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Alexia Torke, MD

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General Internal Medicine

Associate Professor of Medicine
Center Scientist, Indiana University Center for Aging Research
Investigator, Regenstrief Institute, Inc.
Associate Director, Fairbanks Fellowship in Clinical Ethics

Academic Office

Health Info and Translational Sci, Suite 2000
410 W 10th St
Indianapolis IN 46202-3002 Map

Contact Information

Phone: (317) 274-9221
Email:

Research Interests

Dr. Torke is interested in the ethical and communication aspects of medical decision making. She conducts research on patients’ preferences for end-of-life care and currently focuses on surrogate decision making, or making major medical decisions for patients with dementia, delirium or other conditions that impair cognitive function.

Education and Training

Fellowship, Medical Ethics and General Internal Medicine, MacLean Center for Clinical Medical Ethics and Department of Medicine University of Chicago, Chicago, IL
Health & Med Prep Program-Oth Chicago, University Of
Primary Care Internal Medicine Resident Emory University Department of Medicine, Atlanta, GA
M.D. Indiana University School of Medicine, Indianapolis, IN
Psychology, General Carleton College

Publications (16)¹

CEASE: A Guide for Clinicians on How to Stop Resuscitation Efforts.
Journal: Annals of the American Thoracic Society
Authors: Torke AM; Bledsoe P; Wocial LD; Bosslet GT; Helft PR;
Publication Date: 2015 Feb 9

Abstract

Resuscitation programs such as Advanced Cardiac Life Support, Cardiac Life Support, Pediatric Advanced Life Support and the Neonatal Resuscitation Program offer inadequate guidance to physicians who must ultimately decide when to stop resuscitation efforts. These decisions involve clinical and ethical judgments and are complicated by communication challenges, group dynamics, and family considerations. This article presents a framework, summarized in a mnemonic (CEASE: Clinical Features, Effectiveness, Ask, Stop, Explain), for how to stop resuscitation efforts and communicate that decision to clinicians and ultimately the patient's family. Rather than a decision rule, this mnemonic represents a framework based on best evidence for when physicians are considering stopping resuscitation efforts and provides guidance on how to communicate that decision.
View details for PubMedID 25664817
Wishard Volunteer Advocates Program: an intervention for at-risk, incapacitated, unbefriended adults.
Journal: Journal of the American Geriatrics Society
Authors: Bandy R; Sachs GA; Montz K; Inger L; Bandy RW; Torke AM;
Publication Date: 2014 Oct 30

Abstract

Unbefriended, incapacitated individuals who lack surrogates to make medical decisions present a complex problem to the healthcare providers who treat them. Adults without surrogates are among the most vulnerable in the community and are often alone and estranged from family, neglected and abused, and at risk of receiving inappropriate medical treatment. This article describes the program model and outcomes for the first 2 years of the Wishard Volunteer Advocates Program (WVAP), a guardianship program using trained, supervised volunteers as surrogates for unbefriended, incapacitated individuals. Of the 50 individuals enrolled during the study period, 20 were female, and 39 were Caucasian and 11 African American. Their average age was 67. Nineteen were insured with Medicare as primary and Medicaid as supplementary insurance. Ninety-eight percent had four or more comorbid conditions at the time of the index hospitalization. Before program referral, many lived alone in unsafe conditions. Adult Protective Services was involved in almost half of the cases at the time of the index hospitalization. Approximately half of the participants required some type of property management. Healthcare usage data demonstrated that most were not receiving medical care before WVAP enrollment; the data indicated a decrease in emergency department visits and hospitalization after WVAP enrollment. The WVAP completed Medicaid applications for 12 participants, resulting in $297,481.62 in reimbursement for the index hospitalization and a payer source for subsequent hospitalization and long-term care. The volunteer advocate model provides an efficient and quality mechanism for providing unbefriended individuals with surrogates.
View details for PubMedID 25354983
Surrogate Decision Makers and Proxy Ownership: Challenges of Privacy Management in Health Care Decision Making.
Journal: Health communication
Authors: Bute JJ; Petronio S; Torke AM;
Publication Date: 2014 Aug 30

Abstract

This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients' private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients' private health information, they actually served in a "proxy ownership" role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients' information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed.
View details for PubMedID 25175060
Moving forward on advance care planning: a novel web site. Commentary on Sudore et al.
Journal: Journal of pain and symptom management
Authors: Torke AM;
Publication Date: 2014 Mar 25
Scope and outcomes of surrogate decision making among hospitalized older adults.
Journal: JAMA internal medicine
Authors: Torke AM; Sachs GA; Helft PR; Montz K; Hui SL; Slaven JE; Callahan CM;
Publication Date: 2014 Mar

