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.     

BRIEF REPORT

This study examined the different facets of emotional intelligence, alexithymia, and mood awareness. Undergraduate students (N = 129) completed the Trait Meta-Mood Scale (TMMS), the Toronto Alexithymia Scale (TAS-20), and the Mood Awareness Scale (MAS). A factor analysis revealed two dimensions, attention to and clarity of emotions, that cut across all three instruments. These two dimensions were differentially associated with personality, as measured by the neuroticism, extraversion, and openness to experience portions of the NEO-FFI, and with performance on an emotional Stroop task. We discuss the implications for the conceptualisation of broad constructs such as emotional intelligence and alexithymia, as well as the potential utility of more narrowly defined individual differences.     

A Dual Coding Theoretical Model of Decoding in Reading: Subsuming the Laberge and Samuels Model

In this article we present a detailed Dual Coding Theory (DCT) model of decoding. The DCT model reinterprets and subsumes The LaBerge and Samuels (1974) model of the reading process which has served well to account for decoding behaviors and the processes that underlie them. However, the LaBerge and Samuels model has had little to say about comprehension processes. Its subsumption into DCT provides an account of decoding in DCT terms and connects it to the established DCT explanation of comprehension. Relevant research evidence is reviewed. We propose that this constitutes an incremental advancement toward unifying theories in reading.     

Doing without Desert

The idea of 'moral responsibility' is typically linked with praise and blame, and with the notion of 'the voluntary'. It is often thought that if we are free, in the relevant sense, we may "deserve" praise or blame; otherwise, we do not. But when we look at whether and why we need the notions of praise and blame, we find that they are not as intimately connected with desert as many philosophers have thought. In particular, this paper challenges the idea that forms of evaluation and behavior tied to our "reactive attitudes" (especially resentment) best further morality's aims, properly understood.     

Preschoolers' social information processing and early school success: The challenging situations task

As part of a larger longitudinal project on the assessment of preschoolers' social‐emotional development, children's social information processing (SIP) responses to unambiguous hypothetical situations of peer provocation were assessed for 298 four‐year‐olds from Head Start and private childcare settings. Measurement focused on emotions children would feel during these situations, and their behaviour response decisions. Participants most often chose sad and angry emotions, and socially competent and passive behaviours. Relations were found between sad emotion and socially competent behaviour choices, as well as between angry emotion and aggressive behaviour choices. Sad emotion and socially competent behaviour responses contributed to variance in contemporaneous and later school adjustment and kindergarten academic readiness. There was evidence that the contributions of sad emotion responses were mediated by those of socially competent behaviour choices. Results bolstered calls to include emotion in SIP measures, supported predictive validity for this SIP measure in a large representative sample of preschoolers, and pointed to fruitful pathways for future research.     

Hospitalizations for Suicide‐Related Drug Poisonings and Co‐occurring Alcohol Overdoses in Adolescents (Ages 12–17) and Young Adults (Ages 18–24) in the United States, 1999–2008: Results from the Nationwide Inpatient Sample

Drug poisoning is the leading method of suicide‐related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide‐related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates of inpatient hospital stays for SRDP and co‐occurring alcohol overdoses in adolescents (ages 12–17) and young adults (ages 18–24) between 1999 and 2008. Among adolescents, there were 14,615 hospitalizations for drug poisonings in 2008, of which 72% (10,462) were suicide‐related at a cost of $43 million. Rates of SRDP in this age group decreased between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 5% in 1999 to 7% in 2008. Among young adults, there were 32,471 hospitalizations for drug poisonings in 2008, of which 64% (20,746) were suicide‐related at a cost of $110 million. Rates of SRDP did not change significantly between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 14% in 1999 to 20% in 2008. Thus, while rates of SRDP decreased for adolescents and remained unchanged for young adults, the prevalence of co‐occurring alcohol overdoses increased for both age groups. Such hospitalizations provide important opportunities to employ intervention techniques to prevent further suicide attempts.