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Improving the Doctor-Patient Relationship
through Patient Care, Teaching and Research.

Research

Pilot Grants

In 2012, our first year, the Bucksbaum Institute started a new pilot grant program for Associate Junior Faculty Scholars. This program was designed to advance research, teaching, and clinical programs relating to the doctor-patient relationship and clinical decision-making.

The Bucksbaum Institute for Clinical Excellence at the University of Chicago focuses on the interaction between medicine and society, emphasizes the doctor-patient relationship, and promotes outstanding patient-oriented medical care. The Bucksbaum Institute supports physicians at critical stages of career development and expects that Bucksbaum Institute Scholars will play a transformative role in the future of medicine in many ways, including

  • enhancing the quality of medical care by improving the doctor-patient relationship and promoting collaborative medicine
  • promoting social justice by working to reduce health care disparities and improving models of delivery and access; and
  • facilitating interactions between medicine and other disciplines including law, economics, social sciences, humanities, ethics, psychology, philosophy and others.

All Associate Junior Faculty Scholars were eligible to apply for pilot grants. In 2012, there were 20 Associate Junior Faculty Scholars, and 14 scholars submitted a total of 13 applications (one application was a joint project between two scholars). A selection committee awarded funds, totaling nearly $70,000 for 13 pilot grants.

The pilot grant program will continue through 2013. Our goal is to engage Associate Junior Faculty Scholars as well as Senior Faculty Scholars in research related to the doctor-patient relationship. In the second year, we will continue to select individual pilot grant applications, but will also encourage a) grant applications involving both Junior and Senior Bucksbaum Scholars and b) grant applications involving scholars from different departments who would focus on important issues such as bedside teaching, obesity or the clinical challenge of LVADs (Left Ventricular Assist Devices).


2013 Pilot Grants

A Formal Curriculum in Surgical Professionalism and Ethics

Peter Angelos, MD, PhD with Ross Milner, MD and Raymon Grogan, MD

To enhance and encourage the professionalism of surgical residents and their understanding of the central concepts of surgical ethics.

Predictors of satisfaction with surgical decision-making in elderly women undergoing gynecologic surgery

Sarah Collins, MD with Sandra Culbertson, MD and Nita Lee, MD

To evaluate the impact of medical and demographic characteristics, such as surgical indications, medical comorbidities, and health literacy, on how elderly women feel about their decisions regarding gynecologic surgical interventions.

A Pilot Program of Cost Communication in Hematologic Malignancies

Jonas de Souza, MD with Michael Bishop, MD, Lauren Kirby, LCSW, and Christopher Daugherty, MD

To develop educational material and further provide education to patients with hematologic malignancies related to the costs of their cancer care.

An Acute Pain Patient with Advanced Stage Cancer AND A Hospice Patient with Respiratory Distress in the ER: Improving Resident Physician Communications with Patients at the End of Life Utilizing Simulation Training

Allen Gustin, MD

To characterize the relative effectiveness of EOL simulation training on improving ACGME Core Competency (patient care, communication, and professionalism) scores of participants residency rotation evaluations.

Quality Improvement vs Research: Controversies and Confusion

Emily Landon, MD and Jessica Curley, MD

To systematically delineate the conflicts that arise in the determination of whether or not a QI project requires IRB approval by applying widely available QI vs research checklists to IRB approved projects and non-approved, self-defined QI projects at UCM.

Dynamic Operational Mapping – Annotation for Patient and Family Education

Alexander Langerman, MD with John Alverdy, MD, David Song, MD, and
Marko Rojnica, MD (resident)

To develop and field-test modules surrounding two common surgical procedures that contain multimedia informational content regarding clinical details, instrumentation, decision-making and workflow. These modules are intended for applicability to a wide-range of audiences - patients, families, medical students, OR staff, anesthesiologists, surgeons, and trainees - and in this project will be specifically annotated for use in patient counseling. Our hypothesis is that annotated dynamic operational maps (DOMs) will enhance surgeon-patient and surgeon-family communication regarding risks and benefits. We will test this hypothesis via the approach of conducting pre- and post-DOM implementation follow-up interviews to assess information transfer during surgeon-patient and surgeon-family encounters.

