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.     

Peter Harzem (1930–2008: Bonds and Remembrances in Mexico

The Psychological Record -     

A more complete task-set reconfiguration in random than in predictable task switch

Three experiments are presented that compare the cost found when switching from one task to another in two different conditions. In one of them, the tasks switch in predictable sequences. In the other condition, the tasks alternate at random. A smaller time cost is found in the random-switch condition when enough preparation time is allowed. Such an effect is due to the random-switch cost continuing to decrease with preparation time after the predictable-switch cost has reached an asymptote. Although the relationship between number of repetitions of one task and time cost is different in the random- and the predictable-switch conditions, only the latter shows the presence of an "exogenous" component of cost. The implications of this finding are discussed in relationship with the usual distinction between an endogenous component of switch cost that is affected by preparation time and another exogenous, residual component (e.g., Rogers & Monsell, 1995). It is proposed that a different kind of task-set preparation is at work when tasks alternate at random.     

不可能有精神分析学的危机——1974年拉康访谈录

在1974年的一次访谈中,拉康针对当时人们越来越多地谈到精神分析学的危机问题,明确回答说,弗洛伊德的学说并没有过时,精神分析学也远远没有走到尽头。不过,当时的精神分析学界确实也出现了一些偏离,后辈们并不总是忠实于他们的鼻祖弗洛伊德,精神分析学面临着被教条化、心理学化和平庸化的危险处境。对此,他再次呼吁要回到弗洛伊德去。弗洛伊德认为,精神分析学主要是一门实践学科,是言语的实践,并非行为的治疗。患者的言语,是精神分析的唯一材料。     

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.