Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.     

The fundamentality of group principles and perceived group entitativity

We argue that the level of consensus about a set of social identity principles, and their perceived fundamentality, can influence the degree to which members perceive their group as an entity. This idea was explored through an experiment in which participants judged the entitativity of specific (in)groups on the basis of the distribution of the opinions held by their members about three identity-related principles that participants had previously rated for fundamentality. The results demonstrated that the more fundamental a principle was judged to be in comparison to other principles, the more important consensus about that principle was for producing group entitativity, relative to consensus about other principles.     

Empathy, group norms and children's ethnic attitudes

Two minimal group studies (Ns = 150, 123) examined the impact of emotional empathy on the ethnic attitudes of 5 to 12-year old white Anglo-Australian children. Study 1 evaluated the relationship between empathy and attitudes towards a same (Anglo-Australian) versus different ethnicity (Pacific Islander) outgroup. A significant empathy × outgroup ethnicity interaction revealed that empathy was unrelated to the children's liking for the same ethnicity outgroup, but that liking for the different ethnicity outgroup increased as empathy increased. Study 2 examined the influence of empathy on attitudes towards the different ethnicity outgroup when the ingroup had a norm of inclusion versus exclusion. A significant empathy × group norm interaction revealed that empathy was unrelated to liking when the ingroup had a norm of exclusion, but that liking for the different ethnicity outgroup increased when the ingroup had a norm of inclusion. Implications of the findings for promoting children's positive attitudes to ethnic minority groups are discussed.     

Characterization of memory impairment following closed-head injury in children using the Rey Auditory Verbal Learning Test (AVLT).

Memory impairment following closed-head injury (CHI) in children is well documented. Characterization of the memory deficits of children with CHI could contribute to the prediction of academic performance and rehabilitation of these children. Twenty-five children who sustained closed-head injury and 25 matched controls were administered the Rey Auditory Verbal Learning Test (AVLT). The advantage of this memory test is that a number of memory components are measured simultaneously, thus enabling us to study the relations between different aspects of memory within the same patient sample. The findings indicate that the Rey AVLT is a good test for characterization of impaired verbal memory in children following CHI. Transformation of scores derived from the Rey AVLT to Z-scores enables us to determine the relative effect of CHI in children on different memory scores. Raw scores were more vulnerable than relational ones, derived as the difference between two raw scores (e.g., learning, Trial 5 - 1), to closed-head injury in children, and scores reflecting word span were the least vulnerable. The results are discussed in terms of the possible contribution of the frontal lobes, which are frequently affected in closed-head injuries, to memory performance.     

Paternal Psychiatric Symptoms and Maladaptive Paternal Behavior in the Home During the Child Rearing Years

Data from the Children in the Community Study, a community-based longitudinal study were used to investigate associations between paternal psychiatric disorders and child-rearing behaviors. Paternal psychiatric symptoms and behavior in the home were assessed among 782 families during the childhood and adolescence of the offspring. Paternal anxiety, disruptive, mood, personality, and substance use disorders were independently associated with specific types of maladaptive paternal behavior in the home during the child-rearing years after paternal age, education, income, co-occurring paternal psychiatric symptoms, offspring age, sex, intelligence, temperament, and psychiatric symptoms were controlled statistically. Paternal psychiatric disorders that were present by mean offspring age 14 were associated with elevated risk for maladaptive paternal behavior in the home at mean age offspring 16, after prior maladaptive paternal behavior was controlled statistically. These findings suggest that paternal psychiatric disorder may be an important determinant of maladaptive paternal behavior in the home during the child-rearing years. Improved recognition and treatment of paternal psychiatric disorders may help to reduce the amount of maladaptive parenting behavior that many children and adolescents might otherwise be likely to experience.     

The self in autobiographical memory: effects of self-salience on narrative content and structure

Contemporary models of autobiographical memory attribute a prominent role to the conceptualisation of the self. In an attempt to better understand the impact of the self as an organising feature of autobiographical memory, narratives of personal episodes were elicited, either after a questionnaire about the self (self-prime condition) or after a distractor task (control condition). Participants also wrote a narrative of a turning-point memory, which is by definition a self-focused narrative. Narratives were divided into propositions and analysed for the types of statements used. As predicted, when writing self-focused turning-point narratives participants included more statements relating to the meaning of an event and connecting it to the self, and fewer statements focusing on the who, what, where, and when of the narrative. Narratives written after the self-prime also demonstrated characteristics that were similar to turning-point narratives, although not on all measures. This shift in narrative focus in turning-point and self-primed memory narratives indicates an increased attempt to fulfil goals of coherence rather than correspondence (Conway, 2005). These findings lend insight into the nature of the relationship between the semantic conceptualisation of the self, and the process of retrieving event-specific knowledge in episodic memory.     

Genetic Testing Likelihood: The Impact of Abortion Views and Quality of Life Information on Women’s Decisions

Little is known about factors predicting the likelihood of choosing genetic testing in college aged women versus older women, including knowledge of quality of life (QOL) associated with a disorder. Using vignettes with female college students (Experiment 1: n = 257, mean age = 19.70 yrs) and female faculty/staff/alumni (Experiment 2: n _nulliparous = 83, mean age = 30.20 yrs; n _mothers = 53, mean age = 33.77 yrs), we examined the contribution of multiple factors to predicting genetic testing likelihood for cystic fibrosis. We investigated malleable situational factors (style of genetic risk presentation and providing QOL information including physical and social aspects) and stable dispositional factors (abortion views). Parity (i.e., prior births) was more influential in women’s genetic testing likelihood than was age. Greater acceptability of abortion for oneself and self-assessed knowledge following QOL information were predictors of higher testing likelihood for college students. Greater acceptability of abortion for another person was a predictor for nulliparous women. Abortion views moderated the effect of predictors for nulliparous women and mothers. Findings encourage genetic counselors to utilize QOL information to promote informed decision making through genetic testing.     

Multiple Criteria Decision‐Making in Management Accounting and Control‐State of the Art and Research Perspectives Based on a Bibliometric Study

As an academic discipline as well as in practice, decision support is one of the most important functions of management accounting and control (MAC). Owing to decision settings' increasing complexity, suitable multiple criteria methods are becoming increasingly important for MAC. We, therefore, examine the extent to which certain multiple criteria decision‐making (MCDM) methods are used in the MAC context. In order to do so, we undertook an extensive bibliometric analysis of the management accounting field during the last three decades. The results indicate an increase in the importance of MCDM. Furthermore, recent research activities were classified into different areas of decision‐making within MAC since the majority of publications deal with the areas of strategic management, budgeting and performance management. More specifically, strategy and performance evaluation, strategic planning and the selection of alternatives are the most prominent MCDM applications. Our analysis reveals that the analytic hierarchy process (AHP) is the most popular analytical tool with which to support management in complex decision‐making situations. The results of the study prove that technical MAC literature does not cover a desirable range of MCDM applications and that the AHP, as well as the analytic network process (ANP) are of increasing importance in respect of the international scope of MAC. Therefore, the area of MCDM continues to be an active part of management science research and application, specifically of MAC. Copyright © 2011 John Wiley & Sons, Ltd.