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111.
Why older adults make more immediate treatment decisions about cancer than younger adults 总被引:2,自引:0,他引:2
Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. 相似文献
112.
As genetic health care and genetic testing expand from primarily addressing conditions that are exclusively genetic in nature
to common diseases with both genetic and environmental components, the scope of genetic counseling has grown. Identification
and utilization of a normative model of practice defined by members of the profession is critical as genetic services become
more commonplace in medical care. The purpose of this paper is to describe the results of a consensus conference convened
to define a model of genetic counseling practice based on the guidance of educators and leaders in the profession. Twenty-three
program directors or their representatives from 20 genetic counseling graduate programs in North America listened to presentations
and participated in group discussions aimed at determining the elements of a model of practice, including tenets, goals, strategies,
and behaviors for addressing patients’ genetic concerns. Their discussion is summarized, training implications and research
recommendations are presented, and a model of practice that extends their ideas is proposed. 相似文献
113.
Dewhurst ME Veach PM Lampman C Petraitis J Kao J LeRoy B 《Journal of genetic counseling》2007,16(2):157-170
Heuristics are mental shortcuts that aid people in everyday problem-solving and decision-making. Although numerous studies
have demonstrated their use in contexts ranging from consumers’ shopping decisions to experts’ estimations of experimental
validity, virtually no published research has addressed heuristics use in problems involving genetic conditions and associated
risk probabilities. The present research consists of two studies. In the first study, 220 undergraduates attempted to solve
four genetic problems—two common heuristic problems modified to focus on genetic likelihood, and two created to study heuristics
and probability rule application. Results revealed that the vast majority of undergraduates used heuristics and also demonstrated
a complete misuse of probability rules. In the second study, 156 practicing genetic counselors and 89 genetic counseling students
solved slightly modified versions of the genetic problems used in Study 1. Results indicated that a large percentage of both
genetic counselors and students used heuristics, but the counselors demonstrated superior problem-solving performance compared
to both the genetic counseling students and the undergraduates from Study 1. Research, training, and practice recommendations
are presented. 相似文献
114.
Lindsay M. Andrews Emily Bullock‐Yowell Eric R. Dahlen Bonnie C. Nicholson 《Journal of counseling and development : JCD》2014,92(3):270-279
This study identified relationships among career‐specific barriers (i.e., perfectionism, negative career thoughts, career decision‐making self‐efficacy) in a sample of 300 college students. The authors found relationships among the constructs of interest, prediction of variance in career decision‐making self‐efficacy, and differences among groups of perfectionists on endorsements of negative career thoughts and career decision‐making self‐efficacy. The findings suggest that interventions addressing maladaptive perfectionism and dysfunctional career thinking may enhance clients’ confidence in decision making. 相似文献
115.
116.
Richard J. Bonnie J.D. Paul S. Appelbaum M.D. Debra A. Pinals M.D. 《Behavioral sciences & the law》2015,33(2-3):178-185
Before the Supreme Court's 2008 decision in District of Columbia v. Heller, the American Psychiatric Association's position on gun policy reflected the strong gun control perspective championed by the nation's public health establishment. After Heller declared that an individual's right to bear arms is constitutionally protected, the APA refocused its attention on the specific aspects of firearm policy that implicate the interests and rights of persons with mental illness. Psychiatrists are mindful of the need to curtail firearm access by persons with mental disorders that elevate the risk of suicide or violence to others, but they are also opposed to stigmatization, discrimination, and unfair treatment of individuals based on mental illness. Although civil commitment is an acceptable basis for prohibiting access to firearms, other adjudications of conduct indicative of elevated risk should also be included. Every state should provide a fair and reasonable process for restoring firearm rights after a suitable waiting period based on individualized assessment of whether the person remains at an elevated risk. However, restricting firearm rights of persons solely on the basis of a diagnosis of a mental disorder or voluntary treatment, whether in-patient or outpatient, discourages treatment and would be counterproductive. Copyright © 2015 John Wiley & Sons, Ltd. (original adopted by the American Psychiatric Association 2014). 相似文献
117.
Debra A. Pinals M.D. Paul S. Appelbaum M.D. Richard J. Bonnie J.D. Carl E. Fisher M.D. Liza H. Gold M.D. Li-Wen Lee M.D. 《Behavioral sciences & the law》2015,33(2-3):186-194
The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Resource Document on “Access to Firearms by People with Mental Disorders.” This article is derived from work done on behalf of American Psychiatric Association and remains the property of APA. It has been altered only in response to the requirements of peer review. Copyright © 2015 American Psychiatric Association. Published with permission (original adopted by the American Psychiatric Association 2014). 相似文献
118.
