• From Trials to Observational Data: Modeling Natural and "Unnatural" History
• Estimating Preference and Selection Effects, How to Untangle the Effect of Informed Choice
• Health Outcomes and Costs of Community Mitigation Strategies for Pandemic Influenza in the U.S
• To Experiment or Observe? The Advantages of Randomized Experiments in Studies of Medical Decision Making
• Unforgettable: Being At "Above Average" Risk Increases Memory For Risk Statistics

Brian Haynes MD, PhD, FRCPC, FRSC
"Knowledge Translation Research: Paving the Road Between Evidence and Health Outcomes"

A. Connections with Judgment and Decision Making This symposium is half of an NSF-supported research exchange between SMDM and the Society for Judgment and Decision Making (SJDM). Three SJDM presenters, partnered with SMDM researchers, will present recent work in basic judgment and decision making that has not been widely disseminated in the MDM literature. A complementary symposium will be held at the SJDM annual meeting in November. Each presentation will be 20 minutes followed by 30 minutes of Q&A/discussion with the speakers as a panel.

Speakers will include:

Wolfgang Gaissmaier, PhD., Chief Research Scientist, Harding Center for Risk Literacy, Max Planck Institute for Human Development "How Research On Fast And Frugal Heuristics Could Help Doctors And Patients To Make Better Decisions"
with
Brian Zikmund-Fisher, PhD, University of Michigan, Center for Behavioral and Decision Sciences in Medicine (CBDSM), Ann Arbor, MI

Sunita Sah, Carnegie Mellon University
"Burdening Patients with Doctors' Conflicts of Interest"
with
Mark Roberts, MD, MPP, University of Pittsburgh, Pittsburgh, PA

Kathleen D. Vohs, Associate Professor of Marketing, Carlson School of Management, University of Minnesota, Minneapolis, MN "Small Reminders of Money Alter Pain Perceptions"
with
Donald Redelmeier, MD, University of Toronto, Sunnybrook Hospital, Toronto, Canada

SMDM Annual Business Meeting
All attendees are encouraged to attend the annual business meeting. This is a great opportunity to learn what SMDM has done over the past year, hear about plans for the future and learn how SMDM has impacted the profession.

Decision Modeling in Cancer: Implications for Comparative Effectiveness
Decision modeling in cancer is essential for assessing the long-term clinical and economic impact of comparing approaches to cancer prevention and treatment and is playing an increasing role in the field of comparative effectiveness research in cancer. There are multiple challenges that analysts face when working with decision models in cancer prevention and treatments. Typically, clinical trials that compare treatments provide us with only comparisons of intermediate outcomes. These intermediate outcomes may be linked to outcomes that are of clinical importance and require the use of validated forecasting models. The challenge of constructing and validating forecasting models that accurately reflect the natural history of cancers has been a long-standing challenge of the field. In terms of comparative effectiveness studies, clinical trials may also not provide us with all comparisons that are of interest to clinicians or policymakers. This requires investigators to be able to manipulate the findings of existing trials and observational studies to address comparisons of interest. A third challenge of comparative effectiveness analysis in cancer care is that therapies are increasingly individualized based on genetic and clinical markers. The individualization of cancer treatments raises questions about whether or not traditional decision models that typically focus on the average effects of treatments across a population are still appropriate. Finally, analysts that use cancer models face a number of changes related to the limited availability of data. Sometimes there is limited data on operating characteristics on diagnostic tests and cancer treatments. In addition, there are limited data on preferences on outcomes for cancer screening and treatment.

As cancer prevention and treatment grows more complex, there is a need to review the latest methodologies in decision modeling and highlight their implications for comparative effectiveness of cancer treatments. For this symposium, we have invited investigators who are active in cancer modeling, many of whom are also involved with the National Cancer Institute sponsored Cancer Investigation and Surveillance Modeling Network (CISNET). We have asked each speaker to identify what they believe to be the major challenge that we face in decision modeling and cancer. We believe that the CISNET collaborative will provide many important lessons in cancer modeling that can be applied to the modeling of other chronic diseases.

Speakers will include:
Moderator, Scott B. Cantor, PhD, Professor, The University of Texas M. D. Anderson Cancer Center. Dr. Cantor is a former president of SMDM. His research focuses primarily on the prescriptive analysis of clinical oncology problems, using the tools of clinical decision analysis and cost-effectiveness analysis. In addition, he has participated in descriptive studies seeking to explain decision-making behavior; these have included utility assessment (i.e., elicitation of preferences for health outcomes). He has also advanced the science of the methods of medical decision making, particularly in the areas of diagnostic testing and cost-effectiveness analysis, through the study of applied clinical problems.

