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Douglas B. White, MD, MAS

UPMC Endowed Chair of Ethics in Critical Care Medicine University of Pittsburgh - School of Medicine

Director, Program on Ethics and Decision Making in Critical Illness

Core Faculty Member, Center for Bioethics and Health Law

Contact:

whitedb@upmc.edu

412-864-3757

 

Address:

University of Pittsburgh Medical Center

Department of Critical Care Medicine

3550 Terrace Street

Scaife Hall, Room 608

HPU010604

Pittsburgh, PA 15261

 

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Dr. White graduated summa cum laude from Dartmouth College in 1995 with a degree in English Literature.  He received his MD from UCSF in 1999 and completed a residency in Internal Medicine and a fellowship in Pulmonary and Critical Care Medicine at UCSF. While at UCSF, he also completed a Master’s degree in Epidemiology and Biostatistics and a fellowship in Bioethics under Bernard Lo. He joined the faculty at UCSF in 2005 as an Assistant Professor of Medicine and a Core Faculty of the Program on Medical Ethics.   In 2009 he joined the faculty of the University of Pittsburgh in the Departments of Critical Care Medicine and Medicine as an Associate Professor.  He was also appointed as a core faculty member in the Center for Bioethics and Health law at the University of Pittsburgh.

 

Dr. White directs the University of Pittsburgh Program on Ethics and Decision Making in Critical Illness.  His research program encompasses both empirical research on and normative ethical analysis of surrogate decision-making for patients with life-threatening illness.  He has several ongoing NIH funded studies. He has published widely using both quantitative and qualitative methods to examine the process of surrogate decision making in intensive care units.  In conducting this work, he collaborates with a multi-disciplinary group of investigators, which includes faculty with expertise in bioethics, law, philosophy, sociology, biostatistics, and health services research.  His empirical research program has two central aims: 1) to identify factors that adversely affect surrogate decision-making for critically ill patients; and 2) to develop and test interventions to improve surrogate decision-making. His normative work focuses on ethical issues that arise in intensive care units, including the allocation of scarce resources, resolving futility disputes, responding to conscience-based treatment refusals by clinicians, and developing fair processes of decision making for incapacitated patients who lack surrogate decision makers.

Education

MD - University of California, San Francisco (1999)

Residency - Internal Medicine, University of California, San Francisco (2002)

Fellowship - Pulmonary and Critical Care Medicine, University of California, San Francisco (2005)

MAS - Epidemiology and Biostatistics, University of California, San Francisco (2006)

Fellowship - Bioethics, University of California, San Francisco (2007)

Awards and Honors

Phi Beta Kappa Honor Society, Dartmouth College (1995)

Alpha Omega Alpha Honor Society; University of California, San Francisco School of Medicine (1999)

Lee Lusted Prize for Outstanding Mentored Research, Society for Medical Decision Making (2006)  

Award for Outstanding Ethics Research, Society for Critical Care Medicine (2008)

Greenwall Foundation Faculty Scholar Award in Bioethics, Greenwall Foundation (2008)             

Paul B. Beeson Career Development Award in Aging, Starr Foundation, Atlantic Philanthropies, NIA American Federation for Aging Research (AFAR) (2008)

Reza Gandjei Lectureship in Bioethics, University of California San Francisco (2009)

Research Support: Ongoing

Family Support Intervention in Intensive Care Units: A randomized trial to improve surrogate decision-making for critically ill elders

National Institute on Aging - 1RO1AG045176-01

Douglas B. White, MD, MAS (PI)

 

The goal of this study is to conduct a multicenter efficacy trial of the Four Supports Intervention among 400 critically ill older adults to reduce their long term symptoms of depression and anxiety. The Four Supports Intervention is a multifaceted intervention in which a specially trained nurse intensively provides four types of support to surrogates in coordination with the clinical team: emotional support, communication support, decision support, and anticipatory grief support.  The central hypothesis is that by intensively supporting surrogates in this highly stressful circumstance, the Four Supports Intervention will improve key elements of decision making, decrease long-term psychological distress among surrogates, and achieve more patient-centered care near the end of life.

