By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.

Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.

Setting: University medical center.

Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center.

Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases.

Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r ² < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study.

Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.     

Lass die Toten ihre Toten begraben

This article presents a part of Danish church history which has previously suffered from a lack of attention: The story of homosexual pastors in Denmark. I want to show how the discussion on homosexuality and ministry ran in Denmark in the 1970's and 1980's and how homosexual pastors were integrated into the ELCD. Moreover, I will analyse this discussion material from the perspective of the German Pfarrhaustradition and point to the civil side of the Lutheran understanding of ministry – marriage and household – as a crucial reason why homosexual pastors, as well as unmarried heterosexual pastors, have been considered a theological problem. Finally, I will compare the image of the pastor in the Lutheran Pfarrhaustradition with a Catholic understanding of ministry and suggest that both set the pastor apart from the world through regulation of relationships and sexuality.     

Cognitive-Perceptual Theory and the Projective Use of Autobiographical Memory

Most clinicians know little about the operation of autobiographical memory. Yet as assessment people, clinicians are frequently called upon to make important decisions about the individuals they evaluate. It is not surprising that clinicians are ignorant regarding many aspects of autobiographical memory because most have not been trained to understand how autobiographical memory functions. This article focuses on a vital domain of autobiographical memories—early memories—and discusses from a clinical perspective the purpose, function, and organization of autobiographical memory as seen by cognitive-perceptual theory.     

Work happiness among teachers: A day reconstruction study on the role of self-concordance

Self-concordant work motivation arises from one's authentic choices, personal values, and interests. In the present study, we investigated whether self-concordant motivation may fluctuate from one work-related task to the next. On the basis of self-determination theory, we hypothesized that momentary self-concordance buffers the negative impact of momentary work demands on momentary happiness. We developed a modified version of the day reconstruction method to investigate self-concordance, work demands, and happiness during specific work-related tasks on a within-person and within-day level. In total, 132 teachers completed a daily diary on three consecutive work days as well as a background questionnaire. The daily diary resulted in 792 reported work activities and activity-related work demands, self-concordance, and happiness scores. Multilevel analysis showed that—for most work activities—state self-concordant motivation buffered the negative association of work demands with happiness. These findings add to the literature on motivation and well-being by showing that the levels of self-concordance and happiness experienced by employees vary significantly on a within-day level and show a predictable pattern. We discuss theoretical and practical implications of the findings to increase employees' well-being.     

Temporal integration of face view sequences and recognition of novel views

When faces are learned from rotating view sequences, novel views may be recognized by matching them with an integrated representation of the sequence or with individual views. An integrated-representation process should benefit from short view durations, and thus from the inclusion of views in a short temporal window, allowing the distribution of attention over the entire sequence. A view-matching process should benefit from long view durations, allowing the attention to focus on each view. In a sequential comparison task, we tested the recognition of learned and novel interpolated and extrapolated views after learning faces from rapid and slow sequences (240 ms or 960 ms for each view). We found a superiority of rapid over slow sequences, in favour of the integrated-representation hypothesis. In addition, the recognition pattern for the different viewpoints in the sequence depended on the absence or presence of extrapolated views, showing a bias of the distribution of attention.     

Looking at others through implicitly or explicitly prejudiced eyes

It is well known that we utilize internalized representations (or schemas) to direct our eyes when exploring visual stimuli. Interestingly, our schemas for human faces are known to reflect systematic differences that are consistent with one's level of racial prejudice. However, whether one's level or type of racial prejudice can differentially regulate how we visually explore faces that are the target of prejudice is currently unknown. Here, White participants varying in their level of implicit or explicit prejudice viewed Black faces and White faces (with the latter serving as a control) while having their gaze behaviour recorded with an eye-tracker. The results show that, regardless of prejudice type (i.e., implicit or explicit), participants high in racial prejudice examine faces differently than those low in racial prejudice. Specifically, individuals high in explicit racial prejudice were more likely to fixate on the mouth region of Black faces when compared to individuals low in explicit prejudice, and exhibited less consistency in their scanning of faces irrespective of race. On the other hand, individuals high in implicit racial prejudice tended to focus on the region between the eyes, regardless of face race. It therefore seems that racial prejudice guides target-race specific patterns of looking behaviour, and may also contribute to general patterns of looking behaviour when visually exploring human faces.     

How psychological resources facilitate adaptation to organizational change

The purpose of this 1-year follow-up study among 580 police officers is to investigate whether identity-related resources are positively related to adaptive behaviour during times of organizational change. Combining the social identity perspective with resources theories, we hypothesized that leader–member exchange (LMX) and personal resources (meaning-making and organization-based self-esteem) are positively related over time. In addition, we hypothesized that resources captured before change implementation, show a positive relationship with adaptivity captured during change. Structural equation modelling analyses showed that LMX and personal resources were positively related. Further, all T1 resources were positively related to T2 adaptivity. The study emphasizes the importance of managing identity-related resources during turbulent times, in order to foster behavioural adaptation to change.     

Regulatory focus and the family–work interface: The role of regulatory fit between cohabiting partners

The aim of the present study was to examine the impact of regulatory focus in goal pursuit and regulatory fit between marital partners on family conditions and the family–work interface. We hypothesized that when both partners are high on promotion focus (fit) they experience higher developmental possibilities at home and have an increased likelihood of family-to-work facilitation (FWF). In addition, we hypothesized that when both partners are prevention focused (fit) they experience less home demands and less family-to-work conflict (FWC). In total, 131 working couples participated in the study. Each partner provided information about his/her own regulatory focus, perceptions of home demands and home developmental possibilities, and experienced FWF and FWC. Results of moderated structural equation modelling analyses largely supported our hypotheses since the interaction between partners’ promotion focus predicted the levels of home developmental possibilities and FWF, whereas the interaction between partners’ prevention focus predicted home demands in the expected direction. In conclusion, the fit between partners’ self regulatory styles can influence family life and, consequently, the impact of family on work.     

Remembrance of remembrance past

Arnold and Lindsay (2002) found that individuals more often failed to remember they had previously recalled an item if that item had been cued in a qualitatively different way on two recall occasions: the “forgot-it-all-along” (FIA) effect. Experiment 1 was designed to determine if the FIA effect arises because participants incorrectly believe they have not been previously tested for an item, or because they incorrectly believe they have failed to recall the item when previously tested. Experiment 2 measured participants' confidence in their incorrect prior-recall judgements, and Experiment 3 tested participants' ability to “recover” their previous recollection when the prior-recall context was restored. Results indicated that participants usually believed they had not previously been cued for the items they failed to remember previously recalling; they were often confident in their incorrect judgements of prior non-remembering; and re-introducing the context of prior remembering sometimes enabled them to recapture their memories of previous recall.     

The creative achievement scale

The Creative Achievement Scale (CAS) was designed to measure the creative accomplishments of deceased individuals based on information extracted from biographical sources (e.g., published biographies). The CAS contains 11 items which pertain to personal attributes, product qualities, and sociocultural factors. Statistical analyses conducted on one small (n = 12) and one larger sample (n = 50) of subjects revealed the CAS to be a reliable and valid instrument.