Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

Cultural Adaptation and Sexual Harassment in the Lives of Asian American Women

ABSTRACT

Despite the prevalence of both historical and current race- and gender-based stereotyping of Asian American women, little is known about their experiences and attitudes regarding sexual harassment. In this study, 109 Asian American women enrolled in a state university or a 2-year community college responded to questionnaires about cultural orientation, experiences of sexual harassment, and sexual harassment attitudes. Asian cultural orientation was associated with sexual harassment attitudes. Specifically, among women with low White cultural orientation, there was a statistically significant positive association between Asian cultural orientation and acceptance of sexual harassment. Results from this study have important implications for clinical practice with Asian American women, including issues of migration, cultural orientation, and the intersection of racism and sexism in the United States.     

Rehabilitating Self-Sacrifice: Care Ethics and the Politics of Resistance

ABSTRACT

How should feminists view acts of self-sacrifice performed by women? According to a long-standing critique of care ethics such acts ought to be viewed with scepticism. Care ethics, it is claimed, celebrates acts of self-sacrifice on the part of carers and in doing so encourages women to choose caring for others over their own self-development. In doing so, care ethics frustrates attempts to liberate women from the oppression of patriarchy. Care ethicists have responded to this critique by noting limits on the level, form, or scope of self-sacrifice that work to restrict its role in their theories. While we do not here take issue with the initial feminist critiques of self-sacrifice, we suspect that the strategies offered by Care ethicists in response are importantly flawed. Specifically, these responses undervalue the positive roles that self-sacrifice can play in fighting patriarchal oppression. As a result, in attempting to restrict an oppressive norm, these responses risk foreclosing on valuable means of resistance. Our aim is to explore these positive roles for self-sacrifice and thereby rehabilitate its standing with feminists.     

Modeling effects of risk and social distance on vaccination choice

Despite vaccines' consistently demonstrated effectiveness, vaccination rates remain suboptimal due to vaccine refusal. Low vaccination rates are particularly problematic for individuals who cannot be vaccinated for medical reasons and thus must rely on herd immunity (i.e., protection of vulnerable individuals due to the high rate of vaccination of other—often socially distant—individuals). The current study uses a novel decision‐making task to examine how three variables impacted participants' highest acceptable probability of side effects to their children: 1) the severity of the side effects their children experience, 2) the social distance to the beneficiary of the vaccination, and 3) the probability that the vaccine will prevent disease for that designated beneficiary. Participants' willingness to risk potential side effects of vaccination systematically decreased as the 1) effectiveness of the vaccination decreased, 2) the beneficiary of the vaccination became more socially distant, and 3) the severity of side effects increased. These data were well‐described by behavioral economic models used to examine the discounting of other health behavior.     

A Method for Universal Screening of Elementary School Students: Development of the Social Challenges Screening Questionnaire

Schools regularly screen students for hearing and vision impairments because they present impediments to academic progress. For the same reason, schools should consider adding a universal screening for social challenges, which may also impede the learning process. This study reports on the development of the Social Challenges Screening Questionnaire (SCSQ), an efficient teacher-report screening questionnaire that identifies students with challenges who may benefit from a psychological evaluation. Further, the questionnaire may help identify students with Autism Spectrum Disorder who were previously undiagnosed. The SCSQ was administered to 549 general education students in the third and fourth grades. Internal consistency was.85. A smaller sample of students (n = 50) was selected for additional follow up assessment using the Social Responsiveness Questionnaire, Second Edition. Scores on the two instruments were strongly correlated (r =.87, p <.01), and sensitivity (.94) and specificity (.88) indicate the SCSQ can efficiently detect students with social challenges in need of a formal evaluation.     

Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence‐based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time‐limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother‐, teacher‐, and child‐reports of mental health, school experiences, and psychosocial well‐being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool‐aged children and externalizing for adolescents 11–16. The intervention led to declines in self‐reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.     

Meta-Analysis of the Effects of Peer-Administered Psychosocial Interventions on Symptoms of Depression

Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost‐efficient adjunct providers. The effectiveness of these and other peer‐administered interventions (PAIs) for treating depression symptoms has not been well‐established. The current study is a meta‐analysis of PAIs’ effects on depression symptoms. Twenty‐three eligible studies were identified. Study characteristics were coded by multiple raters, random‐effects models were used to compare mean effect sizes, and mixed‐effects models were used to test for moderation. PAIs produced significant pre‐post reductions in depression symptoms (d = .5043 [95 % CI .3675–.6412]). In direct comparisons, PAIs performed as well as non‐peer‐administered interventions (.0848 [?.1455–.3151]), and significantly better than no‐treatment conditions (.2011 [.0104–.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer‐administered, and educational/skills‐based PAIs produced better outcomes than those that were mainly supportive. Follow‐up data, when available, indicated that PAIs’ benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs’ benefits, and whether they are better suited as stand‐alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.