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Effective Health Care Program

Communicating (Im)Precision and Uncertainty In Clinical Evidence (Session I)

White Paper

This conference took place on September 13, 2011, in Gaithersburg, Maryland. Presenters and discussants explored the theory-based and practical approaches to patient-provider communication in order to offer the EHC Program guidance on developing resources and tools that support decisionmaking by patients and their health care providers.

This first session addresses communicating clinical evidence.

Presentations

Conceptual, Methodological, and Ethical Problems in Communicating Uncertainty in Clinical Evidence

Paul K.J. Han, M.D., M.A., M.P.H., Presenter
Maine Medical Center Research Institute, Center for Outcomes Research and Evaluation, Portland, Maine

The Right Tool is What They Need, Not What We Have: A Taxonomy of Appropriate Levels of Precision in Patient Risk Communication

Brian J. Zikmund-Fisher, Ph.D., Presenter
University of Michigan, School of Public Health, Ann Arbor, Michigan

Discussant Presentation

Dominick L. Frosch, Ph.D., Discussant
University of California, Los Angeles, Los Angeles, CaliforniaDiscussant Presentation

Steven H. Woolf, M.D., M.P.H., Discussant
Virginia Commonwealth University, Richmond, Virginia

Biosketches

Paul K. J. Han, M.D., M.A., M.P.H., is a Clinical Investigator with the Center for Outcomes Research and Evaluation at Maine Medical Center. He received an A.B. from Cornell University, an M.D. from the New York University School of Medicine, and an MPH and MA in Bioethics from the University of Pittsburgh. He is a board-certified general internist and palliative medicine physician, and completed Internal Medicine residency training at UCLA Medical Center, and a research fellowship in cancer prevention at the National Cancer Institute (NCI), where he also served as a Medical Officer with the Division of Cancer Control and Population Sciences, prior to joining Maine Medical Center in 2009.

Dr. Han’s research focuses on risk communication, medical decision making, cancer, and palliative and end-of-life care, and his work bridges the disciplines of behavioral and health services research. His specific interests are in the communication and management of uncertainty in health care, and on improving methods and outcomes of communicating scientific uncertainty to patients. His clinical activity is in palliative medicine, and he is an attending physician at the Hospice of Southern Maine.

Dominick L. Frosch, Ph.D., is Associate Staff Scientist at the Palo Alto Medical Foundation and Assistant Professor of Medicine at the University of California, Los Angeles. Dr. Frosch completed his PhD in clinical health psychology at the University of California, San Diego and a fellowship as a Robert Wood Johnson Health & Society Scholar at the University of Pennsylvania. For the past 12 years his research has focused on developing, evaluating and implementing patient decision support interventions. He has served as PI for three randomized controlled trials of decision support interventions (DESIs) for prostate cancer screening and currently serves as PI for a large scale federally funded randomized implementation project (1R18AE000023-01). He has also served as PI for demonstration projects, funded by the Foundation for Informed Medical Decision Making, focused on the implementation of DESIs in routine clinical practice in primary and specialty care settings since 2006. His research draws extensively on qualitative research methods to identify factors associated with successful implementation of DESIs, as well as patient perspectives on shared decision-making and patient centered care.

Steven H. Woolf, M.D., M.P.H., is Professor at the Departments of Family Medicine, Epidemiology and Community Health at Virginia Commonwealth University and is director of the Virginia Commonwealth University Center on Human Needs. He received his MD in 1984 from Emory University and underwent residency training in family medicine at Virginia Commonwealth University. Dr. Woolf is also a clinical epidemiologist and underwent training in preventive medicine and public health at Johns Hopkins University, where he received his MPH in 1987. He is board certified in family medicine, preventive medicine, and public health.

Dr. Woolf has published more than 150 articles in a career that has focused on evidence-based medicine and the development of evidence-based clinical practice guidelines, with a special focus on preventive medicine, cancer screening, quality improvement, and social justice. From 1987 to 2002, he served as science advisor to and then member of the United States Preventive Services Task Force. Dr. Woolf edited the first two editions of the Guide to Clinical Preventive Services and is author of Health Promotion and Disease Prevention in Clinical Practice. He is associate editor of the American Journal of Preventive Medicine and served as North American editor of the British Medical Journal. He has consulted widely on various matters of health policy with government agencies and professional organizations in the United States and Europe, and in 2001 was elected to the Institute of Medicine.

Brian J. Zikmund-Fisher, Ph.D., is an Assistant Professor in the Department of Health Behavior and Health Education, University of Michigan (UM) School of Public Health, a Research Assistant Professor in the UM Department of Internal Medicine, and a member of both the UM Center for Bioethics and Social Sciences in Medicine and the UM Risk Science Center. Dr. Zikmund-Fisher received his PhD in Behavioral Decision Theory (a combination of decision psychology and behavioral economics) from Carnegie Mellon University. He uses this interdisciplinary background to study factors that affect individual decision making about a variety of health and medical issues, with a particular emphasis on risk communication and numeracy (people's ability to use numbers to inform their decisions). He co-directed the recently published National Survey of Medical Decisions (the DECISIONS Study) and has current projects studying perceptions of risk from dioxin exposure within affected communities, communication of genetic test results to optimize cancer screening, development of novel risk graphics, and approaches for overcoming cognitive and emotional biases in decision support materials. At Michigan, Dr. Zikmund-Fisher teaches graduate courses in risk communication and designing memorable health messages.