Improving Patient-Centered Technology (iPaCT) Use

Wei Wei Lee, MD

To understand how patients perceive technology use by physicians in inpatient and outpatient interactions, with a focus on the impact on the patient-doctor relationship and to develop and implement the “Improving Patient-Centered Technology Use (iPaCT)” curriculum for internal medicine (IM) residents.

Improving professionalism for physicians in training: A curriculum based approach.

Ross Milner, MD with Jerome Klafta, MD and Baddr Shaksheer (resident)

To create a program that improves professionalism in housestaff that receive poor evaluations as determined by the AGCME competency system.

Provider training to improve patient medication adherence in Federally Qualified Health Center settings: The Case of Pre-Exposure Prophylaxis (PrEP)

John Schneider, MD, MPH

The objective of this clinical initiative pilot grant is to develop strategies and tools for providers in resource restricted settings to improve Pre-exposure Prophylaxis (PrEP) across the spectrum of adherence. We will focus on both physician-patient and physician-health system interactions that drive adherence.


2012 Pilot Grant Abstracts

University Of Chicago Adult Sickle Cell Care Team – “Patient-centered Self Management Tools”

Gina Dudley, MD

With the support of the Bucksbaum Institute Pilot Grant, the University Of Chicago Medicine Adult Sickle Cell Program has implemented a project to develop a patient-centered self-management tool for improved disease control. The purpose of the project is to improve patient/provider communication by creating a portable medical record for sickle cell patients. This tool features specific details of care individualized for each patient, serving as a communication tool when patients present to acute care facilities, hospitals, and outside clinics. Central to this tool is input from patients, as provided in a focus group that allowed clinic participants to brainstorm about revisions to previous iterations of the card. By incorporating patient recommendations, the tool emphasizes the importance of the patient-doctor dyad.

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Incidence rates of thyroid cancer have increased worldwide for several decades.

Raymon Grogan, MD

In a recent study our group estimated that by 2019, thyroid cancer will be the 3rd most common cancer in women of all ages, and the second most common cancer in women under the age of 45 in the United States. Despite the increasing incidence, thyroid cancer survival has remained relatively stable in recent years. The prognosis for thyroid cancer is good as the 10-year survival rate for papillary thyroid cancer is as high as 97% in some studies. A high rate of survival, a relatively younger age at diagnosis, and the rising incidence is resulting in a greater prevalence of thyroid cancer survivors. In another recent study our group found that 11% of thyroid cancer recurrences and 17% of deaths occur more than 20 years after diagnosis. This leads to a lifetime of follow-up and the knowledge that once diagnosed, a person will never be fully cured of their cancer. Unfortunately, the psychology of thyroid cancer survivorship has been neglected and understudied. Our recent findings confirm that there is a clear need for a comprehensive evaluation of the psychological impact of thyroid cancer on survivor QoL so that physicians can be better equipped to help patients cope with these lifelong consequences.


Improving Patient Perception During Disclosure Conversations of Unanticipated Outcomes Utilizing Disclosure Training for Anesthesiology Residents and Critical Care Medicine Fellows: A Novel Approach

Allen Gustin, MD

Since the 1999 landmark Institute of Medicine report “To Err is Human,” evolving healthcare innovations have intended to reduce harmful patient events through education and systems improvements. Many organizations have been advocating for patient safety by instituting quality measures meant to create environments of transparency and encourage disclosure practices. Educational disclosure training programs are slow to grow and currently seem to be limited to cognitive exercises via electronic learning modules. I proposed a simulation study employing "real time" simulation disclosure training within the University of Chicago Medical Center. Simulation training has proven a viable training modality in sustaining changes in communication behaviors. To date, no investigator has validated the relationship between educational disclosure training and the perceptions of trained actors acting as patients after disclosure of harmful events. I propose this novel project with the following specific aims: to characterize the relative effectiveness of simulation disclosure conversations using Effective Arts actors and using the “Attend-To’s” methodology, to characterize the relative effectiveness of simulated disclosure conversations after simulated unanticipated outcomes using utilizing real time disclosure simulation as best practice as assessed by pre and post simulation assessments, and to characterize the relative experiences of participants using post evaluations and reflective practices after each RT unanticipated outcome simulation.

