Lessons We Learned: Stories of Volunteer–Patient Communication in Hospice

As our population ages, the questions of how to care for and communicate with the dying have become increasingly important areas for research. This study identifies hospice volunteers as both important members of the hospice team and as an underresearched source of wisdom regarding end-of-life communication. This article presents preliminary findings from a longitudinal, ethnographic study of volunteer–patient relationships in hospice. Three themes related to volunteer–patient communication are described using stories from hospice volunteers. The article concludes with reflections on end-of-life communication as experienced by the volunteers, and suggests that narrative ethnography is an appropriate and effective research method for the study of hospice and end-of-life care.     

The adversity of secret relationships

Are secret romantic relationships alluring or aversive? Previous research suggests that romantic secrecy (i.e., keeping a romantic relationship secret from others) creates a cognitive preoccupation that enhances romantic attraction. In contrast, we predicted that romantic secrecy interferes with relationship interdependence and thereby decreases relationship quality. Three studies of secrecy in ongoing romantic relationships confirmed this prediction. In Study 1, romantic secrecy predicted lower levels of initial relationship quality and decreased relationship quality over a 2‐week period. In Study 2, relationship burden mediated partially the negative association between romantic secrecy and relationship quality. In Study 3, the negative association between romantic secrecy and relationship quality was primarily explained by decreased relationship satisfaction. The importance of understanding romantic secrecy is discussed.     

Understanding developmental changes in the stability and flexibility of spatial categories based on object relatedness

Two experiments examined the flexibility and stability with which children and adults organize locations into categories on the basis of object relatedness. Seven-, 9-, and 11-year-olds and adults learned the locations of 20 objects belonging to 4 categories. Displacement patterns revealed that children and adults used object cues to organize the locations into groups. The organization remained the same following a 7-day delay for all 4 ages, demonstrating stability. Moreover, for 11-year-olds and adults, this organization shifted after a new pattern of object-location pairings was introduced. The pattern was less clear for the younger children, suggesting that flexibility increases across childhood. Discussion focuses on the dynamics of organization processes, particularly stability and flexibility, and the integration of objects and locations.     

On being eager and uninhibited: narcissism and approach-avoidance motivation

This article demonstrates the validity and utility of conceptualizing narcissistic personality in terms of relative approach-avoidance motivation. Across three studies (N = 1,319), narcissism predicted high approach and low avoidance motivation. That is, narcissists reported being strongly motivated to approach desirable outcomes but only weakly motivated to avoid negative outcomes. Relative approach-avoidance motivation was shown to be useful in terms of explaining behavioral tendencies associated with narcissism (i.e., functional and dysfunctional impulsivity) and distinguishing different "flavors" of narcissism (i.e., overt and covert narcissism). Discussion focuses on how approach-avoidance motivation may be used to explain prior findings in the narcissism literature and generate novel future hypotheses.     

Overt and Relational Aggression and Victimization: Multiple Perspectives within the School Setting

The current study involved a comprehensive comparative examination of overt and relational aggression and victimization across multiple perspectives in the school setting (peers, teachers, observers in the lunchroom, self-report). Patterns of results involving sociometic status, ethnicity and gender were explored among 4th graders, with particular emphasis on girls. Controversial and rejected children were perceived as higher on both forms of aggression than other status groups, but only rejected children were reported as victims. Both European American and African American girls showed a greater tendency toward relational aggression and victimization than overt aggression or victimization. Results indicated negative outcomes associated with both relational and overt victimization and especially overt aggression for the target girl sample. Poorer adjustment and a socially unskillful behavioral profile were found to be associated with these three behaviors. However, relational aggression did not evidence a similar negative relation to adjustment nor was it related to many of the behaviors examined in the current study. Implications of these results are discussed.     

Disclosure of Genetics Research Results after the Death of the Patient Participant: A Qualitative Study of the Impact on Relatives

