Patient-provider care goal concordance: implications for palliative care decisions

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients’ care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers’ predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.

Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N?=?492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients’ care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.

Results: For 28% of providers, their own care goals differed from their patients’. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients’ goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.

Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.     

Intersubjectivity in infancy: A second-person approach to ontogenetic development

The aim of this paper is to present the principles of intersubjectivity as a second-person relational account of mind, set against individualist first- and third-person accounts of the sharing of mental representations. I will set out a summary of these positions and defend the claim that understanding proto-conversations as “expressive communications” allows one to understand them as genuine communications, as in, mutually manifest communications that entail intersubjectivity. To support this interpretation, I will propose a novel explanation of expression, understood as constitutive of the mental state.     

Table talk: inviting students to share the feast

This account describes part of the first morning of the AFT accredited South Yorkshire Foundation Course in Family Therapy and Systemic Practice. The course committee members join together in a reflective conversation about the course. We share with the students our ‘kitchen table’ discussions, the history of our involvement, and how it has affected our lives. We aim to introduce social constructionist practice in which we present the context of the course and address the power relationships in the room by being transparent about our own experiences. We hope to create an atmosphere in which learning can flourish.     

Estimating Age-Based Developmental Trajectories Using Latent Change Score Models Based on Measurement Occasion

Abstract

Accelerated longitudinal designs (ALDs) are designs in which participants from different cohorts provide repeated measures covering a fraction of the time range of the study. ALDs allow researchers to study developmental processes spanning long periods within a relatively shorter time framework. The common trajectory is studied by aggregating the information provided by the different cohorts. Latent change score (LCS) models provide a powerful analytical framework to analyze data from ALDs. With developmental data, LCS models can be specified using measurement occasion as the time metric. This provides a number of benefits, but has an important limitation: It makes it not possible to characterize the longitudinal changes as a function of a developmental process such as age or biological maturation. To overcome this limitation, we propose an extension of an occasion-based LCS model that includes age differences at the first measurement occasion. We conducted a Monte Carlo study and compared the results of including different transformations of the age variable. Our results indicate that some of the proposed transformations resulted in accurate expectations for the studied process across all the ages in the study, and excellent model fit. We discuss these results and provide the R code for our analysis.