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Communication Skills Training Program for Oncology Trainees: Small Group Skills Practice

Olwen Hahn, MD

Effective communication is crucial to successful physician-patient encounters. Cancer patients report unmet communication needs for information about disease extent, prognosis, and treatment options. In communicating with patients, physicians tend to focus on technical and cognitive information, and they often omit key communication tasks such as eliciting patient’s perceptions and tailoring information to meet patient’s needs. Several studies have demonstrated that effective communication is not an innate talent, but a learned series of skills. Communications skills training (CST) is a vehicle to learn and solidify skills that improve doctor-patient interactions and professionalism. Only 5% of practicing oncologists have received formal training in communication and most fellowship programs do not offer CST. In 2010, a CST curriculum was initiated for the University of Chicago’s Hematology-Oncology fellows. The teaching methods include didactic lectures and workshop-based sessions. The Bucksbaum Institute’s grant provides an opportunity to augment this program by piloting a critical component of CST for trainees: experiential role-play of common oncology topics with standardized patients. The grant funds small-group practice sessions with standardized patients, faculty facilitator, and trainee. Topics to be covered include: breaking bad news, family meetings, and transitions to hospice. The goal of this educational initiative is to improve the communication skills by oncology trainees and improve their interactions with patients. If successful, our program could be adopted by other graduate training programs at University of Chicago.

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Physicians as First Line Responders Against Human Trafficking

Jennifer Hofer, MD

The Bucksbaum Institute Pilot Grant was awarded for the creation of guidelines and a curriculum that would empower physicians to be first line responders against human trafficking. Nearly one-third of victims interact with medical providers at least once during their captivity, yet the victims are not identified as victims and are instead returned to captivity. Human trafficking affects up to 200 million people worldwide. In Chicago alone between 2006-2007, an estimated 16,000-25,000 women were victims of trafficking. These victims are at high risk for illness, severe mental trauma, violent physical trauma, and sexually transmitted disease. Physicians are in an ideal position to screen and identify victims of human trafficking and to intervene to help them obtain medical care. Physicians can also work with other disciplines including social services, psychology departments, and the law to help victims obtain safe shelter, counseling, and legal aid. The ultimate goal is to restore human rights to the victims, bring the captors to justice, and end human trafficking. The grant money was designated towards education to create awareness on this topic, and to develop a lecture series to empower young physicians to identify, and intervene to help trafficked victims.


Patient Beliefs Regarding How the Timing of A1C and BP Control Affects Diabetes Outcomes

Neda Laiteerapong, MD

Patients are routinely challenged by complex medical decisions regarding when to undertake preventive, acute, or chronic care. Evidence from the UKPDS has suggested that, among adults with newly diagnosed diabetes, early tight hemoglobin A1C (A1C) control has benefits both at ~10 and ~20 years, while tight blood pressure (BP) control may have benefits only while tight control is maintained. For patients with established diabetes, more recent trial results have suggested that pursuing very tight A1C control may have little benefit, or even cause harm. Thus the timing of A1C and BP control may have important clinical consequences for patients with diabetes. A fundamental questions is raised by these timing effects: what do patients believe regarding how time affects the burdens and benefits of achieving tight A1C and BP control, defined by an A1C<7% and BP<130/80 mmHg.

I will conduct semi-structured interviews with 40 patients with diabetes from diverse clinical settings, in order to: Aim 1. Describe patients’ beliefs regarding when medications are needed for tight A1C and BP control, when benefits from tight A1C and BP control are expected to accrue, and whether the timing of tight A1C and BP control alters benefits. Aim 2. Explore how patients evaluate a given treatment regimen in the context of new information about the timing effects of tight A1C and BP control.


