Society for Medical Decision Making

SMDM is excited to announce nine symposia for the 43rd Annual North American Meeting which will be held virtually October 18 - October 20, 2021. You must register for the meeting to attend the symposia. Recordings of all Scientific Sessions will be available to view through 14 January 2022!

Monday, October 18, 2021

2:30 PM - 4:00 PM EDT | 6:30 PM - 8:00 PM UTC | 8:30 PM - 10:00 PM CET

Open Science and Model Transparency in the context of COVID-19 Pandemics
Chairs: Luciana Garbayo and Fernando Alarid-Escudero

Following SMDM participation in the Call for Transparency in Covid-19 Models (Science, May 2020), this symposium proposal aims to provide SMDM members with a panel of top researchers leading innovative open science and model transparency initiatives for Covid-19 pandemics. The panel shall illuminate new ways to share models, knowledge and technology to better anticipate, predict, and respond to the Covid-19 pandemics (and beyond).

Valuing Diversity: Addressing Health Disparities in Value Assessment
listed as Methods Development in Health Economic Evaluation
Chair: Joanne Westphal

The historic events of 2020 have brought significant public health and social challenges into stark relief. Unquestionably, the COVID-19 pandemic has magnified disparities in health status and health care access, which can be linked to upstream determinants such as a patient’s underlying socioeconomic environment. The persistence of serious health disparities and inequities in the U.S. raises the question of whether we have placed adequate value on eliminating them. This includes rethinking our conceptions of value, addressing everyday drivers of health inequities, and increasing representation of diverse populations in research, all of which affect how we make decisions about health care. Cost-effectiveness analysis and other methods offer frameworks to evaluate and render decisions based on evidence on the outcomes of care relative to the costs. This panel will discuss new research and approaches to account for health disparities and represent of diverse populations and advance health equity in value assessments.

Incorporating Costs into Health Decisions: Patient, Clinician, and System Level Issues
Chair: Mary C Politi

The United States healthcare system has increasingly moved toward high-deductible insurance plans that require patients to pay large amounts out of pocket before insurance starts sharing care costs. Along with out-of-pocket costs, patients often experience burden from indirect costs of care, such as time off work, caregiving challenges, and even employment loss. Direct and indirect costs often factor into patients’ decisions when there are choices between several reasonable options. However, clinicians and patients often miss opportunities to address costs during shared decision-making. In addition to the burden on patients, across many countries, clinicians provide services (e.g., tests, referrals) to reduce perceived legal risks. Such practices drive over-treatment and low value healthcare, adding cost burden to the system and complicating health decisions. In this symposium, we will discuss: 1. ongoing work incorporating cost discussions into shared decision-making, 2. work on employment-related support for patients with cancer, and 3. an international review of defensive medicine and the burden it places on patients and the healthcare system.

Tuesday, October 19, 2021

2:00 PM - 3:30 PM EDT | 6:00 PM - 7:30 PM UTC | 8:00 PM - 9:30 PM CET

Advancing research on emotional well-being: introducing a family well-being research network
Chair: Eve Wittenberg

This symposium will present a newly-launched emotional well-being research network: FAM-Net, a collaboration of the University of Michigan, the University of Pittsburgh, and Harvard University. Sponsored by NIH, the US-wide network of researchers will advance the science of emotional well-being through six distinct efforts ranging from animal studies of brain function to mindfulness-based interventions across the lifespan, from child well-being within a family to older adults’ well-being among family members and relatives. Critical knowledge gaps exist in both understanding the research on the role of emotional well-being in health and in measuring well-being outcomes, which constrain the rigorous incorporation of emotional well-being into clinical and policy decisions. Both emotional well-being and family well-being can be influenced by policy decisions and are often considered when an individual makes decisions about healthcare. This symposium will present an overview of the NIH effort and FAM-Net specifically. We will introduce the Network investigators and present sample research activities. The symposium will include an online interactive collaborative component to generate ideas about family well-being measurement. We invite SMDM members and others interested in this field to learn about the program and ways to become involved.

Can CEA and simulation models advance equity and justice in health?
Chairs: Anton Avanceña and Jovan Julien

Equity and efficiency are equally important goals in healthcare; however, traditional methods in economic evaluation such as cost-effectiveness analysis (CEA) and simulation modeling rarely consider equity and economic, racial, and social justice. As a result, scholars outside the field of decision sciences (e.g., Lübbe, Klonschinski, and Richardson) have criticized these methods as inherently "inequitable," "colonial," and "racist" because they do not consider how underlying societal forces and historical structures of (dis)advantage shape the magnitude and distribution of intervention costs and benefits. Similarly, scholars within the field (e.g., Cookson, Norheim, Nord, Reckers-Droog, and Brouwer) have tried to address the limitations of traditional CEA and simulation modeling by devising methods that explicitly incorporate equity concerns in economic evaluation. This symposia aims to convene a transdisciplinary group of scholars to critically examine the progress, potential, and pitfalls of economic evaluation in creating more equitable and just healthcare systems globally. The speakers will engage in a thoughtful discussion about the role of economic evaluation decision-making and resource allocation in health and how it can be a tool for change.

