News

Reuters: 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 and Fierce Healthcare.

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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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Making End-of-life Care More Scientific

Source: Philadelphia Inquirer, May 22, 2016 The Philadelphia Inquirer featured an article on the FIELDS program, highlighting their current studies and recent publications. FIELDS is ” the country’s only program devoted to applying the principles of behavioral economics, in essence the study of how people make choices, to end-of-life care,” says director Scott Halpern.

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JAMA Features Two FIELDS Publications in its End-of-Life Issue

Source: JAMA, January 19, 2016 In “Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries”, Scott Halpern et al. studied patients 65 years or older who died with cancer in Belgium, Canada, England, Germany, Norway, the Netherlands, and the United States in 2010.  Findings indicate that end-of-life care in the United States and the Netherlands was less hospital-centric for these patients than it was in the other countries, but that hospital expenditures at end-of-life were higher in the United States, Norway, and Canada than they were in the other…

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