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.     

Facilitated Disclosure Versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 2: Therapy Ethics,Pragmatics, and Protocol

In couple therapy, one partner's private disclosure of infidelity presents a potentially polarizing issue involving the therapist's decision to facilitate disclosure or accommodate non-disclosure. Some therapists may assume accommodating an infidelity secret is the most compassionate and efficient option. We consider this decision in the context of therapy ethics of equal advocacy and confidentiality, implications for individual and relationship healing, and pragmatic aspects of conducting therapy. We conclude that measured disclosure of infidelity, determined by the aggrieved spouse, best resolves the potential collision of multilateral advocacy with confidentiality and offers the best prospects for a working therapy alliance and couple healing and renewal. A clinical protocol for facilitating disclosure of infidelity secrets is presented.     

Modifying driver behaviour with passenger feedback

A feedback programme was employed to help drivers improve their safety behaviour based on the idea that particular types of driver error result from contingency traps as defined by Fuller [Journal of Applied Behaviour Analysis, 24 (1991) 73]. Two drivers and their single respective passengers participated. For each driver, repeated in-car observations were made of four unsafe driving behaviours. Two of these were sequentially targeted in the behavioural intervention that involved the passengers providing informational feedback to their driver. Both drivers showed a marked improvement across the targeted behaviours. The study demonstrated the applicability of behaviour analysis to the traffic domain and the efficacy of individual feedback as a behavioural tool for positive behaviour modification.     

The effect of adults' eating on young children's acceptance of unfamiliar foods

Adults presented unfamiliar foods to 14- to 20- and 42- to 48-month-old children individually in their homes. More children put the food in their mouths when the adults also were eating than when the adults simply were offering the food. More children put food in their mouths when their mothers were the source than when the source was a friendly adult “visitor”. However, even when alone with a child, the visitor's eating elicited reliably more tasting. Analysis of requesting behavior indicated that the adults' eating aroused a desire to eat in the children. There were no consistent sex differences or interactions between sex of visitor and sex of child in children's food acceptance. There was a suggestion that younger children were more affected by repeated offerings than were older children. It is concluded that a relatively “low level” form of observational learning—“social facilitation”—can account for the data.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.