Embodied Knowledge and Making Sense of Prenatal Diagnosis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating embodied knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of women's complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.     

Exploring the Role of Religiosity and Spirituality in Amniocentesis Decision-Making Among Latinas

Given the complex array of emotional and medical issues that may arise when making a decision about amniocentesis, women may find that their spiritual and/or religious beliefs can comfort and assist their decision-making process. Prior research has suggested that Latinas’ spiritual and/or religious beliefs directly influence their amniocentesis decision. A more intimate look into whether Latinas utilize their beliefs during amniocentesis decision-making may provide an opportunity to better understand their experience. The overall goal of this study was to describe the role structured religion and spirituality plays in Latinas’ daily lives and to evaluate how religiosity and spirituality influences health care decisions, specifically in prenatal diagnosis. Semi-structured interviews were conducted with eleven women who were invited to describe their religious beliefs and thoughts while considering the option of amniocentesis. All participants acknowledged the influence of religious and/or spiritual beliefs in their everyday lives. Although the women sought comfort and found validation in their beliefs and in their faith in God’s will during their amniocentesis decision-making process, results suggest the risk of procedure-related complications played more of a concrete role than their beliefs.     

To Use or Not to Use: Male Partners' Perspectives on Decision Making About Prenatal Diagnosis

We conducted an exploratory, qualitative pilot study investigating the use of genetic counseling and prenatal genetic technologies between women and their male partners for two referral groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews and 50 observations of genetic counseling sessions. Male partners' styles of decision making and the way they viewed prenatal diagnosis decision making were examined. We defined three decision-making styles based on our interpretation of the data: (1) domain, (2) joint-delegated, and (3) saliency. The male partners also seemed to view prenatal diagnosis as either an information decision or an action decision and appeared to take a more active role in decision making when the decision was viewed as an action decision.     

Identification and the commitment shift: accounting for gender differences in relationship illusions

Previous work revealed gender differences in relationship illusions. Women, and not men, perceived their dating partners more favorably than their partners' self-perceptions. In two studies, the authors replicated these findings and showed they are moderated by relationship commitment but not by relationship satisfaction. Dating men low in commitment devalued their partners' virtues, whereas those high in commitment exaggerated their partners' virtues compared to their partners' self-perceptions. In contrast, dating women showed relationship illusions irrespective of their commitment. In Study 2, similar results were obtained with relationship-specific identification. Moreover, men's commitment mediated the effect of identification with the relationship. This suggests that gender differences in relationship identities exist at a general level and that men need to identify with and then commit to a specific relationship before they exhibit pro-relationship thinking, which women exhibit as general dispositions.     

Emotional communication in close relationships

Emotional communication patterns characterizing interactions between partners in close relationships were investigated by asking 29 couples who were married or living together to engage in a videotaped discussion of a problem they were having in their relationship. In a later experimental session, partners identified specific communications that they believed had an important influence on the discussion and then rated the communications in terms of the feelings the communicator intended to convey and the recipient's reactions. Partners attempted to reciprocate both the positive and negative feelings that they perceived their partner to express toward them. However, only negative feelings were actually reciprocated. This was because subjects were sensitive to differences in the negative feelings their partners reported expressing and interpreted those feelings correctly, but they were inaccurate in perceiving their partners' expressions of positive feelings. Men (but not women) interpreted their partners' failures to express love as an indication of hostility, whereas women (but not men) interpreted their partners' lack of hostility as an indication of love. These and other results were conceptualized in terms of a general model of emotional communication. Parameters of the model pertaining to the hostility of partners' communications were often related to women's satisfaction with their relationship and their beliefs about relationships in general. However, they were unrelated to men's satisfaction and general beliefs. This suggested that women are generally more adversely affected by overt expression of hostility than are men.     

People's Perceptions of Women's and Men's Worry about Life Issues: Worrying about Love, Accomplishment, or Money?

The study was designed to examine people's perceptions of women's and men's worry about life issues and self-perceptions of worry. Some undergraduates (n = 498) rated typical women's or men's worry, and others (n = 396) rated significant others' worry based on the Worry Domain Questionnaire (Tallis, Eysenck, & Mathews, 1992). As expected, participants perceived women as worrying more than men do about relationships, when they rated typical or significant others. As well, they rated typical men as worrying more than typical women about achievement and finances. Participants who rated significant others' worry also rated their own worry and parallel findings were expected. However, women tended to report more worry about achievement than men did. Overall, the findings indicate that the better people know their targets, the less likely they are to perceive their worry in gender stereotypical terms. This article is partially based on Wendy-Jo Wood's Master's thesis.     

