Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.     

Do we know how we cope? Relating daily coping reports to global and time-limited retrospective assessments

The current study examined the concordance among daily, trait (global retrospective), and time-limited retrospective reports of coping. A sample of 93 adults completed the COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989) prior to recording coping with the day's most negative event for 30 consecutive days. At the end of daily data collection, participants recalled to what extent they used each of 16 coping strategies over the past 30 days. Whereas findings indicate generally good concordance between daily and time-limited retrospective reports, concordance between global and daily reports was weak. Only limited evidence was found for systematic individual differences in concordance. Time-limited reports appear to be an adequate, though not ideal, method of determining usual patterns of coping with stress.     

Reexploring the connection between terror management theory and dissonance theory

Building upon suggestive earlier findings, the present study sought to test more informatively the notion that reminders of mortality can intensify efforts at dissonance reduction. Toward this end, an induced-compliance experiment was conducted in which participants were given high versus low choice to write a counterattitudinal statement regarding a boring topic under conditions of either mortality salience (MS) or uncertainty salience (control). It was predicted that although dissonance reduction (via attitude change) would be provoked in the control group, MS would significantly exacerbate this effect. These predictions were borne out empirically. The findings, obtained using the historically preeminent paradigm for assessing dissonance reduction, provide firm support for the notion that MS amplifies concerns with cognitive consistency.     

From the grave to the cradle: evidence that mortality salience engenders a desire for offspring

On the basis of terror management theory, the authors hypothesized that reminders of mortality (mortality salience) should promote the desire for offspring to the extent that it does not conflict with other self-relevant worldviews that also serve to manage existential concerns. In 3 studies, men, but not women, desired more children after mortality salience compared with various control conditions. In support of the authors' hypothesis that women's desire for offspring was inhibited as a function of concerns about career success, Study 3 showed that career strivings moderated the effect of mortality salience on a desire for offspring for female participants only; furthermore, Study 4 revealed that when the compatibility of having children and a career was made salient, female participants responded to mortality salience with an increased number of desired children. Taken together, the findings suggest that a desire for offspring can function as a terror management defense mechanism.     

Gender-typical responses to sexual and emotional infidelity as a function of mortality salience induced self-esteem striving

The authors propose that gender-differentiated patterns of jealousy in response to sexual and emotional infidelity are engendered by the differential impact of each event on self-esteem for men and women. Study 1 demonstrated that men derive relatively more self-esteem from their sex lives, whereas women's self-esteem is more contingent on romantic commitment. Based on terror management theory, it is predicted that if gender-differentiated responses to infidelity are motivated by gender-specific contingencies for self-esteem, they should be intensified following reminders of mortality. In Study 2, mortality salience (MS) increased distress in response to sexual infidelity for men and emotional infidelity for women. Study 3 demonstrated that following MS, men who place high value on sex in romantic relationships exhibited greater distress in response to sexual infidelity, but low-ex-value men's distress was attenuated. The authors discuss the implications for evolutionary and self-esteem-based accounts of jealousy as well as possible integration of these perspectives.     

The 4 year stability of psychopathic traits in non-referred youth

One significant limitation in research extending the construct of psychopathy to youth has been the absence of longitudinal studies testing the stability of psychopathic traits prior to adulthood. To begin to address this limitation, the current study estimated the stability of psychopathic traits over a 4 year period in a sample of non-referred children in the third, fourth, sixth, and seventh grades at the first assessment. For parent ratings of psychopathic traits, stability estimates using intra-class correlation coefficients ranged from 0.80 to 0.88 across 2-4 years, with a stability estimate of 0.93 across all four assessments. There were also distinct trends in the patterns of stability found in the sample. Specifically, children rated as being initially high on these traits were more likely to be rated lower at later assessments than was the case for children rated initially low on these traits. Finally, the child's level of conduct problems, the socioeconomic status of the child's family, and the quality of parenting the child received were the most consistent predictors of stability of psychopathic traits.     

Are People Polite to Computers? Responses to Computer-Based Interviewing Systems1

The present studies were designed to test whether people are “polite” to computers. Among people, an interviewer who directly asks about him- or herself will receive more positive and less varied responses than if the same question is posed by a third party. Two studies were designed to determine if the same phenomenon occurs in human–computer interaction. In the first study (N= 30), participants performed a task with a text-based computer and were then interviewed about the performance of that computer on 1 of 3 loci: (a) the same computer, (b) a paper-and-pencil questionnaire, or (c) a different (but identical) text-based computer. Consistent with the politeness prediction, same-computer participants evaluated the computer more positively and more homogeneously than did either paper-and-pencil or different-computer participants. Study 2 (N= 30) replicated the results with voice-based computers. Implications for computer-based interviewing are discussed.     

Prevalence and predictors of benevolent childhood experiences among a representative sample of young people

Emerging research evidence suggests that benevolent childhood experiences (BCEs) may partly explain more favourable mental health outcomes among individuals affected by adverse childhood experiences (ACEs). However, much of this research has focused on adult populations. Consequently, this study sought to provide the first rigorous assessment of the prevalence and predictors of BCEs using a nationally representative sample of young people from Northern Ireland (NI). Participants were 11–19-years-olds (N = 1293) who participated in the NI Youth Wellbeing Prevalence Survey (NI-YWS, 2020). Prevalence rates, gender differences and predictors of BCEs were investigated. Results revealed how most of the sample experienced multiple BCEs (95%, n = 1084), with females reporting higher levels of BCEs. Significant positive predictors of BCEs were female gender, parental education, living with both biological parents, and living in areas with lower deprivation, while significant negative predictors of BCEs included family being in receipt of social welfare and older age. Overall, this study highlights how BCEs are common, while the identification of factors associated with likelihood of having positive experiences during early development provides novel insights into those young people who may be at greater risk for maladaptive psychological outcomes.     

Ethically Allocating COVID-19 Drugs Via Pre-approval Access and Emergency Use Authorization

Abstract

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research. In conditions of scarcity, prioritization approaches should minimize harm, maximize benefit, and promote fairness. To promote continued data collection, patients seeking access to unproven COVID-19 drugs should receive lower priority for allocation when they decline to participate in clinical trials, either of the requested drug or other investigational products, offering a comparable balance of risks and benefits; special attention should be paid to concerns of voluntariness and distrust. In addition, institutional treatment protocols that can contribute more robust real world data should be preferred to single patient requests for access, with priority for inclusion based on traditional clinical allocation criteria relying on available evidence. Fairness demands distribution of these protocols across a diverse range of sites, particularly those serving marginalized populations, among other protections.