A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

The fight against stigma: an overview of stigma-reduction strategies and interventions

In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.     

Delusions and decision-making style: use of the Need for Closure Scale

Clinicians and researchers have suggested that rapidity in belief formation, due to having a high 'need for closure' (NFC), may contribute to the acceptance of delusional explanations. The aim of the study is to determine whether NFC has such a direct link with delusions. A secondary aim is to examine if NFC is related to the delusion-associated reasoning process of 'jumping to conclusions'. One hundred and eighty-seven patients with psychosis, recruited for a treatment trial of psychological therapy (the PRP trial), completed the Need for Closure Scale (NFCS), symptom measures, and probabilistic reasoning tasks. The NFCS was considered in terms of its two dimensions: a desire for simple structure and a preference for quick, decisive answers. The individuals with psychosis reported being poor at making quick, decisive answers but required a greater need for simple structure. NFC was associated with levels of anxiety and depression. There were weak links between NFC and both positive and negative symptoms of psychosis, but these were explained by differences in affect. NFCS scores were unrelated to jumping to conclusions. Contrary to the argument that NFC is directly linked to delusions, individuals with delusions actually perceive themselves as indecisive. There was no evidence that NFC-at least as assessed by the NFCS-could be a proximal cause of delusions. Any potential effect on psychotic symptom presentation is indirect, mediated through affect. The use of the NFCS on its own in the study of psychotic symptoms cannot be recommended.     

Fear and pain: investigating the interaction between aversive states

Pain and fear often co-occur and appear to interact, although the nature and direction of their relation is not clearly delineated. The present study investigates how exposure to the experience of one of these states subsequently affects responding to the other. Pressure stimulation and carbon dioxide-enriched air (CO2) were used to induce pain and fear, respectively, in 48 healthy individuals. The order in which the stimuli were introduced was manipulated, as was the CO2 level. Measures of overt behavior, physiological responding, and self-report were obtained; analyses of stimuli effects generally supported their ability to produce pain or fear. Results indicate that the stimulus rated as the most aversive, the higher level of CO2, led to the highest levels of distressed responding across dependent measures. This pattern was replicated for the stimuli found to be less aversive (i.e., pressure stimulation and low-level CO2, respectively). The authors conclude that fear and pain, in and of themselves, do not dictate the nature of their interaction; the most important factor is how aversive they are perceived to be in relation to one another.     

Life before and after quitting smoking: an electronic diary study

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.     

Relationships among team ability composition, team mental models, and team performance

This study examined the relationship between the similarity and accuracy of team mental models and compared the extent to which each predicted team performance. The relationship between team ability composition and team mental models was also investigated. Eighty-three dyadic teams worked on a complex skill task in a 2-week training protocol. Results indicated that although similarity and accuracy of team mental models were significantly related, accuracy was a stronger predictor of team performance. In addition, team ability was more strongly related to the accuracy than to the similarity of team mental models and accuracy partially mediated the relationship between team ability and team performance, but similarity did not.     

The impact of financial and nonfinancial incentives on business-unit outcomes over time

Unlike previous behavior management research, this study used a quasi-experimental, control group design to examine the impact of financial and nonfinancial incentives on business-unit (21 stores in a fast-food franchise corporation) outcomes (profit, customer service, and employee turnover) over time. The results showed that both types of incentives had a significant impact on all measured outcomes. The financial incentive initially had a greater effect on all 3 outcomes, but over time, the financial and nonfinancial incentives had an equally significant impact except in terms of employee turnover.     

Examining the long-term stability of overgeneral autobiographical memory

Overgeneral autobiographical memory (OGM) is a proposed trait-marker for vulnerability to depression, but relatively little work has examined its long-term stability. This study investigated the stability of OGM over several years in 271 late adolescents and young adults participating in a larger longitudinal study of risk for emotional disorders. The Autobiographical Memory Test (AMT) was administered twice, with test–retest intervals ranging from approximately 3 to 6 years. There was evidence of significant but modest stability in OGM over several years. Specifically, Spearman rank correlations (ρs) between the proportions of specific and categoric memories generated on the two AMTs were .31 and .32, respectively. We did not find evidence that the stability of OGM was moderated by the length of the test–retest interval. Furthermore, the stability coefficients for OGM for individuals with and without a lifetime history of major depressive disorder (MDD) were relatively similar in magnitude and not significantly different from one another (ρs=.34 and .42 for the proportions of specific and categoric memories for those with a history of MDD; ρs=.31 for both the proportions of specific and categoric memories for those without a history of MDD). Implications for the conceptualisation of OGM are discussed.     

Fooled by the brain: Re-examining the influence of neuroimages

A series of highly-cited experiments published in 2008 demonstrated a biasing effect of neuroimages on lay perceptions of scientific research. More recent work, however, has questioned this bias, particularly within legal contexts in which neuroscientific evidence is proffered by one of the parties. The present research moves away from the legal framework and describes five experiments that re-examine this effect. Experiments 1 through 4 present conceptual and direct replications of some of the original 2008 experiments, and find no evidence of a neuroimage bias. A fifth experiment is reported that confirms that, when laypeople are allowed multiple points of reference (e.g., when directly comparing neuroimagery to other graphical depictions of neurological data), a neuroimage bias can be observed. Together these results suggest that, under the right conditions, a neuroimage might be able to bias judgments of scientific information, but the scope of this effect may be limited to certain contexts.