Abstract

Hospitalized older adults often lack decisional capacity, but outside of the intensive care unit and end-of-life care settings, little is known about the frequency of decision making by family members or other surrogates or its implications for hospital care.
View details for PubMedID 24445375
Caregiver perspectives on cancer screening for persons with dementia: "why put them through it?".
Journal: Journal of the American Geriatrics Society
Authors: Torke AM; Schwartz PH; Holtz LR; Montz K; Sachs GA;
Publication Date: 2013 Jul 18

Abstract

To describe the perspectives of family caregivers toward stopping cancer screening tests for their relatives with dementia and identify opportunities to reduce harmful or unnecessary screening.
View details for PubMedID 23865814
Older adults and forgoing cancer screening: "I think it would be strange".
Journal: JAMA internal medicine
Authors: Torke AM; Schwartz PH; Holtz LR; Montz K; Sachs GA;
Publication Date: 2013 Apr 8

Abstract

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients' perceptions regarding cessation of cancer screening. Information on older adults' views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.
View details for PubMedID 23478883
Communicating with clinicians: the experiences of surrogate decision-makers for hospitalized older adults.
Journal: Journal of the American Geriatrics Society
Authors: Torke AM; Petronio S; Purnell CE; Sachs GA; Helft PR; Callahan CM;
Publication Date: 2012 Aug 6

Abstract

To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult.
View details for PubMedID 22881864
A conceptual model of the role of communication in surrogate decision making for hospitalized adults.
Journal: Patient education and counseling
Authors: Torke AM; Petronio S; Sachs GA; Helft PR; Purnell C;
Publication Date: 2011 Sep 1

Abstract

To build a conceptual model of the role of communication in decision making, based on literature from medicine, communication studies and medical ethics.
View details for PubMedID 21889865
The patient-doctor relationship and online social networks: results of a national survey.
Journal: Journal of general internal medicine
Authors: Bosslet GT; Torke AM; Hickman SE; Terry CL; Helft PR;
Publication Date: 2011 Jun 25

Abstract

The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient-doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described.
View details for PubMedID 21706268
Caregiver and noncaregiver attitudes toward dementia screening.
Journal: Journal of the American Geriatrics Society
Authors: Boustani MA; Justiss MD; Frame A; Austrom MG; Perkins AJ; Cai X; Sachs GA; Torke AM; Monahan P; Hendrie HC;
Publication Date: 2011 Mar 25

Abstract

To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving.
View details for PubMedID 21438862
Palliative care for patients with dementia: a national survey.
Journal: Journal of the American Geriatrics Society
Authors: Torke AM; Holtz LR; Hui S; Castelluccio P; Connor S; Eaton MA; Sachs GA;
Publication Date: 2010 Nov

Abstract

To determine the extent to which hospice and nonhospice palliative care (PC) programs provide services to patients with dementia and to describe barriers and facilitators to providing nonhospice PC.
View details for PubMedID 21054292
Physicians' views on the importance of patient preferences in surrogate decision-making.
Journal: Journal of the American Geriatrics Society
Authors: Torke AM; Moloney R; Siegler M; Abalos A; Alexander GC;
Publication Date: 2010 Feb 11

Abstract

To explore the degree to which physicians report reliance on patient preferences when making medical decisions for hospitalized patients lacking decisional capacity.
View details for PubMedID 20158556
Physicians' experience with surrogate decision making for hospitalized adults.
Journal: Journal of general internal medicine
Authors: Torke AM; Siegler M; Abalos A; Moloney RM; Alexander GC;
Publication Date: 2009 Jul 25

Abstract

Hospitalized patients frequently lack decision-making ability, yet little is known about physicians' approaches to surrogate decision making.
View details for PubMedID 19633896
Self-neglect and resistance to intervention: ethical challenges for clinicians.
Journal: Journal of general internal medicine
Authors: Torke AM; Sachs GA;
Publication Date: 2008 Nov
Substituted judgment: the limitations of autonomy in surrogate decision making.
Journal: Journal of general internal medicine
Authors: Torke AM; Alexander GC; Lantos J;
Publication Date: 2008 Jul 10

Abstract

Substituted judgment is often invoked as a guide for decision making when a patient lacks decision making capacity and has no advance directive. Using substituted judgment, doctors and family members try to make the decision that the patient would have made if he or she were able to make decisions. However, empirical evidence suggests that the moral basis for substituted judgment is unsound. In spite of this, many physicians and bioethicists continue to rely on the notion of substituted judgment. Given compelling evidence that the use of substituted judgment has insurmountable flaws, other approaches should be considered. One approach provides limits on decision making using a best interest standard based on community norms. A second approach uses narrative techniques and focuses on each patient's dignity and individuality rather than his or her autonomy.
View details for PubMedID 18618201