Impact of a Patient-Facing Enhanced Genomic Results Report to Improve Understanding,Engagement, and Communication

“The objective of this study was to” test the effectiveness of an enhanced genomic report on patient-centered outcome domains including communication, engagement and satisfaction. “Study design utilized” a prospective, randomized, mixed-methods desctiptive study of a whole genome sequencing results report, GenomeCOMPASS?, that was accessed by providers through the electronic health record and by patients through the associated patient portal. “The study was set in” an integrated healthcare delivery system in central Pennsylvania. “Eighty-four” parents of 46 children with undiagnosed Intellectual Disability, Autism Spectrum Disorder and/or multiple congenital anomalies who had participated in a previous study offering whole genome sequencing for their affected child were invited to enroll. Fifty-two parents enrolled. Following a traditional genetics results informing visit, the study coordinator stratified families by diagnostic result and uninformative result and then randomized families within each group to an intervention arm to receive the GenomeCOMPASS? report or to the usual care arm to receive a summary letter from the medical geneticist. A letter inviting enrollment included a baseline survey, which once returned, constituted enrollment. Surveys were administered at 3 months post-genetics visit. At 6 months, the usual care arm crossed over to receive the intervention and were administered an additional survey at 3 months. Qualitative interviews were conducted following survey completion to augment the survey data regarding the patient centered outcomes of interest. Patient reported outcomes including communication, engagement, empowerment and satisfaction. In the intervention arm, GenomeCOMPASS? reports were released to 14 families (N?=?28 parents) and of those 21 (75%) returned 3 month surveys. In the usual care arm, 12 families (N?=?24 parents) received usual care summary letters and of those 20 (83%) returned 3 month surveys. At crossover, GenomeCOMPASS? reports were released to 20 individuals and 15 (75%) returned 3 month surveys. Qualitative interviews were conducted with 5 individuals. Use of the GenomeCOMPASS? report was reported by this small group of parents to improve communication with providers and non-health professionals such as educators and therapists and led to increased engagement and high satisfaction. Providers and others involved in the children’s care also endorsed the report’s effectiveness. Reports that addressed negative findings, i.e. uninformative results, were not found to be useful. Although the number of users was small, this study supports that customizable template reports may provide a useful and durable source of information that can support and enhance the information provided by genetics professionals in traditional face-to-face encounters. Trial registration: Clinicaltrials.gov (Record 2013–0594).     

Fat talk and self-presentation of body image: Is there a social norm for women to self-degrade?

The current investigations build upon previous ethnographic research, which identified a social norm for adolescent females to engage in “fat talk” (informal dialogue during which individuals express body dissatisfaction). In Study 1, participants were shown a vignette involving women engaging in fat talk dialogue and were subsequently asked to chose one of three self-presentational responses for a target female: (1) self-accepting of her body, (2) providing no information, or (3) self-degrading about her body. Male and female participants believed the target would be most likely to self-degrade, and that this would lead women to like her, while the self-accepting response would lead men to like her most. Study 2 used the same vignette but participants were asked to respond in an open-ended fashion. Participants again expected the target female to self-degrade. The present findings suggest college students perceive fat talk self-degradation of body image as normative.     

Identification, situational constraint, and social cognition: studies in the attribution of moral responsibility

In three experiments we studied lay observers' attributions of responsibility for an antisocial act (homicide). We systematically varied both the degree to which the action was coerced by external circumstances and the degree to which the actor endorsed and accepted ownership of the act, a psychological state that philosophers have termed "identification." Our findings with respect to identification were highly consistent. The more an actor was identified with an action, the more likely observers were to assign responsibility to the actor, even when the action was performed under constraints so powerful that no other behavioral option was available. Our findings indicate that social cognition involving assignment of responsibility for an action is a more complex process than previous research has indicated. It would appear that laypersons' judgments of moral responsibility may, in some circumstances, accord with philosophical views in which freedom and determinism are regarded to be compatible.     

Attention and eye movements in reading: inhibition of return predicts the size of regressive saccades

A spatial cuing task was used to identify two types of readers, those with a relatively fast and those with a relatively slow buildup of inhibition of return (IOR). Backward-directed eye movements (regressions) during sentence reading were then examined as a function of the two IOR types. The results revealed that readers with fast IOR executed larger regressions than readers with slow IOR, as they directed the eyes away from the most recently attended area of text. Forward-directed eye movements (saccades), by contrast, were not a function of IOR type. Ease of sentence comprehension influenced the size of regressions, but this effect was also independent of IOR type. Multiple mechanisms of spatial attention, including IOR, bias eye movements toward upcoming words in the text during reading.     

Semantic inhibition of return is the exception rather than the rule

Inhibition of return (IOR) has recently been reported for lexical/semantic categories (see, e.g., Fuentes, Vivas, & Humphreys, 1999). The present research examines the impact on semantic IOR of three components: item repetition, item heterogeneity, and spatial variability. Experiments 1 and 2 indicate that lexical/semantic IOR occurs only after extensive repetition. Experiment 2 also shows that semantic IOR is independent of spatial variability. Experiments 3 through 5 show facilitatory rather than inhibitory effects when the item pool is heterogeneous. The results support an episodic account of semantic IOR, according to which inhibitory effects accumulate with massive repetition of homogeneous items.     

The genesis and microgenesis of sudden insight in the creation of literature

Examination of literary insight and inspiration experiences suggests the need to extend current notions of the concept as follows: (a) insight involves a family of phenomena which goes beyond problem‐solving and problem‐finding; (b) insights can reorganize thought, for example, by integrating previously unrelated elements, but they can also function to organize thought by providing a seminal idea from which the work then evolves; (c) the insight itself is a microgenetic process, more intricate than the subjectively experienced sudden flash suggests, and firmly yoked to prior and subsequent creative work; and (d) insights are either experienced in a specific modality or are multi‐modal.     

Racial healthcare disparities: A social psychological analysis

Around the world, members of racial/ethnic minority groups typically experience poorer health than members of racial/ethnic majority groups. The core premise of this chapter is that thoughts, feelings, and behaviours related to race and ethnicity play a critical role in healthcare disparities. Social psychological theories of the origins and consequences of these thoughts, feelings, and behaviours offer critical insights into the processes responsible for these disparities and suggest interventions to address them. We present a multilevel model that explains how societal, intrapersonal, and interpersonal factors can influence ethnic/racial health disparities. We focus our literature review, including our own research, and conceptual analysis at the intrapersonal (the race-related thoughts and feelings of minority patients and non-minority physicians) and interpersonal levels (intergroup processes that affect medical interactions between minority patients and non-minority physicians). At both levels of analysis, we use theories of social categorisation, social identity, contemporary forms of racial bias, stereotype activation, stigma, and other social psychological processes to identify and understand potential causes and processes of health and healthcare disparities. In the final section, we identify theory-based interventions that might reduce ethnic/racial disparities in health and healthcare.     

Within-Person Fluctuations of Proactive Behavior: How Affect and Experienced Competence Regulate Work Behavior

This article studies proactive work behavior from a within-person perspective. Building on the broaden-and-build model and the mood-as-information approach, we hypothesized that negative trait affect and positive state affect predict the relative time spent on proactive behavior. Furthermore, based on self-determination theory we argued that persons want to feel competent and that proactive behavior is one way to experience competence. In an experience-sampling study, 52 employees responded to surveys 3 times a day for 5 days. Hierarchical linear modeling confirmed the hypotheses on trait and state affect. Analyses furthermore showed that although a higher level of experienced competence at core task activities was associated with a subsequent increase in time spent on these activities, low experienced competence predicted an increase in time spent on proactive behavior.