Ethics and Decision Making in Critical Illness

 

The CRISMA Program on Ethics and Decision Making in Critical Illness (EDM) conducts scholarly work to understand and improve how medical decisions are made for critically ill patients who are unable to make decisions for themselves. Bringing together health services researchers, decision scientists, philosophers, bioethicists, and clinicians, EDM investigators design interventions that go beyond the standard 'informed decision making' paradigm. These interventions help clinicians address the convergence of several of the most difficult aspects of modern medicine: dying patients, expensive technological care, and uncertainty about how best to deliver care consistent with patients' values and preferences.

Policies available for download:

UPDATE: “Allocation of Scarce Critical Care Resources During a Public Health Emergency”
(PDF)

To assist hospitals and health systems to implement a fair and transparent approach to allocating scarce critical care resources during the COVID-19 pandemic, we have created a model hospital policy that hospitals can download and adapt for their needs. In light of the large disparities in COVID-19 outcomes among disadvantaged groups, the policy was revised on April 9, 2021 to contain two additional strategies to promote equity. For more detail on the ethics and rationale for the policy, see Dr. White's paper "Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic" in the American Journal of Respiratory and Critical Care Medicine.

“Model Hospital Policy for Fair Allocation of Medications to Treat COVID-19” (PDF)

Policies developed by:
Douglas B. White, MD, MAS
UPMC Endowed Chair for Ethics in Critical Care Medicine
Professor of Critical Care Medicine, Medicine, and Clinical and Translational Science
Department of Critical Care Medicine
University of Pittsburgh

Primary Faculty

  • Deepika Mohan, MD, MPH

Affiliated Faculty

  • Emily Brant, MD, MS, Clinical Instructor, Department of Critical Care Medicine
  • Marie K. Norman, PhD, Division of General Internal Medicine
  • Jennifer Seaman, PhD, RN, School of Nursing

Program Staff

  • Rachel Butler, MHA, MPH, Program Manager
  • Elke Brown, MD
  • Praewpannarai Buddadhumaruk-Sun, MS, RN
  • Sana Khalid, MBBS
  • Dave Maloney, BS
  • Rae Oanesa, BS
  • Grace Vincent, BA

Current Trainees

  • Sarah Andersen, MD, T32 Postdoctoral Fellow
  • Ravi Doobay, MD, Fellow
  • William Gautier, MS, Medical Student
  • Bailey Sparks, MD, Resident
  • Alexis Steinberg, MD, Fellow
  • Vlad Razskazovskiy, Medical Student
  • Kathryn Vessel, Medical Student

Alumni

  • Alexandra Bursic, MD
  • Mary Callahan, MD
  • Tracy Campbell, MD
  • Brett Curtis, Medical Student
  • Natalie Ernecoff, PhD
  • Taylor Lincoln, MD
  • Kate Petty, MD, Fellow
  • Angela Suen, MD

Online PARTNER Training Pilot Study
The goal of this study is to pilot test a low-cost, scalable platform to train clinicians in the serious illness communication skills needed to achieve goal-concordant care for incapacitated patients, including those with Alzheimer’s disease and related dementias. Funding: NIH/NINR 3R01NR014663-05S1 (PI: White)

Randomized Trial of a Scalable, Interactive Tool to Support Surrogate Decision-makers of Critically Ill Older Adults
The goal of this study is to test the efficacy of the Family Support Tool, an interactive, web-based tool to help family members of older incapacitated patients navigate the emotional, psychological, and cognitive complexities of being a surrogate, on the patient-centeredness of care, surrogates’ psychological symptom burden, and patients’ healthcare utilization. We will conduct a mixed methods qualitative study in parallel with the RCT to better understand factors that influenced the efficacy of the intervention. Funding: NIH/NIA R01AG066731 (PI: White)

Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Critically Ill Older Adults at High Risk of Death or Severe Disability
The goal of this study is to determine the effect of specialty palliative care integrated with critical care on patient and family outcomes. We will conduct a mixed methods qualitative study in parallel with the RCT to better understand factors that influenced the efficacy of the intervention. Funding: NIH/NIA R01AG068567 (MPIs: White, Schenker)

Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
This study leverages insights from organizational behavior, social psychology, and decision science to: characterize the attitudes and actual practices of clinicians toward providing interprofessional team-based decision support to surrogate decision-makers; conduct exploratory analyses examining associations between team functioning and outcomes of patients with advanced respiratory failure; and determine whether and how clinicians elicit values and preferences of incapacitated patients from surrogates. Funding: NIH/NHLBI K24HL148314 (PI: White)

Prediction of Functional Outcomes from Chronic Critical Illness
This is the first multicenter prospective cohort study that measures risk factors for long-term physical and cognitive dysfunction in chronical critical illness (CCI). The goal is to construct a multi-outcome prognostic model to facilitate shared decision-making and resource planning. Funding NIH/NINR R01NR016489 (PI: Carson, UNC)

For information on program activities or to inquire about collaborations and training opportunities, please contact douglas.white [at] pitt.edu (Douglas White, MD, MAS).

 

 

Program Director


Douglas B. White, MD, MAS
UPMC Endowed Chair for Ethics in Critical Care Medicine
Professor of Critical Care Medicine, Medicine, and Clinical and Translational Science