Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/ObjectiveCollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care.MethodA cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables.ResultsExploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE.ConclusionsThis study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.     

Stillbirth, neonatal death and Sudden Infant Death (SIDS): parental reactions

The differences between parental grief reactions following different types of infant losses were investigated. A total of 117 parents (55 couples) from three groups of parents (stillbirth, neonatal death and Sudden Infant Death), 53% women and 47% men, answered a survey on different grief reactions one to four years following the death. Included in the survey were psychometric measures relating to anxiety, depression, impact of event, bodily discomfort, and general wellbeing. The results demonstrated that the three groups differed in their experience of various grief reactions. Sudden Infant Death Syndrome (SIDS) parents reported significantly more anxiety and intrusive thoughts than the other two groups in the early post-loss period, as well as significantly more anger, restlessness, and sleep disturbances than the neonatal group. The SIDS parents also scored significantly higher on some of the measures (experience of recovery, IES intrusion) relating to how they felt at the time of study. While the death being sudden did not show any correlation with the parents experience of recovery or the psychometric measures, the length of time the child had lived showed a strong relationship to these measures. It is emphasized that counselling to parents must be based on increased knowledge about parental reactions, tailored to the individual family's needs.     

Primary care physician attitudes and values toward end-of-life care and physician-assisted death

This study explores how primary care physician attitudes toward physician-assisted death (PAD) are related to their personal values toward end-of-life care and PAD. A group of 810 Michigan family physicians, internists, and general practitioners, divided into 4 typology groups by their intention toward participating in PAD, rated their attitudes toward PAD, along with their values and preferences for their own end-of-life care. Respondents who most objected to PAD were less likely to have executed an advance directive and more likely to have values promoting continued life-sustaining treatment in their own terminal care. Furthermore, a significant number of physicians, who had strong values against their own withdrawal of treatment in terminal care, were opposed to the withdrawing or withholding of life-sustaining treatment in patient care. Considerations of personal physician values are relevant in the discussion of PAD and the withdrawal of treatment in terminal care.     

Breaking the bad news: dilemmas in shared decision-making in medical practice

In a review of the literature, very little empirically based research was uncovered to guide the practice of health professionals who need to tell their patients bad news and help them to decide on their preferred treatment option. Various practising styles and guidelines are presented, and ethical and crosscultural challenges discussed. An enormous amount of research still needs to be done to discover the least stressful ways of dealing with these issues in health care settings.     

Social representations and group membership: shared and diffused parental ideas in three Israeli settings

The study investigates how the characteristics of subgroups within a culture are related to the structure of parental ideas held by their members. Two subsets of social representations were suggested—shared parental ideas (SPI) which are largely common to members of a group and serve the goals of individuals as group members as well as the goals of the group itself, and—diffused parental ideas (DPI) which are dispersed within social groups, and are instrumental in achieving individual goals. The respondents were kibbutz and two subgroups of urban parents with high and low levels of education (N=299) which differed in the extent of exposure to mainstream compared to group-specific parental ideas, the desirability of the group as indicated by its social status and the permeability of group boundaries. The findings were specific to the research task: only small differences in SPI and DPI were found among groups in a sorting task of child-rearing items; but major differences were found in their responses to a similar set of items organized as a Likert-style questionnaire. Only DPI and no SPI were found in the questionnaires of urban parents with low levels of education. In contrast, two similar clusters of SPI were identified in the kibbutz and among urban parents with high education. Another set of ideas was recognized as DPI in the kibbutz. The findings suggest that the Israeli urban parents with a low education did not share the parental ideas with each other, or with urban-high and kibbutz parents, whereas similar parental ideas prevailed in the kibbutz and among middle-class urban parents. Hypotheses were formulated regarding the group characteristics that foster the construction of SPI versus DPI by group members.     

Motivated decision making: effects of activation and self-centrality of values on choices and behavior

Six studies examined the value-behavior relation and focused on motivational properties of values, the self, and value activation. Priming environmental values enhanced attention to and the weight of information related to those values, which resulted in environmentally friendly consumer choices. This only occurred if these values were central to the self-concept. Value-congruent choices were also found in response to countervalue behavior in an unrelated context. Donating behavior congruent with central altruistic values was found as a result of enhanced self-focus, thus demonstrating the importance of the self in the value-behavior relation. The external validity of the value-centrality measure and its distinction from attitudes were demonstrated in the prediction of voting. Values were thus found to give meaning to, energize, and regulate value-congruent behavior, but only if values were cognitively activated and central to the self.     