Work and Family Commitment and Decision-Making Status Among Emerging Adults

This study was designed to investigate work–family attitudes among emerging adults. Participants were 46 male and 49 female college juniors and seniors. Men and women had similar levels of work and family commitment. For women there was a negative correlation between work and family commitment. Exploratory analyses indicated different relationships between work decision-making status and commitment and family decision-making status and commitment. In addition, whereas men were more likely than women not yet to have thought about family roles, women were more likely than men to have decided about family roles. Implications of these findings for our understanding of the processes and meanings of emerging adult men's and women's decisions about entry into and commitment toward work and family roles are discussed. Although earlier literature employs the term “young adults” to refer to individuals in the emerging adult stage of development, for the sake of consistency we use the term “emerging adults” throughout this article.     

Eye of the beholder: the individual and dyadic contributions of empathic accuracy and perceived empathic effort to relationship satisfaction

This study examined links between two distinct facets of empathy-empathic accuracy and perceived empathic effort-and one's own and one's partner's relationship satisfaction. Using a video recall procedure, participants (n = 156 couples in committed relationships) reported on their own emotions and their perceptions of partners' emotions and partners' empathic intentions during moments of high affect in laboratory-based discussions of upsetting events. Partners' data were correlated as a measure of how accurately they were able to read what the other was feeling and to what degree they felt the other was trying to be empathic at those moments. The perception of empathic effort by one's partner was more strongly linked with both men's and women's relationship satisfaction than empathic accuracy. Men's relationship satisfaction was related to the ability to read their partners' positive emotions accurately, whereas women's relationship satisfaction was related to their partners' ability to read women's negative emotions accurately. Women's ability to read their husbands' negative emotions was positively linked to both men's and women's relationship satisfaction. Findings suggest that the perception of a partner's empathic effort-as distinct from empathic accuracy-is uniquely informative in understanding how partners may derive relationship satisfaction from empathic processes. When working with couples in treatment, heightening partners' perceptions of each other's empathic effort, and helping partners learn to demonstrate effort, may represent particularly powerful opportunities for improving satisfaction in relationships.     

A longitudinal examination of couples' coping strategies as predictors of adjustment to breast cancer

This study's goals were to examine coping strategies of women and their male partners as predictors of change in women's adjustment over the year following breast cancer treatment and to test whether partners' coping processes interact to predict adjustment. In a sample of women who had recently completed breast cancer treatment and were taking part in a psychoeducational intervention trial, the patients' and partners' cancer-specific coping strategies were assessed at study entry (average of 10 months after diagnosis). Assessed at study entry and 20 months after diagnosis (n = 139 couples), dependent variables were women's general (i.e., vitality, depressive symptoms, relationship satisfaction) and cancer-specific adjustment (i.e., cancer-specific distress, perceived benefits). Both patients' and partners' coping strategies at study entry predicted change in women's adjustment at 20 months. Women's use of approach-oriented coping strategies predicted improvement in their vitality and depressive symptoms, men's use of avoidant coping predicted declining marital satisfaction for wives, and men's approach-oriented strategies predicted an increase in women's perception of cancer-related benefits. Patients' and partners' coping strategies also interacted to predict adjustment, such that congruent coping strategy use generally predicted better adaptation than did dissimilar coping. Findings highlight the utility of examining patients' and partners' coping strategies simultaneously.     

Life Trajectories, Genetic Testing, and Risk Reduction Decisions in 18–39 Year Old Women at Risk for Hereditary Breast and Ovarian Cancer

This qualitative study identified four life trajectories that influenced the decision in young women to have genetic testing for mutations in BRCA1/2 and subsequent risk reduction decisions after receiving a positive mutation result. Fifty nine women between the ages of 18–39 years were interviewed in this grounded theory study, 44 of those tested were found to have a mutation in either BRCA1 or BRCA2. Of those with a mutation, 23 had no history of cancer and 21 had a breast cancer diagnosis. Analysis of the 44 participants tested found that risk reducing decisions were related to the life trajectories that preceded genetic testing. These life trajectories included: 1) Long-standing awareness of breast cancer in the family, 2) Loss of one’s mother to breast cancer at a young age, 3) Expression of concern by a health care provider, and 4) Personal diagnosis of breast cancer. Understanding possible influences behind decision making for genetic testing and risk reduction in young women may assist health care providers in offering age appropriate guidance and support.     

Risk-Reduction Surgery Decisions in High-Risk Women Seen for Genetic Counseling

Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO), and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%) underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery. Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women considering this surgery.     