Public Deliberation to Improve Medical Decision Making
Chair: Peter H. Schwartz

Public deliberation has been used to provide lay input into health policy decisions that require complex tradeoffs and priority setting. Deliberation processes have also been used in a small number of projects in medical decision making, and there is significant promise for this technique to improve the active involvement of the lay publics in research and practical initiatives in this area in the future. In one approach to public deliberation, a diverse group of 25-40 lay individuals meet for an extended period of time, e.g. 4 days over two non-consecutive weekends. Participants learn about the relevant issues and conflicting perspectives, discuss the issues in small and large groups with facilitators, and then develop and vote on recommendations. This symposium will include presentations by three researchers who have used these techniques in the context of: 

• shared decision making for lung cancer screening 

• design and evaluation of decision aids for colorectal cancer screening 

• consent and governance for biobanks.   

With the benefit of hindsight, the speakers will describe the advantages and disadvantages of public deliberation for their projects, facilitators and barriers they found when conducting these exercises, and will look forward to possible uses of public deliberation in medical decision making projects in the future. Attendees will leave this session with a better understanding of the method of public deliberation and its strengths and weaknesses as a tool for studying and improving medical decision making. They will also better appreciate the practical and ethical challenges of truly involving patients, research participants, and other members of the public in directing research studies and improving decision making.

Wednesday, October 20, 2021

1:30 PM - 3:00 PM EDT | 5:30 PM - 7:00 PM UTC | 7:30 PM - 9:00 PM CET

Individual and Government Perspectives on Vaccination Introduction
Chair: Abram Wagner

The on-going roll-out of COVID-19 vaccines has brought governmental vaccine recommendations to the forefront of everyday conversation. Moreover, in recent years there have been advances not only in the methods used to evaluate vaccine candidates within these government communities, but also within surveys of the general population. In a discussion on multiple perspectives of vaccination introduction, this symposium will gather together a diverse selection of panelists, in terms of career progression, field, gender, race/ethnicity, geographic location, and gender. The panel will be structured to have panelists very briefly introduce topics, flowing from governmental to individual perspectives followed by a moderated discussion.

Systemic and societal factors that constrain caregivers’ healthcare decisions for their children
Chair: Erika Waters

Stakeholders across multiple levels of healthcare delivery for children, including policy makers, healthcare payors (e.g., private insurance companies, Medicaid), healthcare providers (e.g., physicians, nurses, community health workers), caregivers, and child patients acknowledge that caregivers’ healthcare decisions for children are influenced by a constellation of factors that are outside of their control or their caregivers’ control. These factors may constrain decisions to such an extent that the caregiver may not be logistically able to follow medical advice. The constraints may also limit the number or quality of healthcare options the caregiver has to choose from. Addressing systemic and societal forces such as healthcare policies, discriminatory governmental practices, and ageist cultural conceptions is critically important for implementing evidence-based interventions that support caregivers in their efforts to care for their child’s health. This symposium will interrogate the effect of systemic and societal factors on caregivers' healthcare decisions and child health. Although this symposium is framed in the context of asthma care, the principles to be discussed apply to many acute and chronic childhood health conditions. The symposium will feature presentations from representatives of key stakeholder groups, including a physician, a caregiver or asthma patient advocate, a medical anthropologist, and a school nurse. The symposium will feature ample time for attendees to share their own impressions.

Measuring the Value of Healthcare Interventions: From Individuals to Society
Chair: Charles E Phelps

The 2017 publication of the Cost Effectiveness in Health and Medicine, Second Edition and the 2018 ISPOR Special Task Force reports ("A Health Economics Approach to US Value Assessment Frameworks") form the basis for most current thinking about Cost Effectiveness Analysis (CEA), its limitations, and ways to expand its scope of value measurement. At the individual level, conventional CEA excludes considerations of uncertainty and risk aversion in health outcomes.  At the societal level, conventional CEA excludes issues involving equity on multiple dimensions, (e.g., systemic racism, income inequality, persons with disabilities, severity of untreated illness).  It also does not capture “externalities” such as scientific spillovers, fear of contagion, and others. Building on the “2nd Panel” and the ISPOR Task Force reports, our Symposium will highlight the “non-conventional” aspects of value, including how to measure and incorporate them into more-comprehensive measures of value. We will review some newly-emerging methods including the Generalized Risk-Adjusted Cost-Effectiveness (GRACE) model.

Please Note: Symposia dates and times are subject to change.