Karen M. Kuntz, ScD, Professor, University of Minnesota School of Public Health. Dr. Kuntz is a former president of SMDM. She is a health decision scientist with experience in the methods and applications of using simulation modeling to evaluate clinical and public health strategies. She is the principal investigator of one of the Cancer Intervention and Surveillance Modeling Network (CISNET) grants funded by the NCI to evaluate the national trends in colorectal cancer incidence and mortality. She is also principal investigator of a grant from the Agency for Healthcare Research and Quality to examine the effects of disparities in screening, follow-up and treatment on cancer-related outcomes. In addition to specific applications, she has become one of the leading authorities on describing errors and biases that can occur in disease modeling.

Sylvia K. Plevritis, PhD, Associate Professor, Stanford University. Dr. Plevritis uses a systems engineering approach to study cancer. Her projects include developing computational models of cancer biology and developing decision-analytic models that inform health policies for cancer control. She has worked on developing stochastic models of the natural history of cancer to derive estimates of the rates that cancer progresses from non-metastatic to metastatic states using clinical data. The disease models of cancer are embedded into population-level simulation models that predict patient outcomes under differing medical interventions; allowing prediction of effectiveness and cost-effectiveness of new cancer imaging technologies.

Ya-Chen Tina Shih, PhD, Associate Professor, The University of Texas M. D. Anderson Cancer Center. The majority of Dr. Shih's research applies statistical or econometric methods to health economics and health services research. Her current research focuses on (1) examining treatment and resource utilization patterns in cancer patients using large claims data such as SEER-Medicare data, (2) applying Bayesian techniques in cost-effectiveness analyses and other pharmacoeconomic studies, and (3) comparing access and utilization of preventive and curative care among different population subgroups.

Natasha K. Stout, PhD, Instructor in the Department for Ambulatory Care and Prevention at the Harvard Medical School and Harvard Pilgrim Health Care. Her research focuses on the development and application of population-based computer simulation models to inform decision making in health policy and improve population health. In particular, she is interested in breast cancer natural history modeling to evaluate prevention and control strategies. Methodological interests include issues in model calibration and validation. She is affiliated with the Program in Health Decision Science at the Harvard School of Public Health and the NCI's CISNET collaboration.

Career Trajectories in MDM: Networking, Applying and Transitioning
A special panel will provide an opportunity for trainees to learn about different career trajectories in medical decision making. Panelists will discuss how to find, apply, and move into positions within their setting, and the benefits and drawbacks of the setting as it relates to MDM.

Panel Facilitator:
Mary C. Politi, Ph.D.,, Washington University in St. Louis, St. Louis, MO
Mary C. Politi, PhD is an Assistant Professor of Surgery and part of the Health Communication Research Laboratory at Washington University in St. Louis. Dr. Politi received her PhD in clinical psychology with a specialization in behavioral medicine from The George Washington University in Washington, D.C. She completed her predoctoral internship and postdoctoral fellowship at Brown University Medical School, where she focused on in transdisciplinary cancer control and prevention research. Her current work involves health communication during the patient-clinician encounter. She is particularly interested in ways to communicate uncertainty during shared decision making. Dr. Politi serves on the membership committee of the Society of Medical Decision Making, and the Health Decision Making Special Interest Group of the Society of Behavioral Medicine.

Panelists will include:

Michael J. Barry, MD
Michael is actively involved in the Foundation for Informed Medical Decision Making, and is the Chief of the General Medicine Unit at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. Dr. Barry has been President of the Society for Medical Decision-Making (SMDM) and the Society of General Internal Medicine (SGIM). He was the PI of the Prostate PORT-II. He is currently PI of a project comparing screening and treatment intensity and prostate cancer mortality in the Connecticut and Seattle SEER areas. He heads the Endpoints Committee for the Prostate cancer Intervention Versus Observation Trial (PIVOT). His research interests include the evaluation and treatment of prostate disease, health status measurement, technology assessment, and the use of decision aids to facilitate patients’ participation in decision-making.