Men’s Decision-Making About Predictive <Emphasis Type="Italic">BRCA1/2</Emphasis> Testing: The Role of Family

Men who have a family history of breast and/or ovarian cancer may be offered a predictive genetic test to determine whether or not they carry the family specific BRCA1/2 mutation. Male carriers may be at increased risk of breast and prostate cancers. Relatively little is known about at-risk men’s decision-making about BRCA1/2 testing. This qualitative study explores the influences on male patients’ genetic test decisions. Twenty-nine in-depth interviews were undertaken with both carrier and noncarrier men and immediate family members (17 male patients, 8 female partners, and 4 adult children). These explored family members’ experiences of cancer and genetic testing, decision-making about testing, family support, communication of test results within the family, risk perception and risk management. Implicit influences on men’s testing decisions such as familial obligations are examined. The extent to which other family members—partners and adult children—were involved in testing decisions is also described. It is demonstrated that mothers of potential mutation carriers not only perceive themselves as having a right to be involved in making this decision, but also were perceived by their male partners as having a legitimate role to play in decision-making. There was evidence that (adult) children were excluded from the decision-making, and some expressed resentment about this. The implications of these findings for the practice of genetic counseling are discussed.     

To Use or Not to Use: The Prenatal Genetic Technology/Worry Conundrum

We conducted an exploratory, qualitative study investigating the factors influencing the use of genetic counseling and prenatal genetic testing for two groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews of women/couples and 50 observations of genetic counseling sessions. Worry turned out to be the most important variable influencing decision making about prenatal genetic testing and was greater in the MSAFP3 group than in the AMA group. The women in the AMA group appeared to assign the risk of having a child with Down syndrome to their age category rather than to themselves individually, whereas, the risk perception for women with an abnormal MSAFP3 appeared to have shifted from a general population risk for pregnant women to an individual, personal risk. There was a general lack of understanding and also more misinformation about the MSAFP3 screen compared to amniocentesis. Women in both groups were torn between fear of an invasive test and worry about the health of their fetus for the rest of their pregnancy if they did not undergo amniocentesis.     

The Current State of Genetic Counseling Before and After Amniocentesis for Fetal Karyotyping in Japan: A Survey of Obstetric Hospital Clients of a Prenatal Testing Laboratory

Pregnant women undergoing prenatal genetic testing should receive genetic counseling so they can make informed decisions. We examined the current state of providing genetic counseling in Japan to pregnant women before they elected amniocentesis for prenatal diagnosis of chromosome abnormalities and after test results were completed, and explored the opportunity for expanding access to certified genetic counselors (CGC) at clinical practices offering amniocentesis. An anonymous survey was mailed to the 298 hospitals that referred amniotic fluid specimens to LabCorp Japan in 2009. Most genetic counseling was provided by the obstetrician alone; 73.8 % (76/103) of pre-amniocentesis, 82.5 % (85/103) if normal results, and 49.4 % (44/89) if abnormal results. Respondents spent limited time in genetic counseling; 57.3 % spent <10 min for pre-amniocentesis, 88.3 % spent <10 min for normal results, and 54.0 % spent <20 min for abnormal results. While 45.8 % indicated that CGC do not have an essential role in clinical practice, responses that supported employment of CGC were more likely to come from hospitals that submitted more than ten specimens annually (p?<?0.0001), university hospitals (p?<?0.0001), and MD geneticists (p?=?0.020). Currently, there is limited genetic counseling available in Japan. This indicates there are opportunities for the employment of CGC to improve the quality of genetic counseling.     

Maintaining Men's Dominance: Negotiating Identity and Power When She Earns More

This article examines the power dynamics in marriages where wives earn substantially more than their husbands based on in-depth interviews with husbands and wives in 30 couples. The results demonstrate how normative gender expectations constrain interactions between spouses and how spouses in these unconventional marriages struggle to construct appropriate gender identities that are more or less consistent with the conventional expectations that men should be breadwinners and women should be homemakers. These data represent an important counterpoint to the growing body of quantitative work that demonstrates that a woman's power diminishes as her income exceeds her husband's by illuminating how men's power is preserved within marriage, even in the absence of their traditional economic dominance.     

Depression in Women with Heart Disease: The Importance of Social Role Performance and Spirituality

Compared with men, women are more likely to experience depression, and depression increases risk of morbidity and mortality in individuals with heart disease. Psychosocial interventions have been developed for depressed patients with heart disease; however, women's experience of chronic disease differs from men's and women may benefit from interventions tailored to address their difficulties. Spirituality and social roles have been related to depressive symptoms in other populations. To identify the relationship between depression and spirituality and social role performance (i.e., role concerns, role rewards and confidence in ability to fulfill roles) in women with heart disease, we assessed depressive symptoms, spirituality, social role functioning and medical history in 125 women with heart disease. After controlling for age and severity of medical conditions, spirituality, role confidence and role concerns were significantly associated with depressive symptoms. Consideration of spirituality and aspects of social role performance may be important when developing psychosocial interventions for depressed women with heart disease.     

