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.

Primary Faculty

  • Deepika Mohan, MD, MPH

Affiliated Faculty

  • Mary Callahan, MD, Division of General Internal Medicine
  • Emily Brant, MD, Fellow, Department of Critical Care Medicine
  • Jennifer Seaman, PhD, RN, School of Nursing

Program Staff

  • Anne-Marie Shields, MSN, RN
  • Menna Abaye, MS
  • Elke Brown, MD
  • Praewpannarai Buddadhumaruk, MS, RN
  • Rachel Butler, MHA, MPH

Current Trainees

  • Tracy Campbell, MD
  • Brett Curtis, Medical Student
  • Kate Petty, MD
  • Bailey Sparks, MD
  • Angela Suen, MD

Alumni

  • Taylor Lincoln, MD

Improving Clinicians' Communication Skills for Patients with Advanced Alzheimer’s Disease or Related Dementias
The goal of this project is to develop a web-based training platform that allows clinicians to complete serious illness communication skills training without traveling to a central location; the innovative methods include use of engaging, interactive, video-based online exercises to learn the core skills, brief video exemplars of experts demonstrating the core skills. Funding: NIH/NINR R01NR014663 (PI: White)

Family Support Intervention in Intensive Care Units: A Randomized Trial to Improve Surrogate Decision-making for Critically Ill Older Adults
The goal of this study is to conduct a multicenter efficacy trial of the Four Supports Intervention among 400 critically ill older adults to improve surrogates’ psychological outcomes and the patient-centeredness of care near the end of life. Funding: NIH/NIA R01AG045176 (PI: White)

PARTNER II: Improving Patient and Family Centered Care in Advanced Critical Illness
PARTNER II is a trial testing the effectiveness of a family support intervention delivered by the interprofessional team on the patient-centeredness of care, surrogates’ psychological symptom burden, and healthcare utilization at the end of life. Funding: NIH/NINR R01NR014663 (PI: White)

Developing a Communication and Shared Decision Making Tool to Prepare Family Members in ICUs for the Role of Surrogate Decision Makers
The purpose of this project is to develop and pilot test a web-based tool to help family members function as surrogates for incapacitated, critically ill patients. Funding: NIH/NIA R21-AG050252-01 (PI: White)

Developing a Novel Intervention to Make Physician Heuristics a Source of Power
In a series of research projects we are evaluating the effect of recalibrating physician heuristics in trauma triage. We will compare the effectiveness of a serious game tool to recalibrate heuristics with the existing standard of practice (education, opinion outreach). Funding: DP2 LM012339-01 (PI: Mohan)

Exploring the Perspectives of ICU Clinicians on the Conduct of Multidisciplinary Family Meetings in the ICU   
The purpose of this study is to explore the perspectives of ICU clinicians (nurses, physicians, and social workers) on perceived barriers and facilitators related to scheduling and conducting timely multidisciplinary family meetings in the ICU and elicit their thoughts and opinions about interventions that might improve the rate of interdisciplinary family meetings in ICU. Funding: NIH/NHLBI T32-HL007820 (PI: Seaman)

Survey of Barriers, Facilitators, Practices and Processes of Care Associated with the Conduct of Interdisciplinary Family Meetings in the ICU
The purpose of this study is to describe on a national level clinician-reported barriers, facilitators, practices and care processes related to the conduct of interdisciplinary family meetings in the ICU. This information will inform the development of a scalable intervention to improve adherence to best practice recommendations for timely interdisciplinary family meetings. Funding: University of Pittsburgh, Innovation Grant (PI: Seaman)

Research on Clinician Stakeholder Engagement in Intervention Development
The purpose of this study is to obtain feedback from clinician stakeholders on a proposed intervention to ensure timely interdisciplinary family meetings and to describe the processes and outcomes related to engagement with clinicians and clinical administrators. Funding:  CAMBIA Health Foundation, Sojourns Scholar Award (PI: Seaman)

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