Dr. Miron-Shatz specializes in medical decision making and has an unusually wide and refreshingly humanistic perspective on the topic. She is constantly asking how we can truly facilitate patient participation, and how we can embrace emotion as a presence, not an obstruction, in medical care.
Her interest began through teaching genetic counseling students. Her first papers dealt with how people understand the results around prenatal screening, prostate cancer, and breast cancer, which she studied extensively with Yaniv Hanoch of Southampton University, and Elissa Ozanne of the University of Utah. They showed that while information is mostly presented in a probabilistic manner, as in “there is an 0.03% chance of receiving this diagnosis,” people greatly benefit from a frequentist presentation, as in “three of every 10,000 people will receive this diagnosis”. Their work also shows the role of emotion in decision making around health, where feeling you understand risk evaluations leads you to test, as does a sense of family risk, and where, for example, smokers, who are at risk for prostate cancer choose not to test for it.
Even more strikingly, she has shown, with Avi Tsafrir of the Shaarei Zedek Medical Center, Jerusalem, that women age 43-45 are told their chances to conceive through fertility treatments are low, yet their subjective estimates of success are high. They set no limit to the number of cycles, or to the money they will spend. Her work on publicly-funded amniocentesis raises similar issues, of whether funding yields a sense of necessity in utilizing the procedure, or leads people to infer its effectiveness.
She elaborated on the shared decision-making paradigm, which she studied in terms of its implementation in Israel as part of an international volume on the topic and where she made a conceptual contribution to the definition of desirable decision processes, focusing on DelibeRate – the steps people need to take before reaching a decision. This was joint work with Glyn Elwyn of Dartmouth College, the leading figure in the shared decision-making arena. Together they also studied how few people complain over security breaches to their health information. Again, the door to participation was seemingly open, yet few walked through it.
On a similar note, she partnered with cardiologist Mladen Vidovich of the University of Illinois to find out what patients know of the heart stenting they just had. The answer was – 2.6 out of 6 possible items about the procedure they had a day or so earlier: of 100 patients, only 19 know the risks of the procedure, and 31 know its relative benefits. When she looked at what atrial fibrillation remember about their medication, the answer was – 1.5 items. All of this begs the question of how informed patients are, and what role knowledge plays in their choices. Patients mainly relied on their physicians for drug choices. Which leads us to trust, and to the doctor-patient relationship.
Covering yet another facet of the medical experience, she worked with nephrologist Stefan Becker of Essen University, Germany, she showed the benefit digital health can bring to patients, yet highlighted the need to ease elderly, non-tech-savvy patients into digital tools. This, again, suggested that there is no empowerment without support and adjustments by providers.
Creating a new research paradigm, she went on to analyze thank you letters to medical centers, which revealed that the doctor’s personality and demeanor mattered as much to patients as did their medical care. Her interest in birth experiences, which she studies with Yasmine Konheim-Kalkstein of Mount St. Mary College, NY, led to insights on how women coped when their birth and delivery diverged from their plans, or ended in an emergency c-section. While the medical afflictions were often unavoidable, support – informational, decisional, and emotional – helped buffer the difficulty.
Early on in her career, Dr. Miron-Shatz studied happiness with Nobel Laureate Daniel Kahneman at Princeton University. Interestingly, her happiness work also placed a high value on people’s subjective experiences. For example, she showed that women’s feelings around financial security mattered as much to their wellbeing as did their actual income. She also introduced the notion of peak and low moments in people’s days, as defined by them rather than measured statistically.
Even her work on user-experience, with Sari Kujala of Aalto University, Finland, showed that throughout a product’s life, there are points when users accept kinks and setbacks as part of the process.
While diverse and inventive, from experiments to surveys, content analysis, and focus groups, Dr. Miron-Shatz’s research converged around the notions of patient-centeredness, and the place that people’s experiences, as they feel and interpret them, deserve to have. She continues to study these topics in her fruitful, and friendly, collaborations with researchers from around the world.
For Dr. Miron-Shatz’s list of publications and full CV, see this page.