The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Multidimensional same--different judgments: evidence against independent comparisons of dimensions

Commonly discussed models of performance in the multidimensional same-different task are based on the assumption that independent same-different decisions are reached for each of the stimulus dimensions used in an experiment. In these models, a higher level mechanism examines th outcome of these independent decisions in order to determine whether the stimuli are the same or different overall. Previous evidence indicating that these models are inconsistent with results from same trials is summarized, and a new test of the above assumption using data from different trials is proposed. Detailed analysis of reaction times from different trials is shown, at least for some pairs of dimensions, to be incompatible with the view that separate same-different decisions are reached for each dimension. The major finding is that there are more relatively fast responses in a condition with two dimensions different, compared with the two conditions with only one of the dimensions different, than any processing model treating the dimensions separately could predict. The results suggest that partial information may be combined across dimensions in order to reach a "different" judgment.     

Scaling clinical judgments of symptom pathology by means of the psychophysiological method of magnitude estimation

Summing scores across heterogeneous symptom items without consideration of their differing psychopathological significance has been criticized as producing an inadequate picture of an individual's clinical status. The purpose of this study was to derive symptom item weights representing clinically judged seriousness of each symptom through the application of Stevens's psychophysical method of magnitude estimation. A nationwide sample of 129 clinicians rated the pathological significance of 221 symptom items in a design such that every rater rated 121 items, 21 of which were rated by all raters and 100 of which were rated only by the A or B subgroup to which each rater was randomly assigned. Each item was rated as to the seriousness of the pathology it would represent if manifested by either a boy child, girl child, boy adolescent, or girl adolescent, with one-fourth of the raters assigned to each condition. The results of 211 two-way analyses of variance revealed that age and age and sex in interaction, but not sex alone, significantly influenced the clinical ratings. The resulting magnitude estimation ratings of symptom pathology ranged from 1.0 to 9.9. They were demonstrated to have satisfactory reliability and convergent validity and to have the psychophysical characteristics of a prothetic continuum.A preliminary version of this paper was presented at the 85th Annual Convention of the American Psychological Association, San Francisco, August 1977. The research was supported by HEW grant MH24886. The authors wish to express appreciation to Walter W. Wengel for his work in developing the median quotient ratings used in the study, to Terrance Auger for making available unpublished raw data, and to Merton S. Krause for helpful suggestions regarding the interpretation of results.     

The effect of set size on hemifield asymmetries in letter recognition

Single letters were presented tachistoscopically in the left or right hemifield to right-handed observers. Superior recognition of letters on the right was found for letters chosen from subsets containing four items, but no differences were found when any letter, or any symmetrical letter, could appear. In a second experiment, the right hemifield advantage was found under conditions requiring the subject to determine the subset only when the subset chosen was appropriate. Results were discussed in terms of the adequacy of language-based explanations of hemifield asymmetries in letter recognition.     

Irrelevant differences in the "same"--"different" task

This article examines the effects of irrelevant information on the multidimensional "same"--"different" task. Subjects were instructed to compare two geometric figures with respect to certain attributes but to ignore other attributes in making the "same"--"different" decision. The irrelevant attributes were chosen in such a way that they could not easily be ignored to see how the existence of irrelevant differences would affect the comparison process. As expected, the overall latencies were longer than is usually found in tasks with no irrelevant differences. However, the nature of the comparison process appeared unchanged. The usual finding of a "fast-same" phenomenon persisted even when irrelevant information was present. The similarity of the results in this task to results in the "same"--"different" task with no irrelevant features supports the idea that the same comparison mechanism is used whether or not irrelevant differences are present in the stimulus pairs. The results suggest a more general-purpose comparison mechanism than is usually included in models of this task. Two-process models of visual comparisons are thus ruled out entirely. A modified version of Krueger's noisy-operator theory does appear consistent with the results.     

Contextual potentiation of acquired behavior after devaluing direct context-US associations

In two experiments, water-deprived rats were exposed to tone-footshock pairings in a particular conditioning context. In Experiment 1, the training parameters were selected on the basis of parametric pilot data so as not to produce direct associations between the conditioning context and footshock. Despite independent evidence of no appreciable direct association between the conditioning context and footshock, animals tested in the conditioning context exhibited more lick suppression to the tone than other animals tested with the tone outside of the conditioning context. Thus, the conditioning context potentiated suppression to the tone in the absence of appreciable fear of the conditioning context. In Experiment 2, training parameters were used that permitted the formation of direct associations between the conditioning context and footshock; however, for half the animals, these associations to the context were then extinguished. With the tone absent, a comparison of extinguished animals tested either in the conditioning context or outside the conditioning context detected no differences in suppression, demonstrating the effectiveness of the extinction manipulation. However, other animals also subjected to extinction of direct context-footshock associations displayed greater suppression to the tone within the conditioning context than comparable animals tested outside the context. Collectively the data indicate that the superior retention-test performance seen within the training context can arise both from the commonly assumed direct associations between the training context and the unconditioned stimulus and from the potentiation by the training context of the associations between the nominal conditioned stimulus and unconditioned stimulus.     

Young children's understanding of displaced aggression

According to previous research, young children do not understand displaced aggression. The present study examines the early phases of the understanding of the causes of moderately and extremely displaced aggression. Preschool and kindergarten children (3 to 5 years of age) viewed eight videotaped episodes of displaced aggression. Their comprehension of this aggression was assessed by means of open ended questions and forced choice picture selections. By age 5 most children had some understanding of displaced aggression, but this understanding was not complete. The early understanding revealed in the present study may be due to the use of short, simple realistic videotaped episodes appropriate for the limited processing abilities of young children. Extreme displacement was not more difficult to understand than moderate displacement.