Using behavioral economics to understand end-of-life decisions

描述（由申请人提供）：这个短期指导的中期职业生涯研究者奖（K18）的目的是提供琥珀Barnato，医学博士，公共卫生硕士，在匹兹堡大学与3个日历月的保护时间超过一年，从教授乔治Loewenstein，博士在卡内基梅隆大学接受指导。K18的总体目标是让Barnato博士学习并将行为经济学的基本行为和社会科学研究（b-BSSR）方法应用于她现有的临床和卫生服务研究组合。她具体的职业发展目标是：1）从行为经济学的角度获得对情绪在决策中的作用的先进理论和应用理解; 2）获得对人类受试者研究伦理的先进理论理解，并磨练作为负责医学生教育的教授的技能，负责研究的进行。由K18支持的拟议试点将：1）检查情绪状态如何影响代理人对患者使用生命维持治疗（LST）的决定; 2）检查医生沟通影响代理人对患者使用生命维持治疗（LST）的决定的机制。实验方法涉及操纵同意的代理决策者之间的情绪状态之前，在一个模拟的家庭会议与医生的参与。主要结果是代理人的假设LST决定。实验变量包括代理人的情绪状态，医生对情绪的关注和沟通的医疗信息的复杂性。协变量包括代理人的自我报告和生理测量水平的情绪唤起和理解的信息。第二个结果是决策冲突。 公共卫生相关性：急诊室或重症监护室中的患者家属经常被要求做出关于使用生命维持治疗的决定（例如，呼吸机、透析、心肺复苏术）。这些家庭成员被称为“代理”决策者。代理人有时会同意接受病人生前遗嘱表明他们可能不想要的治疗。这可能是由于代理人非常不安，因为我们知道，在情绪状态下做出的决定不一定是最“理性”的。“我们研究的目的是探索情绪如何影响代理人对患者治疗的决定（使用假设场景），以及不同风格的家庭医生沟通是否可以平息情绪并改善决策。

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.