 

Identifying Effective Strategies to Disclose Prognosis in Patients with ARDS

National Heart, Lung, and Blood Institute (NHLBI) - 5R01HL094553-02

Douglas B. White, MD, MAS (PI)

 

The goal of this research study is to improve decision-making and communication about prognosis for patients with acute respiratory failure through the development of evidence-based interventions. The proposed research will provide important insights about acceptable and effective methods of disclosing prognosis to surrogates of patients with acute lung injury (ALI) at high risk of death or severe functional impairment. It will provide an estimate of the magnitude of association between misunderstandings and use of life sustaining treatment, which will provide the foundation for developing and testing an innovative intervention to improve decision-making and communication about prognosis for patients with ALI at high risk of death.

 

The second part is a nested sub-study led by Dr. Wendy Anderson from UCSF Medical Center.  The sub-study employs semi-structured interviews of surrogates and physicians who participated in the main study.  Additionally, we will conduct semi-structured interviews with other providers who care for ICU patients (i.e., nurses, social workers, spiritual care providers) and national experts in the fields of critical care, ethics, communication, palliative care, prognostication, and bereavement.  The goal is to use multiple perspectives to identify potentially effective methods to communicate about prognosis and to prospectively identify barriers to implementing these strategies.

 

Eliciting and Incorporating Patients' Values into Life Support Decisions

National Institutes of Health - pending funding

Leslie P. Scheunemann, MD & Douglas B. White, MD, MAS (PIs)

The purpose of our study is to test the reliability and validity of a simulation model and an outcomes measure of how physicians elicit incapacitated patients' values from their surrogates during ICU family conferences.  It will involve actors portraying family members during a staged family conference and research staff using the outcomes measure to document how physicians discuss patients' values.

 

Using Simulation to Study ICU Conflicts

Pulmonary T32 - 5T32HL007563

Rachel Schuster, MD & Douglas B. White, MD, MAS (PIs)

The purpose of our study is to test the feasibility of using simulated family conferences with actors portraying surrogate decision makers to study physician-surrogate conflict about goals of care in the intensive care unit. 

 

Improving Psychological Distress Among Critical Illness Survivors and Their Informal Caregivers

Patient Centered Outcomes Research Institute (PCORI) - Funding Award 195

Christopher E. Cox, MD (PI)

The purpose of this randomized trial is to reduce distress and improve quality of life for the ICU survivor-informal caregiver (family) dyad. Dyads will be randomized to receive one of two 6-week, telephone-based interventions: an ICU survivor-specific coping skills training (CST) program or a critical illness educational program. Both programs were developed with patient input and are promising interventions for this high risk group.

 

Improving Decision Making for Patients with Prolonged Mechanical Ventilation

National Institues of Health - 1 RO1 HL109823

Christopher E. Cox

This is a multicenter, randomized, controlled trial (RCT) comparing the efficacy of a tablet computer-based decision aid to usual care control in improving the quality of the decision making process for surrogates of incapacitated prolonged mechanical ventilation (PMV) patients, and their ICU physicians and nurses.

Selected Publications

Schuster RA, Hong SY, Arnold RM, White DB. Investigating conflict in ICUs-Is the clinicians' perspective enough? Crit Care Med 2014 Feb;42(2):328-35. doi: 10.1097/CCM.0b013e3182a27598.

 

Troug RD, White DB. Futile treatments in intensive care units. JAMA Intern Med 2013 Nov 11; 173(20): 1894-5. doi: 10.1001/jamainternmed.2013.7098.

 

Gries CJ, White DB, Truog RD, Dubois J, Cosio CC, Dhanani S, Chan KM, Corris P, Dark J, Fulda G, Glazier AK, Higgins R, Love R, Mason DP, Nakagawa TA, Shapiro R, Shemie S, Tracy MF, Travaline JM, Valapour M, West L, Zaas D, Halpern SD; American Thoracic Society Health Policy Committee. An official american thoracic society/international society for heart and lung transplantation/society of critical care medicine/association of organ and procurement organizations/united network of organ sharing statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med 2013 Jul 1;188(1):103-9. PMID: 23815722

 

White DB, Ernecoff N, Billings JA, Arnold R. Is dying in an ICU a sign of poor quality end-of-life care? Am J Crit Care 2013 May;22(3):263-6. doi: 10.4037/ajcc2013604.

