Fostering Improvement in End-of-Life Decision Science

No decisions in healthcare are as complex, and few are as important, as the end-of-life decisions made by patients, their family members, and their clinicians. The Fostering Improvement in End-of-Life Decision Science (FIELDS) Program was launched in 2012 by Dr. Scott Halpern with support from the Otto Haas Charitable Trust. The program is supported by both CHIBE and the PAIR (Palliative and Advance Illness Research) Center.

The FIELDS Program’s core goals are to understand and improve upon the ways in which end-of-life decisions are made.  We believe that end-of-life decisions often are influenced by the ways in which choices are presented and the environments in which decisions are made. Rather than passively accepting these influences on choice, we use approaches from psychology, economics, epidemiology, and sociology to design scalable interventions to increase the probabilities that end-of-life choices match the goals of patients, family members, providers, and society.

Here's some of our work in the area of end-of-life decisions

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If you'd like to partner with CHIBE on an end-of-life decision-making project, email us here

Default Options in Advance Directives

In this randomized controlled trial, CHIBE researchers found that default options for advanced directives can influence the choices seriously ill patients made toward their goals of care and preferences for life support.

Life Support Decisions

This paper explores the question “Do seriously ill patients’ decisions about life support interventions differ when made intuitively vs deliberatively?”

Expanding Choice

This study looked at increasing the number of options for completing an advance directive. While more options was not significantly associated with increased rates of completion, offering additional options did increase the proportion of patients who wanted to complete an advance directive and took one home.

Predictions

What is the discriminative accuracy of ICU physicians and nurses in predicting 6-month patient mortality and morbidity, including ambulation, toileting, and cognition? This paper found the discriminative accuracy varied depending on the outcome being predicted and confidence of the predictors.

Our Experts in End-of-Life Decisions

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Scott Halpern

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Katherine Courtright

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Joanna Hart

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Ravi Parikh

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Dylan Small

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Andrea Troxel