The costs and benefits of sexism: resistance to influence during relationship conflict

This study tested whether men's and women's hostile sexism (HS) and benevolent sexism (BS) were associated with resistance to influence in couples' conflict interactions. Ninety-one heterosexual couples were recorded while trying to produce desired changes in each other. Participants reviewed their discussions and rated how open they were to their partner's perspective. Objective coders also rated the extent to which each partner exhibited hostile communication. We tested key principles arising from ambivalent sexism theory (Glick & Fiske, 1996). First, BS is necessary because mutual interdependence reduces the power of HS to influence women within intimate relationships. We found that the more men endorsed HS, the less open and more hostile both partners were, and the less successful their discussions were in producing desired change. Second, BS reduces the threat of women's dyadic power by revering and respecting women's interpersonal roles while restricting women's influence outside the relationship domain. We found that men who expressed higher agreement with BS were more open to their partners' influence and behaved with less hostility, and their discussions were more successful. These relationship benefits illustrate why BS is effective at disarming women's resistance to wider inequalities. These benefits, however, were contingent on men adopting BS attitudes. When women strongly endorsed BS but their male partner did not, women were less open, behaved with greater hostility, and perceived their discussions as less successful. These results indicate that, because BS increases the stakes within the relationship domain, women who endorse BS will react more negatively when their expectations are not realized.     

Racial-Ethnic Differences in Genetic Amniocentesis Uptake

The objective of this study was to determine the role of health beliefs in genetic amniocentesis acceptance in a diverse racial-ethnic population. Participants completed a previously-validated questionnaire consisting of three sections: (1) demographics, (2) amniocentesis knowledge, and (3) health beliefs, which assessed perceived susceptibility, seriousness of potential impact, benefits of testing, and barriers to testing. The results showed that Hispanic women were less likely to accept amniocentesis (51.5% vs. Caucasian 82.8%, African American 82.9%, Asian 82.8%). Education level was the only demographic factor higher among acceptors. Women who accepted amniocentesis had higher perceived seriousness, susceptibility, and benefits HBM scores and higher knowledge scores than women who declined. HBM scores and knowledge predicted the amniocentesis decision correctly 91.5% of the time. Individual health beliefs and knowledge play a greater role in genetic amniocentesis acceptance than do demographic factors such as race-ethnicity.     

Attitudes toward maternal serum screening in Chinese women with positive results

Maternal serum screening for fetal Down syndrome has been integrated into routine antenatal care in most clinics in Taiwan. We examined the attitudes toward serum screening and the possible implications in women with positive results. From January to July 1995, 276 women were referred to the Genetic Counseling Clinic, Mackay Memorial Hospital for amniocentesis because of positive screening results, and 214 participated in this study. All women opted for amniocentesis after genetic counseling. Over 40% stated that they made decisions independently after being informed of the serum screening. Need for certainty was the most frequently mentioned reason. Two-thirds believed that serum screening could provide a diagnosis. Almost all women would apply for maternal serum screening for future pregnancies. This study demonstrated that Chinese women need more counseling and autonomy regarding maternal serum screening.     

Genetic Risk Communication: Experiences of Adolescent Girls and Young Women from Families with Fragile X Syndrome

Little is known about how and what genetic risk information parents communicate to their children and even less is known about what children hear and remember. To address this void, we explored how genetic risk information was learned, what information was given and who primarily provided information to adolescent girls and young adult women in families with fragile X syndrome. We explored three levels of risk knowledge: learning that fragile X syndrome was an inherited disorder, that they could be a carrier, and for those who had been tested, actual carrier status. These data were collected as part of a study that also explored adolescent self concept and age preferences about when to inform about genetic risk. Those findings have been presented separately. The purpose of this paper is to present the communication data. Using a multi-group cross-sectional design this study focused on girls ages 14–25 years from families previously diagnosed with fragile X syndrome, 1) who knew they were carriers (n = 20), 2) noncarriers (n = 18), or 3) at-risk to be carriers (n = 15). For all three stages of information the majority of the study participants were informed by a family member. We identified three different communication styles: open, sought information, and indirect. The content of the remembered conversations varied based on the stage of genetic risk information being disclosed as well as the girls’ knowledge of her own carrier status. Girls who had been tested and knew their actual carrier status were more likely to report an open communication pattern than girls who knew only that they were at-risk.