Krista Redlinger-Grosse Patricia McCarthy Veach Stephanie Cohen Bonnie S. LeRoy Ian M. MacFarlane Heather Zierhut 《Journal of genetic counseling》2016,25(2):239-257
The need for evidence-based medicine, including comparative effectiveness studies and patient-centered outcomes research, has become a major healthcare focus. To date, a comprehensive list of genetic counseling outcomes, as espoused by genetic counselors, has not been established and thus, identification of outcomes unique to genetic counseling services has become a priority for the National Society of Genetic Counselors (NSGC). The purpose of this study was to take a critical first step at identifying a more comprehensive list of genetic counseling outcomes. This paper describes the results of a focus group study using the Reciprocal-Engagement Model (REM) as a framework to characterize patient-centered outcomes of genetic counseling clinical practice. Five focus groups were conducted with 27 peer nominated participants who were clinical genetic counselors, genetic counseling program directors, and/or outcomes researchers in genetic counseling. Members of each focus group were asked to identify genetic counseling outcomes for four to five of the 17 goals of the REM. A theory-driven, thematic analysis of focus group data yielded 194 genetic counseling outcomes across the 17 goals. Participants noted some concerns about how genetic counseling outcomes will be measured and evaluated given varying stakeholders and the long-term nature of genetic concerns. The present results provide a list of outcomes for use in future genetic counseling outcomes research and for empirically-supported clinical interventions. 相似文献
119.
Sabra Ledare Finley Pat McCarthy Veach Ian M. MacFarlane Bonnie S. LeRoy Nancy Callanan 《Journal of genetic counseling》2016,25(2):344-358
Supervision is a primary instructional vehicle for genetic counseling student clinical training. Approximately two-thirds of genetic counselors report teaching and education roles, which include supervisory roles. Recently, Eubanks Higgins and colleagues published the first comprehensive list of empirically-derived genetic counseling supervisor competencies. Studies have yet to evaluate whether supervisors possess these competencies and whether their competencies differ as a function of experience. This study investigated three research questions: (1) What are genetic counselor supervisors’ perceptions of their capabilities (self-efficacy) for a select group of supervisor competencies?, (2) Are there differences in self-efficacy as a function of their supervision experience or their genetic counseling experience, and 3) What training methods do they use and prefer to develop supervision skills? One-hundred thirty-one genetic counselor supervisors completed an anonymous online survey assessing demographics, self-efficacy (self-perceived capability) for 12 goal setting and 16 feedback competencies (Scale: 0–100), competencies that are personally challenging, and supervision training experiences and preferences (open-ended). A MANOVA revealed significant positive effects of supervision experience but not genetic counseling experience on participants’ self-efficacy. Although mean self-efficacy ratings were high (>83.7), participant comments revealed several challenging competencies (e.g., incorporating student’s report of feedback from previous supervisors into goal setting, and providing feedback about student behavior rather than personal traits). Commonly preferred supervision training methods included consultation with colleagues, peer discussion, and workshops/seminars. 相似文献
120.
Bonnie J. Baty Angela Trepanier Robin L. Bennett Claire Davis Lori Erby Catriona Hippman Barbara Lerner Anne Matthews Melanie F. Myers Carol B. Robbins Claire N. Singletary 《Journal of genetic counseling》2016,25(4):625-634
There are currently multiple paths through which genetic counselors can acquire advanced knowledge and skills. However, outside of continuing education opportunities, there are few formal training programs designed specifically for the advanced training of genetic counselors. In the genetic counseling profession, there is currently considerable debate about the paths that should be available to attain advanced skills, as well as the skills that might be needed for practice in the future. The Association of Genetic Counseling Program Directors (AGCPD) convened a national committee, the Committee on Advanced Training for Certified Genetic Counselors (CATCGC), to investigate varied paths to post-master’s training and career development. The committee began its work by developing three related grids that view career advancement from the viewpoints of the skills needed to advance (skills), ways to obtain these skills (paths), and existing genetic counselor positions that offer career change or advancement (positions). Here we describe previous work related to genetic counselor career advancement, the charge of the CATCGC, our preliminary work in developing a model through which to view genetic counselor advanced training and career advancement opportunities, and our next steps in further developing and disseminating the model. 相似文献