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.     

Group Membership,Status, and Social Power Preference1

The power literature supports the notion that power‐base preferences can serve as a means for gaining advantage over others, thereby satisfying the personal self. Here, we inquired whether the use of power bases also serves as a means for gaining in‐group advantage, thereby satisfying the social self. A 2 × 3 × 2 design, including group membership (in‐group/out‐group), influencing agent's status (low, same, high), and gender as independent variables was employed. After reading scenarios describing work‐situation conflicts that differed by the relative status of the influencing agent and group membership of the target person, students and workers completed the Interpersonal Power Inventory for assessing power usage. In general, participants attributed greater use of harsh bases toward the out‐group. Status effects were obtained for in‐group targets and were less clear for out‐group targets. The discussion addresses theoretical implications for both the power interaction model and social identity theory, as well as practical ones for intergroup relations in organizations.     

Neuropsychological characteristics of children with the 22q11 Deletion Syndrome: a descriptive analysis.

Previous reports of cognitive functioning in children with the 22q11 Deletion Syndrome have reported marked variability in IQ and achievement subtest scores. Studies have begun to explore neuropsychological function in 22q11 DS however results are inconsistent and the profile incomplete. We assessed 40 children ages 5-12 with 22q11 DS. Consistent with past results, visual-spatial memory was significantly lower than verbal memory. Differentially lowered scores were found only in visual attention, working memory and motor function. Contrary with some past results quantitative, verbal ability, and visual spatial memory scores were within 1 SD from the standardization sample mean. Motor behavior, not typically discussed with regard to 22q11 DS school-age children, may be critical to incorporate in neurocognitive studies of children with 22q11 DS. Implications of these findings are considered with regard to past results.     

Pedagogies of Interpretation in Educating Clergy

Abstract. In this essay the authors describe how four seminary educators pedagogically engage students in practices of interpretation and explore how the variations in their teaching practices shape the critical thinking they seek to cultivate in their students. The piece is excerpted from an ethnographic study of Jewish and Christian seminary educator teaching practices sponsored by the Carnegie Foundation for the Advancement of Teaching (Educating Clergy: Teaching Practices and Pastoral Imagination, Jossey‐Bass Publishers, November 2005). The study explores how the classroom‐ and community‐based teaching practices of seminary educators prepare students to integrate professional knowledge and skill with moral integrity and religious commitment in professional practice. In addition to the pedagogies of interpretation explicated here, we observed pedagogies that engage students in practices of formation, contextualization, and performance. Attention is also given in the study to the influence of pedagogies embedded in the traditions of seminary education on student learning and to the cultivation of spiritual and professional practices beyond the classroom in community worship and through strategies of field education and small groups.     

Coercion in Intimate Partner Violence: Toward a New Conceptualization

For decades, battered women’s advocates have placed coercive control squarely at the center of their analysis of intimate partner violence. Yet, little work has been done to conceptualize and measure the key construct of coercive control. In this article, we apply French and Raven’s social power model to a conceptualization of coercive control in intimate partner violence relationships. Central elements of the model include: social ecology; setting the stage; coercion involving a demand and a credible threat for noncompliance; surveillance; delivery of threatened consequences; and the victim’s behavioral and emotional response to coercion. These elements occur in spiraling and overlapping sequences to establish an overall situation of coercive control. The implications of this model for theory and practice are discussed.     

Philosophical and Political Issues in Research on Women’s Violence and Aggression

This essay organizes the philosophical and political issues raised by researching women’s aggression and violence by posing three questions. What does a research focus on women’s violence and aggression offer feminist scholars and activists? What are the potential hazards of such a focus? What are promising directions for research? To focus on women as aggressors and perpetrators as well as victims sheds light on compelling and difficult questions of gender and violence, especially violence and aggression between intimate partners. It also presents some political pitfalls for the most vigilant researchers, including oversimplification and misinterpretation of complex empirical findings. The author concludes with a call for researchers to follow the lead of the ideas and evidence collected in this special issue.