News

STAT: End-of-life decisions can be difficult. This doctor thinks ‘nudges’ can help

For tax payments, “nudges” have helped municipalities increase revenues and decrease collection-related costs. For energy consumption, “nudges” have helped homeowners save money and utilities preserve capacity. But in health care, the technique has been slower to catch on. First described by the pioneering economists Richard Thaler and Cass Sunstein (who is also a legal scholar), a “nudge” is a way of framing a set of choices to essentially steer people toward a particular option without shutting out other options. Dr. Scott Halpern, a critical care physician at University of Pennsylvania who studies the ethics and effectiveness of nudges in health…

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Washington Post: Why It’s So Hard to Die in Peace

For those of us who had hoped that American attitudes toward death were shifting in ways that would promote a wider reconstruction of the health-care system, there’s discouraging news from Health Affairs, the preeminent journal of health policy. It devotes its latest issue to “end-of-life” care and finds that — at least so far — the power to make health care more compassionate and cost-effective is limited. Superficially, the vision seems to be triumphing, according to the 17 studies in Health Affairs. By one study, a third of American adults — and nearly half those 65 and older — have some sort of…

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NPR: Two out of three U.S. adults have not completed an advance directive

A team of researchers led by Katherine Courtright, MD, MS, revealed that 63 percent of American adults have not completed an advance directive, reported by the most comprehensive study to date on the subject.  Advance directives are the primary tool for individuals to communicate their wishes if they become incapacitated and are unable to make their own health care decisions, particularly near the end of life. Read more at Reuters, NPR, Kaiser Health News, Fierce Healthcare, Benefits Pro and Times of Malta; listen to a WTOP Radio interview, or watch the video at CBS News.

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Philly Voice: Penn medical school alum confronts what ‘no one wants to talk about’ in new podcast

Philly Voice highlights Dr. Lauren Kelly, a recent graduate of the Perelman School of the University of Pennsylvania, began producing her own podcast, “When I Die, Let Me Live”, that explores how we talk about death.  “I’m on a journey to talk about the one thing that no one wants to talk about,” Kelly says in the first episode. “Death is something that happens to all of us, yet it hardly comes up.” The idea for “When I Die, Let Me Live,” became realized with support from Scott Halpern, director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program…

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Removing Legal Barriers to Advance Care Planning

In a Perspective in the New England Journal of Medicine, Joshua Rolnick, a Penn National Clinician/VA Scholar, and LDI Senior Fellows David Asch and Scott Halpern suggest that an advance directive (AD) should be understood primarily as a clinical document, rather than a legal one. The authors argue that the existing legal framework around ADs – a document containing a designated health care decision maker, a living will, or both – creates several impediments to successful advance care planning and does little to prevent disputes over the care provided. The authors identify three major legal limitations to creating, updating, and…

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Fierce Healthcare: Study asks how accurate ICU doctors, nurses are at prognostics

Predictions of long-term survival and functional outcomes influence decision making for critically ill patients, yet little is known regarding their accuracy. Michael Detsky, Scott Halpern and colleagues from the FIELDS Program at CHIBE conducted a study that included five intensive care units (ICU’s) and patients who spent at least three days in the ICU and required mechanical ventilation, vasopressors, or both. The patients’ attending physicians and bedside nurses were also enrolled. Physicians were more accurate in predicting the likelihood of death and less accurate in predicting cognitive abilities in six months for critically ill intensive care unit (ICU) patients; nurses’…

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New York Times: How behavioral economics can produce better health care

A New York Times Upshot article by Dr. Dhruv Khullar profiles the research of Dr. Kevin Volpp as part of the Center for Health Incentives and Behavioral Economics. Khullar says that “insights [from behavioral economics] might be particularly valuable in health care because medical decision-making is permeated with uncertainty, complexity and emotion — all of which make it hard to weigh our options.”

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Scott Halpern Honored with 2017 Translational Science Awards

CHIBE Deputy Director Scott Halpern, MD, PhD, MBE was recognized this week with two awards as part of the Translational Science 2017 Awards Program. Halpern received not only the Association for Clinical and Translational Science Distinguished Investigator: Translation from Clinical Use into Public Benefit and Policy Award, but also the American Federation for Medical Research Outstanding Investigator Award. The Outstanding Investigator Award is presented annually to an investigator age 45 or younger in recognition of excellence in biomedical research, while the Distinguished Investigator Award recognizes senior investigators who have had an impact on clinical and translational science resulting in a…

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What Do Hospitalized Patients Say Would Be Worse Than Death?

Survey says… In caring for hospitalized patients with serious illnesses, and in evaluating interventions designed to help them, clinicians and researchers often focus on death as the primary outcome to be avoided. We tend to pay less attention to avoiding other outcomes that may be equally or more unacceptable to some patients. Between July 2015 and March 2016, Anna Buehler, Scott Halpern, and I asked 180 patients with serious illnesses who were hospitalized at the Hospital of the University of Pennsylvania to rate a series of single-dimension health states on a 5 point Likert scale with options of worse than…

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Conditions Worse Than Death as Rated by the Seriously Ill

Source: The Economist, WHYY, WBUR, Fox News, Philly.com, Medscape, LDI Health Policy$ense, Live Science, August 1, 2016 Research from CHIBE’s Fostering Improvement in End-of-Life Decision Science (FIELDS) program was highlighted in The Economist after the publication of a JAMA Internal Medicine article entitled, “States Worse Than Death Among Hospitalized Patients with Serious Illnesses.” The magazine wrote: “Asking people approaching, or threatened with death, how they feel about it, and the moment at which they would like it to come, is a welcome development. Both sides of the doctor-assisted-dying debate should pay attention to it.”

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