Endometrial Cancer Survivorship: A qualitative approach to understanding healthy lifestyle change in African American endometrial cancer survivors and their support network

Nita Lee, MD

Endometrial cancer is the most common gynecologic malignancy, affecting 43,000 women each year. Women with endometrial cancer are likely to be diagnosed early and cured of their disease. Despite a positive cancer outcome, the major risk factors for the disease, which include obesity and diabetes, persist long after the cancer diagnosis, placing these women at high risk for future morbidity and mortality. Sixty to eighty percent of women are overweight or obese at the time of diagnosis. Thus, a new diagnosis of endometrial cancer becomes a compelling reason to promote nutrition, healthy behaviors, and weight loss in individual patients and their families.

The objective of this pilot proposal is to better understand knowledge, attitudes, and behaviors regarding endometrial cancer, obesity, and feasibility of lifestyle change among African American women with endometrial cancer and their female family and social network using qualitative research methodology. A cancer diagnosis can be teachable moment in which the clinician can influence obesity-related behaviors. Themes and concerns elucidated via moderated focus groups will build the foundation and drive future patient-centered interventions supporting cancer education and healthy lifestyle change among African American women.

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Communication during Pediatric Resuscitation: a pilot simulation training program for pediatric critical care and emergency medicine fellows

Diana Mitchell, MD and Alisa McQueen, MD

One of the most stressful events for medical providers is the resuscitation of a critically ill child. And of course, such an event is unthinkable for parents. However, survey shows that parents wish to be present during the resuscitation of their child. We developed a simulation-based resuscitation curriculum to train fellows in pediatric critical care and emergency medicine how best to carry out a pediatric resuscitation in the presence of a family member. Each case uses a high-fidelity mannequin to guide fellows through advanced medical interventions and procedural skills in the resuscitation of a pediatric patient. During the scenarios, fellows communicate with standardized patients acting as parents. Program evaluations rate the sessions as highly realistic. All fellows report they plan to change their management of patients based on the sessions. Self-assessment of skills before and after each session indicate that fellows feel more comfortable with parental presence during a resuscitation, explaining medical interventions, communicating with family members, and answering hard questions (i.e. “is my child going to die?”) after completion of the sessions. Future directions include implementing the curriculum as a mandatory component of fellow training and development of a best practices video so that key skills can be disseminated across other training programs and medical disciplines.

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The 1200 Patients Project: Evaluating How Results Delivery in the Genomic Era Might Promote Communication in the Doctor-Patient Relationship

Peter H. O’Donnell, MD

“Personalized medicine” has been practiced for centuries, but with sequencing of the first human genome in 2000, the expectation became that ‘personalized medicine’ would also mean inclusion of genetic information. The field of pharmacogenomics has permitted discovery of genetic polymorphisms for many drugs, but thus far, information has infrequently been utilized due to poor physician knowledge about drug-gene relationships, limited avenues for testing, and time delays to receive results.

This project aims to overcome these barriers to realize the promise of pharmacogenomics. We are prospectively enrolling 1200 adults receiving routine outpatient care from early-adopter physicians at The University of Chicago. Patients are preemptively genotyped across a panel of polymorphisms selected based upon clinically relevant evidence of their pharmacogenomic role. Patient-specific results are made available to early-adopters through a created research portal (the “genomic prescribing system”) which provides instantaneous pharmacogenomic consultations. Through this individualized health care model, we are studying how pharmacogenomic results are utilized by physicians if timely, interpretable results are provided, and whether inappropriate or high risk medications are less likely to be prescribed in patients for whom pharmacogenomic results are known. Importantly, we are studying how the availability of pharmacogenomic information impacts the nature of the doctor-patient relationship.