Marilyn Schapira, MD, MPH, Zablocki VAMC, Milwaukee, WI
Dr. Schapira is a clinician-investigator in the area of risk communication and medical decision-making. She has conducted original research in the development and evaluation of decision-aids for prostate cancer treatment and postmenopausal hormone therapy. Dr. Schapira has focused her area of investigation how patients understand and use quantitative information in the context of clinical decision-making and doctor-patient communication. Her current work involves the development of a construct of health numeracy and the evaluation of numeracy as a potential link between formal education and improved health. Dr. Schapira is currently funded for her work by a grant from the National Cancer Institute. Dr. Schapira directs the General Internal Medicine fellowship program at the Medical College of Wisconsin and serves as the director of research in the Division of General Internal Medicine. Her clinical and teaching practice is based at the Women's Health Clinic at the Zablocki VA Medical Center. Dr. Schapira serves on the Council of the Society of Medical Decision Making and is an active member of the Society of General Internal Medicine.

David Sugano, DrPH, Novartis Pharmaceuticals Corporation, East Hanover, NJ

Two Decades of Clinical Reasoning: Where Do We Stand Now?
Jerome Kassirer, with moderator John B. Wong and panelists, Arthur Elstein, Stephen Pauker and Valerie Reyna will revisit the quotations, sentiments and words of wisdom that Kassirer articulated in his book, Learning Clinical Reasoning, which was first published in 1991 -- almost 20 years ago. The group will then reflect on what is still true and what is not still true about those statements in light of the many changes in medical technology since 1991.

Speakers for this symposium include:

Moderator,
John B. Wong, MD, Chief, Div of Clinical Decision Making, Tufts Medical Center, Boston, MA
Dr. Wong is a general internist and a Professor of Medicine at Tufts University School of Medicine. After training with Drs. Pauker and Kassirer at Tufts Medical Center, he is a Past President of the Society for Medical Decision Making and the current recipient of the Society's Eugene Saenger Award. A Fellow of the American College of Physicians, he is the statistical editor in decision and cost-effectiveness analysis for the Annals of Internal Medicine and the editor in heart disease and heart failure at the Foundation for Informed Medical Decision Making, initiated through the AHCPR Ischemic Heart Disease PORT some 20 years ago. He has been a member of guideline committees for the American Association for the Study of Liver Disease, the European League Against Rheumatism and the American College of Chest Physicians and has helped propose quality of care measures for the National Quality Forum for hepatitis C, coronary artery disease, hypertension and heart failure through the Physician Consortium for Practice Improvement. Having published over 100 peer reviewed articles, his research focuses on the application of decision analysis to patient-centered decision making to help patients, physicians and policy makers choose among alternative tests, treatments or policies based on the best available evidence about the likely outcomes and their importance. He is a co-author of Drs. Kassirer and Kopelmans' second edition of Learning Clinical Reasoning.

Jerome P. Kassirer, MD
Distinguished Professor, Tufts Medical Center, Boston, MA
Visiting Professor at Stanford University.
Former Editor-in-Chief of the New England Journal of Medicine
Dr. Jerome P. Kassirer received his MD from the University of Buffalo in 1957 and has been associated with the Tufts University School of Medicine and the New England Medical Center for 40 years. An internationally recognized scholar and teacher, he had served as Editor-in-Chief of the New England Journal of Medicine, where his has been a clear voice for academic medicine, critical thinking and ethical behavior by physicians. In addition, Dr. Kassirer has been Professor of Medicine at the Tufts University School of Medicine since 1974 and served as Vice Chairman of the Department of Medicine and Associate Physician-in-Chief at the New England Medical Center from 1971-1991. A member of many committees both at the Tufts School of Medicine and at the New England Medical Center, he also serves on many national and local committees. He has given many honorary lectures and has held visiting professorships throughout the world. Among Dr. Kassirer's awards and honors are many teaching awards and honorary degrees from Tufts University; the University of Massachusetts, Worcester; L'University Rene Descartes, Paris; Thomas Jefferson University, Philadelphia; SUNY Health Science Center at Syracuse; and the Medical College of Ohio. Dr. Kassirer and his wife, Sheridan, have five children: Amy, Richard, Wendy, Elizabeth, Winston, and Samuel.