When a gene mutation is identified in a research study following the death of the study participant, it is not clear whether such information should be made available to relatives. We report here an evaluation of the impact on relatives of being informed of study results that detected pathogenic BRCA2 mutations in a male relative, now deceased, who had early onset (under the age of 55) prostate cancer. The breast and ovarian cancer risk was unknown to the living relatives. Qualitative analysis of interviews with thirteen relatives indicated that those who had a higher risk perception, resulting from an awareness of cancer family history or experiential knowledge of cancer in their family, tended to adjust more easily to the results. All participants believed that genetics research results of clinical significance should be fed back to relatives. Those who were fully aware of the BRCA2 results and implications for themselves felt they had benefited from the information, irrespective of whether or not they had elected for genetic testing, because of the consequent availability of surveillance programs. Initial anxiety upon learning about the BRCA2 result was alleviated by genetic counselling. Factors influencing those who have not engaged with the information included scepticism related to the relative who attempted to inform them, young age and fear of cancer. Those who had not sought genetic counselling did not attempt further dissemination, and some were not undergoing regular screening. Implications for informed consent in genetics research programs, and the requirement for genetic counselling when research results are disclosed, are discussed. Names have been changed to protect the privacy of study participants.     

Do people use category-learning judgments to regulate their learning of natural categories?

Although research has established that people can accurately judge how well they have learned categories, no research has examined whether people use their category-learning judgments (CLJs) to regulate their restudy of natural categories. Thus, in five experiments we investigated the relationship between people’s CLJs and selections of categories for restudy. Participants first attempted to learn natural categories (bird families; e.g., finches, grosbeaks, and warblers) so that they could categorize new exemplars on a final test. After this initial study phase, participants made a CLJ for each category and then selected a subset of the categories for restudy. Across experiments, we also manipulated several variables (e.g., selecting either three or nine categories, or obtaining 30% vs. 80% performance on the final test) that were expected to influence restudy selections. However, the manipulations typically had minimal impact. More important, in all experiments we found an unexpected outcome: Some participants tended to select the categories they judged to be most well learned for restudy, and others tended to select those judged to be least well learned. We discovered these qualitative differences in the use of CLJs to make restudy selections by using post-hoc analyses in Experiments 1a and 1b, and hence we sought to (a) replicate them in Experiments 2, 3, and 4 and (b) provide preliminary evidence regarding factors that can (vs. cannot) account for them. Most important, evidence across all of the experiments supported the conclusion that people do use their CLJs to select categories for restudy.     

Assessor cognitive processes in an operational assessment center

The purpose of this study was (a) to provide additional tests of C. E. Lance, Newbolt, et al.'s (2000) situational specificity (vs. method bias) interpretation of exercise effects on assessment center postexercise dimension ratings and (b) to provide competitive tests of salient dimension versus general impression models of assessor within-exercise evaluations of candidate performance. Results strongly support the situational specificity hypothesis and the general impression model of assessor cognitive processes in which assessors first form overall evaluations of candidate performance that then drive more specific dimensional ratings.     

Unit price and choice in a token-reinforcement context

Pigeons were exposed to multiple and concurrent second-order schedules of token reinforcement, with stimulus lights serving as token reinforcers. Tokens were produced and exchanged for food according to various fixed-ratio schedules, yielding equal and unequal unit prices (responses per unit food delivery). On one schedule (termed the standard schedule), the unit price was held constant across conditions. On a second schedule (the alternative schedule), the unit price was either the same or different from the standard. Under conditions with unequal unit prices, near-exclusive preference for the lower unit price was obtained. Under conditions with equal unit prices, the direction and degree of preference depended on ratio size (number of responses per exchange period). When this ratio differed, strong preferences for the smaller ratio were observed. When this ratio was equal, preferences were nearer indifference. Response rates on the multiple schedule were generally consistent with the preference data in showing sensitivity to ratio size. Results are discussed in terms of a unit-price model that includes handling and reinforcer immediacy as additional costs. On the whole, results show that preferences were determined primarily by delay to the exchange period.     

Prior knowledge and subtyping effects in children's category learning

Two experiments examined how 5- and 10-year-old children revise their category representations when exposed to exemplars that are congruent or incongruent with existing knowledge. During training children were presented with exemplars containing features that were congruent or incongruent with children's social stereotypes together with a stereotype-neutral feature. In the knowledge-subtyping condition this neutral feature predicted the stereotype-congruence of the other features. In the knowledge-standard condition the neutral feature was uncorrelated with stereotype-congruence. At test children made judgements about feature co-occurrence within the learned category. In each experiment these judgements were influenced by both stereotypical beliefs and exemplar observation. Stereotypical beliefs, however, had a greater influence on co-occurrence judgements in the knowledge-subtyping than in the standard conditions. In Experiment 2 these effects were shown to generalize to judgements about features that were not presented during training. These results challenge current models of knowledge-based categorization by showing that exemplar structure determines whether novel exemplar features are incorporated into category representations.