Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.     

Death Threat,Religiosity, and Fear of Death: A Repertory Grid Investigation

Personal construct methodologies in the study of death threat have been limited by the use of death-specific constructs as well as global measures of other variables. To address these shortcomings, 40 males completed the 40-construct provided form of the Threat Index (Tip), an interpersonal repertory grid ORG), and multifaceted scales of religiosity and death concern. Death threat scores derived from the Tip and repertory grid correlated only moderately. Significant negative correlations were found between death threat and different components of religiosity, particularly when IRG measures of death threat were used. In keeping with past research, death threat also correlated significantly with fear of death subscales that particularly focus on the self (as opposed to the death of others). The implications of these results for future work in the area of death threat were discussed.     

Age differences in managing response to sadness elicitors using attentional deployment,positive reappraisal and suppression

The current study investigated age differences in the use of attentional deployment, positive reappraisal and suppression while regulating responses to sadness-eliciting content. We also tested to what extent these emotion regulation strategies were useful for each age group in managing response to age-relevant sad information. Forty-two young participants (M_age = 18.5, SE = .15) and 48 older participants (M_age = 71.42, SE = 1.15) watched four sadness-eliciting videos (about death/illness, four to five minutes long) under four conditions—no-regulation (no regulation instructions), attentional deployment (divert attention away), positive reappraisal (focus on positive outcomes) and suppression (conceal emotional expressions). We assessed negative emotional experience, expression, skin conductance level (SCL) and visual fixation duration while participants watched the emotional clips and followed the instructions for each condition. Results suggest that older adults were more successful than younger adults at implementing both attentional deployment and positive reappraisal. Ability to suppress emotions appears to remain stable with age. Within age-group comparisons suggested that for the older adults, positive reappraisal was a more useful emotion regulation strategy than the others, while the pattern among younger adults was less conclusive. Age-relevant differences in motivation and successful emotion regulatory efforts based on theoretical and empirical literatures are discussed.     

‘Undesirable’ and ‘desirable’ shifts in children's responses to repeated questions: age differences in the effect of providing a rationale for repetition

This study examined factors influencing children's tendency to shift responses when questions are repeated within an interview. Forty nine 4–5‐year‐olds and 40 7–8‐year‐olds were questioned about a video they had seen, with questions repeated by the same or a different interviewer. Half the children were given a rationale for question repetition, and half were not. Overall, the older children shifted less than the younger children, and, unlike the younger children, more to misleading than unbiased questions. The rationale did not affect overall shifting, but reduced the probability of ‘undesirable’ shifts (towards inaccuracy) in the younger children, and increased ‘desirable’ shifts (towards accuracy) at both ages. In the younger children, the rationale reduced total number of shifts, but only with the same interviewer, while in the older children the reverse applied. The results suggest developmental progression in the relative contributions of memorial and social/motivational factors to shifting. Implications for investigative interviewing with children are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Why Do You Regulate What You Eat? Relationships Between Forms of Regulation, Eating Behaviors, Sustained Dietary Behavior Change, and Psychological Adjustment

In 3 studies, the authors examined how autonomous and controlled forms of motivation for the regulation of eating behaviors were related to self-reported eating behaviors, and sustained dietary behavior change. Studies 1 and 2 supported the factorial structure and the psychometric properties of a scale designed to measure different forms of regulation as defined by Self-Determination Theory. A motivational model of the regulation of eating behaviors suggested that an autonomous regulation was positively associated with healthy eating behaviors whereas a controlled regulation was positively associated with dysfunctional eating behaviors and negatively associated with healthy eating behaviors. In Study 3, long-term adherence to healthier dietary behaviors in a population at risk for coronary artery disease was examined over a 26-week period. A general measure of self-determined motivation assessed at week 1 was found to be a reliable predictor of the level of self-determination for eating behaviors 13 weeks later. In turn, self-determination for eating behaviors was a significant predictor of dietary behavior changes at 26 weeks. Finally, the dietary behavior measures were related to improvements in weight and blood lipid parameters (LDL-cholesterol, HDL-cholesterol, triglycerides). Results are discussed in terms of their implication for the integration and maintenance of a successful healthy regulation.     

Psychosoziale Interventionen bei Patientinnen mit Brustkrebs

Breast cancer patients are subject not only to physical strain but also to substantial psychological and social stress as well as major threats and challenges.The paper presented gives an overview of the research status on psychosocial interventions to support patients in their coping endeavours.Psychosocial basic care of women with breast cancer is performed by the physicians treating oncologically and includes information fitting patients' information needs,and responding to their emotional stress.Evaluated training and educational programs are available for physicians to enhance their psychosocial competence.Psychosocial basic care is completed by psychoeducational interventions.In 20–30% of women with breast cancer, there is a need for a special psychotherapeutic treatment.Especially, supportive and cognitive-behavioral therapies in an individual or a group setting contribute to a reduction of anxiety and depression. Even anticipated side-effects of somatic treatments can be diminished by psychotherapy. Research in the field supports that there is a need for broad integration of psychosocial interventions into disease management programs for women suffering from breast cancer.     

Do We Feel the Same Way If We Think the Same Way? Shared Attitudes and the Social Induction of Affect

Drawing on the literature on emotional mimicry, we argue that attitude similarity between a sender and a receiver influences the social induction of affect. Studies 1, 2, and 3 supported this reasoning by showing that similarity fostered, whereas dissimilarity blocked concordant reactions to a happy sender (but not to a sad sender). We also examined the mechanism behind these effects and found that similarity influenced liking of the happy sender but did not affect liking of the sad sender. Study 4 provided causal evidence for this idea by showing that similarity influenced the induction of positive affect through liking.     

Prenatal diagnosis and management of intrauterine growth restriction: A long‐term prospective study on outcome and maternal stress

This study examines long‐term effects of antenatal management of intrauterine growth restriction (IUGR) on developmental outcome and on maternal coping using a prospective cross‐sectional design. Sixty‐nine families were evaluated using psychological testing and risk questionnaires. The effects of timing of diagnosis (prenatal/perinatal) and of pregnancy management [induction of labor (IL)/conservative management (CM)/none, i.e., diagnosed‐at‐birth (DaB)] on maternal stress were tested at 6 years' postbirth. In general, prenatal management protocols of IUGR were efficient in preventing major disabilities; however, 49% of the variance in maternal stress at 6 years' postbirth could be attributed to the child's presenting behavior and to pregnancy management of IUGR condition. Mothers who received CM treatment reported being more stressed by their child's poor emotional adjustment (ps < .01–.002) and distractibility (p < .029), and to have more difficulty in accepting them (p < .01). Prenatal psychological consultation to better handle stress for parents whose fetus is diagnosed with IUGR is recommended, particularly when pregnancy is managed conservatively and familial–educational resources are low.