 

Uy J, White DB, Mohan D, Arnold RM, Barnato AE. Physicians' decision-making roles for an acutely unstable critically and terminally ill patient. Crit Care Med 2013 Jun;41(6):1511-7. doi: 10.1097/CCM.0b013e318287f0dd.

 

Schenker Y, White DB, Crowley-Matoka M, Dohan D, Tiver GA, Arnold RM. "It hurts to know... and it helps": exploring how surrogates in the ICU cope with prognostic information. J Palliat Med 2013 Mar;16(3):243-9. doi: 10.1089/jpm.2012.0331.

 

White DB, Cua SM, Walk R, Pollice L, Weissfeld L, Hong S, Landefeld CS, Arnold RM. Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. Am J Crit Care 2012 Nov;21(6):396-409. PMID: 23117903

 

Schenker Y, Tiver GA, Hong SY, White DB. Association between physicians’ beliefs and the option of comfort care for critically ill patients. Intensive Care Med 2012 Oct;38(10):1607-15. Epub 2012 Aug 11. PMID: 22885651

 

Majesko A, Hong SY, Weissfeld L, White DB. Identifying family members who may struggle in the role of surrogate decision maker. Crit Care Med 2012 Aug;40(8):2281-6. PMID: 22809903

 

Schenker Y, Crowley-Matoka M, Dohan D, Tiver GA, Arnold RM, White DB. I Don't Want to Be the One Saying 'We Should Just Let Him Die': Intrapersonal Tensions Experienced by Surrogate Decision Makers in the ICU. J Gen Intern Med 2012 Dec;27(12):1657-65. doi: 10.1007/s11606-012-2129-y. Epub 2012 Jul 28 PMID: 23011253

 

Zier LS, Sottile PD, Hong SY, Weissfield LA, White DB. Surrogate decision makers' interpretation of prognostic information: a mixed-methods study. Ann Intern Med 2012 Mar 6;156(5):360-6. PMID: 22393131

 

Schenker Y, White DB, Asch DA, Kahn JM. Health-care system distrust in the intensive care unit.  J Crit Care 2012 Feb;27(1):3-10.  PMID: 21715134

 

Scheunemann LP, White DB. The ethics and reality of rationing in medicine. Chest 2011 Dec;140(6):1625-32. PMID: 22147821

 

White DB, Arnold RM. The evolution of advance directives. JAMA 2011 Oct 5;306(13):1485-6. PMID: 21972313

 

Johnson SK. Bautista CA. Hong S, Weissfeld L. White DB. An empirical study of surrogates’ preferred level of control over value-laden life support decisions in intensive care units. Am J Respir Crit Care Med 2011 Apr 1;183(7):915-21. PMID: 21037019

 

Lee Char SJ, Evans LR, Malvar GL, White DB. A randomized trial of two methods to disclose prognosis to surrogate decision makers in intensive care units. Am J Respir Crit Care Med 2010 Oct 1;182(7):905-9. PMID: 20538959

 

Boyd EA, Lo B, Evans LR, Malvar G, Apatira L, Luce JM, White DB. "It's not just what the doctor tells me:" factors that influence surrogate decision-makers' perceptions of prognosis. Crit Care Med 2010 May;38(5):1270-5. PMID: 20228686

 

White DB, Malvar G, Karr J, Lo B, Curtis JR. Expanding the paradigm of the physician's role in surrogate decision-making: an empirically derived framework. Crit Care Med 2010 Mar;38(3):743-50. PMID: 20029347

 

White DB, Engelberg RA, Wenrich MD, Lo B, Curtis JR. The language of prognostication in intensive care units. Med Decis Making 2010 Jan-Feb; 30(1):76-83. PMID: 18753685