Browsing by Author "Schwartz, Peter H."

Now showing 1 - 7 of 7
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    Benchmarks for ethically credible partnerships between industry and academic health centers: beyond disclosure of financial conflicts of interest
    (Springer (Biomed Central Ltd.), 2015-12) Meslin, Eric M.; Rager, Joshua B.; Schwartz, Peter H.; Quaid, Kimberly A.; Gaffney, Margaret M.; Duke, Jon; Tierney, William H.; Department of Philosophy, IU School of Liberal Arts
    Relationships between industry and university-based researchers have been commonplace for decades and have received notable attention concerning the conflicts of interest these relationships may harbor. While new efforts are being made to update conflict of interest policies and make industry relationships with academia more transparent, the development of broader institutional partnerships between industry and academic health centers challenges the efficacy of current policy to effectively manage these innovative partnerships. In this paper, we argue that existing strategies to reduce conflicts of interest are not sufficient to address the emerging models of industry-academic partnerships because they focus too narrowly on financial matters and are not comprehensive enough to mitigate all ethical risk. Moreover, conflict-of-interest strategies are not designed to promote best practices nor the scientific and social benefits of academic-industry collaboration. We propose a framework of principles and benchmarks for "ethically credible partnerships" between industry and academic health centers and describe how this framework may provide a practical and comprehensive approach for designing and evaluating such partnerships.
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    Erratum to: Benchmarks for ethically credible partnerships between industry and academic health centers: beyond disclosure of financial conflicts of interest.
    (Springer, 2016) Meslin, Eric M.; Rager, Joshua B.; Schwartz, Peter H.; Quaid, Kimberly A.; Gaffney, Margaret M.; Duke, Jon; Tierney, William M.; Department of Philosophy, IU School of Liberal Arts
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    Family Communication About End-of-Life Decisions
    (2025-04) Myers, Anne Louise; Goering, Elizabeth M.; Bute, Jennifer J.; Parrish-Sprowl, John; Schwartz, Peter H.
    Purpose: For adults with serious illness nearing the end of life there are difficult decisions to be made about medical care and treatment. However, persons with life-threatening illness are commonly incapacitated, leaving the responsibility for making critical end-of-life decisions to family. To date, research on end-of-life decision-making and communication has framed proxy decision-making as a role for a “key” individual, despite growing evidence that multiple relatives often make decisions together. Also, although the literature examines communication between clinicians and patients or surrogates there is little research focused on family communication and how it relates to end-of-life decisions. The objective of the current study is to move towards bridging these gaps by examining within-family communication and decision-making from the perspectives of the family members themselves. Methods: This qualitative study explored family communication about end-of-life decisions through in-depth family interviews (n = 22). I applied Relational Dialectics Theory 2.0, a framework used for understanding relational communication within a particular context. To examine text derived from interviews, I used contrapuntal analysis, a type of discourse analysis that facilitates identification of competing discourses. Results: Three competing sets of discourses were predominant: 1) families providing care versus families relinquishing care, 2) independent versus interdependent decision-making, and 3) the certainty of knowing the patient’s wishes versus the uncertainty of knowing how to honor those wishes. Conclusions: The results highlight three key aspects of family decision-making. First, because families perceived caring for a loved one at home as normative, relinquishing end-of-life care to hospice or long-term care was a significant source of emotional burden. Second, families engaged in collaborative decision-making rather than having a primary decision-maker acting independently. Third, even when a patient’s wishes were known to the family, decision-makers still struggled with the uncertainty of understanding how to apply those preferences to medical decisions. Implications: This study provides insight into the communicative needs of family decision-makers that can be used to refine communication interventions and improve end-of-life experiences for families. These findings also suggest that more support is needed from clinicians to guide decision-makers with in-the-moment decision-making.
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    Presenting Stool Testing as the Default Option for Colorectal Cancer Screening: Results of a Randomized Trial
    (2015-01) Schwartz, Peter H.; Perkins, Susan M.; Schmidt, Karen K.; Muriello, Paul F.; Althouse, Sandra; Rawl, Susan M.
    Individuals eligible for colorectal cancer (CRC) screening can choose from multiple approved tests, including colonoscopy and stool testing. The existence of multiple options allows patients to choose a preferred strategy but also may lead to indecision and delay. Behavioral economics suggests presenting one option as a default choice, i.e. the one that patients should receive if they do not wish to decide. We conducted a randomized trial to measure the impact of describing stool testing as the default option for CRC screening in a decision aid (DA).
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    Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial
    (SAGE, 2017-08-01) Schwartz, Peter H.; Perkins, Susan M.; Schmidt, Karen K.; Muriello, Paul F.; Althouse, Sandra; Rawl, Susan M.; Medicine, School of Medicine
    Background. Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a “nudge” towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Methods. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Results. Patients viewing the quantitative module were more likely to be screened than those who did not (P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not (P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not (P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT (P = 0.028) than did those who did not. Limitations. The limitations of this study were the limited sample size and single healthcare system. Conclusions. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.
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    Questioning the Quantitative Imperative: Decision Aids, Prevention, and the Ethics of Disclosure
    (2011-03) Schwartz, Peter H.
    Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.
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    To be or not to be - a research subject
    (Cambridge University Press, http://www.cambridge.org/9780521744416, 2010) Meslin, Eric M.; Schwartz, Peter H.
    Most people do not know there are different kinds of medical studies; some are conducted on people who already have a disease or medical condition, and others are performed on healthy volunteers who want to help science find answers. No matter what sort of research you are invited to participate in, or whether you are a patient when you are asked, it’s entirely up to you whether or not to do it. This decision is important and may have many implications for your health and well-being, as well as those of other patients now and in the future. Making a good decision – the right one for you – requires you to become educated about topics you may not have thought about before, some of which may be quite complicated. This chapter explains the key issues to help you make a good decision.