                           

 

Selected Program Publications

View Douglas B. White's Publications on PubMed

 

Empirical Work

 

Normative and Policy Work

 

Around the Program

Program on Ethics & Decision Making vs. Health Policy & Management Program Kickball Game 7-15-2016

          Fun Balloon Slingshot at Team Picnic          Team Meeting

 

 

 

 

 

 

 

Enjoying the view-Mount Major, Alton NH, July 2013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Supporting Ethics and Decision Making Research

Donations to the Program on Ethics and Decision Making at the University of Pittsburgh support important research and training of new physician researchers.

To donate:

  • Print Donor Card and return it with your donation to the Department of Critical Care Medicine, University of Pittsburgh

Every donation is tax deductible to the full extent of the law.

All contributions will support the Program’s vision, mission and activities. For more information on specific funding options for this research program, please contact:

Douglas B. White
Department of Critical Care Medicine
University of Pittsburgh
3550 Terrace Street Scaife Hall, Room 608
Pittsburgh, PA 15261
Phone: 412-864-3757

whitedb@upmc.edu

Your contributions are important to furthering the work of the Program on Ethics and Decision Making in Critical Illness, the critical care profession, and the delivery of quality patient care.

Thank you!

 

Contact

Douglas B. White, MD, MAS

UPMC Endowed Chair for Ethics in Critical Care Medicine
Professor of Critical Care Medicine
Director, Program on Ethics and Decision Making in Critical Illness
University of Pittsburgh Medical Center

Email: whitedb@upmc.edu

Phone: 412-864-3757
Fax: 412-647-8060


Mailing address:

University of Pittsburgh Medical Center
Department of Critical Care Medicine
3550 Terrace St. Scaife Hall, Room 608
HPU010604
Pittsburgh, PA 15261