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Engineering Patient-Oriented Clinic Handoffs (EPOCH)

Amber Pincavage, MD

While patients are especially vulnerable as they transition to care by a new physician, patient input into the resident clinic handoff process is lacking. To create a patient-centered process, we interviewed patients shortly after their transition for suggestions. Using this input, two months before the 2012 handoff, patients were sent a “transition packet” with a welcome letter from the new resident with their picture and personal information (i.e. hobbies), a certificate of teaching recognition, and a visit preparation tool. In 2012 (post-packet), patients were interviewed by phone on the impact of the packet. In 2011 and 2012, charts were reviewed to examine outcomes. The majority of patients post-packet (99%) were aware of the handoff. Of the 44% of patients who remembered the packet, most (70%) reported that it helped them build rapport, acknowledged their role as a teacher, and helped them prepare for their first visit. Fewer patients missed their first visit with their new physician (43% 2011 vs. 31% 2012, p<0.01) and were lost to follow-up six months after the handoff (22% 2011 vs. 12% 2012, p<0.01). A patient-centered clinic handoff was helpful to patients and may have encouraged patients to return for care after the handoff.

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The Power of Daily Prognostication of Outcome in the Pediatric Intensive Care Unit

Neethi Pinto, MD

Limited data exists regarding the accuracy of clinician predictions of morbidity and mortality in the Pediatric Intensive Care Unit (PICU). Our objective was to determine the accuracy of such prognostications. We hypothesized that predictions, obtained daily from members of the clinician care team (attending physician, fellow, resident/nurse practioner, and bedside nurse) would have limited predictive value for distinguishing survivors versus nonsurvivors. We expected the positive predictive value of prognostication to increase with level of experience, confidence in prediction, concordance among the team, and if the outcome measure included severe functional morbidity. We enrolled 143 children and obtained 3266 intuitions from clinicians over 978 patient days. Our preliminary results indicate that a prediction of death by any member of the care team was not predictive of mortality, but increased when agreement existed across the team, with serial predictions over time, and with experience. Regarding functional outcome at 1 month, there was limited concordance between attending predictions, parent assessment, and a validated scoring tool. Expansion of enrollment and analysis of 6 month outcomes will increase knowledge of the accuracy of clinician prognosis with the potential of improving overall physician-patient communication during an especially stressful time for families and their critically ill children.

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Enhancing the patient satisfaction and patient-doctor relationship through various ways of education

Tao Xie, MD

Patient education is very important to enhance patient-doctor relationship, patient satisfaction and their quality of life as well. Patient education in movement disorders could help patients understand and manage better their motor and non-motor symptoms and take best advantage of the state-of-the-art treatment option such as deep brain stimulation (DBS). Patient education, however, was not well addressed here and in many other places.

We therefore have conducted a serial of patient education initiatives. We prepared written materials and video clips on various movement disorders, including Parkinson’s disease, tremor and dystonia, particularly on the DBS treatment. We also routinely videotaped the pre-surgical status of the movement disorders for post-surgical comparison, which helps the patient to appreciate and enjoy better the post-surgical function improvement and has particular benefit for those patients who somehow do not recognize the improved function capacity even with the significant improved motor symptoms on objective post-surgical evaluation, cases so far difficult to be treated otherwise. In addition, we have more education and outreaching activity in April to benefit more patients including those currently not under our care.

Through these educations, we have enhanced patient satisfaction and patient-doctor relationship, delivered quality of care, and improved quality of life.

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Operationalizing the Virtues for Good Doctor-Patient Relationships

John Yoon, MD

Delivering compassionate, patient-centered care remains a key aspirational goal of the medical profession and is central to good doctor-patient relationships. But can such professional virtue be taught and assessed? In our previous work funded by the Science of Virtues at the University of Chicago, we have surveyed a nationally representative sample of medical students clustered within schools. With support from the Bucksbaum Institute, we conducted qualitative interviews with purposively sampled subgroups in order to test and refine the methods and measures that will be deployed in a future longitudinal study. One sub-group was those nominated into the Gold Humanism Honor Society. The other sub-group was those who were not nominated for Gold Humanism. Overall, 21 students were interviewed (10 from Gold subgroup, 11 from non-Gold subgroup). Currently, interviews are now transcribed and being coded for thematic analysis. We hypothesize that role models (clinical exemplars) play a major formative role in those nominated for the Gold Humanism Honor Society. The project contributes to research on the doctor-patient relationship by developing physician-specific measures of these professional virtues and by generating novel insights about character development and moral enculturation among physicians-in-training.

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