Arthur Elstein, PhD, University of Illinois at Chicago, Wilmette, IL
Dr. Elstein came to DME in 1984 from the Office of Medical Education Research and Development at Michigan State University, where he had received the Distinguished Faculty Award. In 1991 Dr. Elstein was awarded both the John P. Hubbard Award by the National Board of Medical Examiners and the American Educational Research Association's Division I Distinguished Scholar Award. He has served as president of the Society for Medical Decision Making, and is presently editor-in-chief of the society's journal Medical Decision Making. He is member of SMDM, AERA, the American Psychological Society, and the Council of Biology Editors. Dr. Elstein's current research interests include evaluating the effects of decision support systems on clinical reasoning; measuring patients' preferences for health states; effects of prognostic estimates on treatment planning in critical care; and the conversation needed between medical ethics and expected utility theory in clinical decision making. He chairs a committee developing a comprehensive curricular sequence in decision making, computers, and information retrieval.

Stephen G. Pauker, MD, MACP, FACC, ABMH, Tufts Medical Center, Boston, MA
Stephen G. Pauker, MD, MACP, FACC, ABMH, is professor of medicine and psychiatry at Tufts University School of Medicine and Tufts Medical Center. He is a member of the Division of Clinical Decision Making, Informatics and Telemedicine, which he founded almost forty years ago. Dr. Pauker recently stepped down from his role as Associate Physician-in-Chief at the Tufts Medical Center from 1995-2008. Board-certified in internal medicine, cardiology and medical hypnosis, Dr. Pauker is a member of the Institute of Medicine of the National Academies of Science, of the Association of American Physicians and of the American Society for Clinical Investigation. He is a past president of the Society for Medical Decision Making, now serving as its historian. He is a Master of the American College of Physicians, a Fellow of the American College of Medical Informatics, the American College of Cardiology, and the American Society for Clinical Hypnosis. Dr. Pauker's research has been in both clinical decision making and medical informatics. He has authored over 250 scientific papers in health policy, decision making, informatics, cardiology, and the study of how physicians reason. He has published widely on the applications of quantitative tools and reasoning in clinical medicine. He designed and implemented one of the first computer programs to apply artificial intelligence techniques to medicine and developed some of the basic techniques of clinical decision making and cost-effectiveness analysis. His decision analyses include a model to support prospective parents deciding about prenatal diagnosis and models that have examined the cost-effectiveness of screening. Dr. Pauker has participated in numerous consensus conferences (sponsored by NIH, by the Institute of Medicine, the American College of Physicians, American College of Chest Physicians, and the National Blue Cross Blue Shield Technology Evaluation Committee). He has been an active participant in developing the conferences methodologies and classification schemata for evaluating the quality of clinical evidence and the relation between quality of evidence and the strength of clinical effect. Dr. Pauker is both a methodologist and an active clinician.

Valerie Reyna, PhD, Cornell University, Ithaca, NY
Valerie Reyna is Professor of Human Development and Psychology at Cornell University, and a Co-director of the Center for Behavioral Economics and Decision Research. Dr. Reyna holds a Ph.D. in experimental psychology from Rockefeller University, and publishes regularly in such journals as Archives of Internal Medicine, Cognitive Psychology, Current Directions in Psychological Science, Psychological Review, and Psychological Science. Her research encompasses human judgment and decision making, numeracy and quantitative reasoning, risk and uncertainty, medical decision making, social judgment, and false memory. Dr. Reyna's current research program is focused on risky decision making in adolescents, on risk communication in genetics, cancer, and AIDS prevention, and on criteria for rationality in decision making. She is a developer of fuzzy-trace theory, a model of the relation between mental representations and decision making that has been widely applied in law, medicine, and public health. Dr. Reyna also teaches an undergraduate and a graduate seminar on Risk and Rational Decision Making. Dr. Reyna has been elected a Fellow of the American Association for the Advancement of Science. She is also a Fellow of the Division of Experimental Psychology, the Division of Developmental Psychology, the Division of Educational Psychology, and the Division of Health Psychology of the American Psychological Association, and she is a Fellow of the American Psychological Society. Dr. Reyna has been a Visiting Professor at the Mayo Clinic, a permanent member of study sections of the National Institutes of Health, and a member on advisory panels for the National Science Foundation and the National Academy of Sciences. Dr. Reyna was appointed Senior Research Advisor in the United States Department of Education, where she oversaw research grant policies and programs, and has also held leadership positions in organizations dedicated to equal opportunity for minorities and women, and on national executive and advisory boards of Centers and grants with similar goals, such as the Arizona Hispanic Center of Excellence, National Center of Excellence in Women's Health, and Women in Cognitive Science (supported by a National Science Foundation ADVANCE leadership award).