Differential disgust responding in people with cancer and implications for psychological wellbeing

Objectives: Evidence suggests that disgust responses, known to negatively affect psychological wellbeing, may differ in people with cancer. We performed the first quantitative investigation of three discrete types of disgust trait – disgust propensity, sensitivity and self-directed disgust – in people diagnosed with a broad range of cancers (versus cancer-free controls), and explored their associations with psychological wellbeing.

Design: In a cross-sectional survey design, 107 participants with heterogeneous cancer diagnoses, recruited from cancer charities and support groups, were matched with cancer-free controls by age and gender.

Outcome measures: Measures of the three disgust traits were taken alongside measures of anxiety and depression.

Results: Disgust sensitivity and physical self-disgust were significantly higher in the cancer than control sample, while disgust propensity and behavioural self-disgust were lower. The disgust traits had a different pattern of associations to psychological wellbeing across the two groups, with disgust sensitivity predicting depressive symptoms to a significantly greater extent in the cancer than control group.

Conclusions: People with cancer differ from matched controls in their disgust responses and these responses have significant predictive relationships with aspects of their psychological wellbeing. The results suggest that emotion-based interventions may be useful for improving psychological wellbeing in people with cancer.     

Kant and Kantians on “the Normative Question”

After decades of vigorous debate, many contemporary philosophers in the Kantian tradition continue to believe, or at least hope, that morality can be given a firm grounding by showing that rational agents cannot consistently reject moral requirements. In the present paper, I do not take a stand on the possibility of bringing out the alleged inconsistency. Instead I argue that, even if a successful argument could be given for this inconsistency, this would not provide an adequate answer to “the normative question” (i.e., “why should I be moral?”). My defense of this claim emerges from a defense of a claim about Kant, namely, that he did not attempt to answer the normative question in this way. After carefully articulating Kant’s answer to the normative question, I argue that his answer to this question contains a lesson about why we should not embrace the approach that is popular among many contemporary Kantians.     

Psychosocial Correlates of Medical Mistrust Among African American Men

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient–physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men’s mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient–physician interactions in ways that impede trust building processes.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.