Church and choices: a qualitative exploration of lived sexual values in young adult women

This qualitative research article discusses three crucial encounters in the sexuality education experiences of young adult women who were raised Catholic by drawing from the analyzed interview data of 15 such women. Using the framework of lived theologies, the author argues that understanding the impact of these encounters helps theological scholars better understand the way that young adults from religious backgrounds make decisions about relationships and sexuality. The young adult women interviewed for this research highlight a defensive posture in sexual decision-making that reflects poor preparation for the realities of relationships and a lack of opportunities to clarify and specify their own sexual values prior to these occasions.     

Alternative death rituals in Switzerland: building a community of shared emotions and practices

New alternative death rituals are gaining significance in Switzerland, like in other contemporary Western societies. This article discusses how celebrants who are independent of any religious community shape alternative funerals and why such rituals may be able to function as a coping resource for a certain kind of participants. I argue that these rituals, co-produced by celebrants and the bereaved and including actively involved participants, can be seen as a re-conquest of ritual agency for lay people. By encouraging physical and mental contact with the deceased, the celebrants try to enable emotional arousal and create a temporary community of shared experiences and emotions and of the living and the dead. Elements of an individually crafted spirituality and a kind of nature religion represent both separation and continuing bonds between the living and the dead. As a consequence, such funerals serve as a resource in the face of death by integrating a singular death with the wider context.     

“金钱-环境”复合收益的风险决策:价值取向的影响

现实中的环境决策,往往要在多个由"金钱-环境"复合而成的结果间做选择。人们如何对异质复合结果进行评估与选择,是决策研究面临的新课题。本研究着重考察个体金钱取向和环境取向的相对强度对复合收益风险决策的影响。结果表明,无论是采用自陈量表(实验1)或内隐联想测验(实验2)来测量价值取向,还是采用混词造句任务(实验3)来启动价值取向,均发现价值取向相对强度对复合风险决策有显著影响。(1)相比于金钱取向占优的个体,环境取向占优的个体在进行复合风险决策时更偏好环境风险较小的复合选项;(2)在复合选项等价匹配任务中,环境取向占优的个体会赋予复合选项中的环境收益以更高权重,倾向于用更多的金钱收益来弥补环境收益的风险折扣;(3)在复合收益风险概率匹配任务中,环境取向占优的个体更倾向于为获取倍增的环境收益而承担更大的复合收益风险。作为对复合结果风险决策的首次探索,本研究初步回答了不同价值取向的个体在金钱-环境复合风险决策中更倾向于规避什么风险、拿什么冒险以及为什么冒险等问题,为今后进一步开展复合决策研究打下了理论和方法基础。     

Effects of parental expectations and cultural-values orientation on career decision-making difficulties of Chinese University students

This study examined the effects of cultural-values conflict and parental expectations on the career decision-making difficulties of university students in three cities in China (Beijing, Wuhan, and Hong Kong, N = 1342). The Multidimensional Scales of Individual Traditionality and Modernity (Yang, Yu, & Ye, 1989) were used as a measure of cultural-values conflict and cultural orientation. The Living-Up-to Parental Expectation Inventory (Wang & Heppner, 2002) was used to measure parental expectations. The Career Decision-Making Difficulties Questionnaire (Gati & Saka, 2001) was used as a dependent measure. It was found that levels of cultural-value conflict were associated with higher levels of career decision-making difficulties for students in the Chinese Mainland cities but not for students in Hong Kong. Perceived parental expectations and perceived self-performance in the expected areas were found to be predictive of career decision-making difficulties. Cultural-value orientation, especially endorsement of Chinese traditional values, was found to moderate the relationship between parental expectation and career decision-making difficulties. Theoretical, research and practical implications of findings were discussed.     

Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework.     

How shared preferences in music create bonds between people: values as the missing link

How can shared music preferences create social bonds between people? A process model is developed in which music preferences as value-expressive attitudes create social bonds via conveyed value similarity. The musical bonding model links two research streams: (a) music preferences as indicators of similarity in value orientations and (b) similarity in value orientations leading to social attraction. Two laboratory experiments and one dyadic field study demonstrated that music can create interpersonal bonds between young people because music preferences can be cues for similar or dissimilar value orientations, with similarity in values then contributing to social attraction. One study tested and ruled out an alternative explanation (via personality similarity), illuminating the differential impact of perceived value similarity versus personality similarity on social attraction. Value similarity is the missing link in explaining the musical bonding phenomenon, which seems to hold for Western and non-Western samples and in experimental and natural settings.