Using behavioral economics to understand end-of-life decisions

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DESCRIPTION (provided by applicant): The purpose of this short-term mentored mid-career investigator award (K18) is to provide Amber Barnato, MD, MPH, MS at the University of Pittsburgh with 3 calendar months protected time over one year to receive mentorship from Professor George Loewenstein, PhD at Carnegie Mellon University. The overarching goal of the K18 is to allow Dr. Barnato to learn and apply the basic behavioral and social science research (b-BSSR) method of behavioral economics to her existing portfolio of clinical and health services research. Her specific career development goals are: 1) to gain advanced theoretical and applied understanding of the role of emotions in decision making from the perspective of behavioral economics; and 2) to gain advanced theoretical understanding of the ethics of human subjects' research and to hone skills as a professor responsible for medical student education in the responsible conduct of research. The proposed pilot supported by the K18 will: 1) examine how emotional state influences surrogates' decisions to use life- sustaining treatments (LSTs) for patients; and 2) examine the mechanism whereby physician communication influences surrogates' decisions to use life-sustaining treatments (LSTs) for patients. The experimental approach involves manipulation of the emotional state among consented surrogate decision makers prior to participation in a simulated family meeting with a doctor. The primary outcome is the surrogate's hypothetical LST decision. Experimental variables include the surrogate's emotional state, the physician's attention to emotion and the complexity of the medical information communicated. Covariables include the surrogate's self- reported and physiologically-measured levels of emotional arousal and comprehension of information. A secondary outcome is decisional conflict. PUBLIC HEALTH RELEVANCE: Family members of patients in the emergency room or intensive care unit are often called upon to make decisions about the use of life-sustaining treatments (e.g., breathing machines, dialysis, CPR) when the patient cannot communicate his or her own wishes. These family members are called "surrogate" decision makers. Surrogates sometimes agree to treatments that the patient's living will suggests they might not have wanted. This could be caused by the surrogate being very upset, since we know that decisions made in an emotional state are not necessarily the most "rational." The purpose of our study is to explore how emotions affect surrogates' decisions about treatments for patients (using hypothetical scenarios) and whether a different style of family-doctor communication can calm emotions and improve decision-making.