Assessing hopelessness in terminally ill cancer patients: development of the Hopelessness Assessment in Illness Questionnaire

Hopelessness has become an increasingly important construct in palliative care research, yet concerns exist regarding the utility of existing measures when applied to patients with a terminal illness. This article describes a series of studies focused on the exploration, development, and analysis of a measure of hopelessness specifically intended for use with terminally ill cancer patients. The 1st stage of measure development involved interviews with 13 palliative care experts and 30 terminally ill patients. Qualitative analysis of the patient interviews culminated in the development of a set of potential questionnaire items. In the 2nd study phase, we evaluated these preliminary items with a sample of 314 participants, using item response theory and classical test theory to identify optimal items and response format. These analyses generated an 8-item measure that we tested in a final study phase, using a 3rd sample (n = 228) to assess reliability and concurrent validity. These analyses demonstrated strong support for the Hopelessness Assessment in Illness Questionnaire providing greater explanatory power than existing measures of hopelessness and found little evidence that this assessment was confounded by illness-related variables (e.g., prognosis). In summary, these 3 studies suggest that this brief measure of hopelessness is particularly useful for palliative care settings. Further research is needed to assess the applicability of the measure to other populations and contexts.     

Systemic strategies for dealing with problem children in institutional settings

Family therapy when a problem child enters residential treatment is complicated and treacherous because of the need to coordinate what may often be competing hierarchies (parental, residential, school). If the goal of residential treatment truly is one of deinstitutionalization, of reintegrating the child into his/her home, school, and community, the family therapist must see to it that the parental hierarchy is the primary one and that all institutional hierarchies are kept secondary. This paper presents, through a discussion of the forces that operate as institutionalization of children progresses and through case illustrations, a framework in which family therapy can be conducted within a residential treatment setting.The author expresses appreciation to Barbara DiCocco, MSW, Phyllis Stern, MA, John Rhead, PhD, and Karen Meckler, MD, for their helpful comments on the initial draft of this article and to Linda McClure, MSW, and Larry McAvoy for their administrative support.     

Physical stigma and the pregnancy role: Receiving help from strangers

Previous research has demonstrated several similarities in the reaction of others to pregnant and to physically stigmatized individuals. This study recorded helping behavior (assistance in picking up scattered keys) directed toward an apparently pregnant, nonpregnant, or facially disfigured woman in an elevator either alone, with a female companion, or with a male companion. A predicted interaction revealed that significantly more assistance was given to the pregnant woman than to either of the other two only when she was alone or with a female companion; she was helped less than the non-pregnant experimenter when she was accompanied by a male. Differences and similarities in the norms that govern behavior toward pregnant women and the physically stigmatized are discussed in light of their relevance to women's development during the childbearing years. The well-documented negative effect of group size on helping was replicated. Unexpected sex differences were found in rate of helping. Women virtually never helped in this situation—even in all-female groups. These findings are discussed in light of previous work on sex differences in helping.Preparation of this article was supported by a faculty development grant awarded to the first author by Rhodes College. We wish to thank Bella DePaulo, Robert Vidulich, and Chris Wetzel for their helpful comments on an earlier draft of the paper.     

Effects of noise on pure-tone thresholds in blackbirds (Agelaius phoeniceus and Molothrus ater) and pigeons (Columba livia)

Blackbirds and pigeons were trained to detect tones in quiet and in broadband noise by using positive-reinforcement techniques. In Experiment 1, thresholds in noise were obtained in blackbirds as a function of both tone frequency and noise intensity for a pulsed noise masker (noise gated on and off with tone). For blackbirds, critical ratios (the ratio of the power of the just-detectable tone in noise to the power of the noise masker) obtained in pulsed noise showed no consistent relation to tone frequency. For pigeons, on the other hand, critical ratios obtained in continuous noise increased by about 3 dB/octave across their range of hearing, being similar to known critical ratio functions for cats and humans. In Experiment 2, critical ratios in blackbirds obtained with both continuous noise and pulsed noise were compared. Blackbird critical ratios were more stable in continuous noise and averaged 4 dB lower than critical ratios in pulsed noise. The blackbird critical ratio function obtained with continuous noise was similar to the known critical ratio function of another avian species, the parakeet. Thus, small birds appear to have atypical critical ratio functions, compared with pigeons and other vertebrates.     

The presence of a temporal discrimination in the conditioned emotional response with humans,

Six college students participated in matching-to-sample tasks. Conditioned emotional response (CER) training consisted of pairing a tone with a "painful" level of shock. Three of the subjects demonstrated response suppression, one subject showed facilitation, and two showed no change. Analysis of response rate during the tone interval indicated that, for those subjects who showed response suppression, the decrease in response rate was greatest immediately before onset of the unconditioned stimulus. This temporal discrimination was similar to that obtained with infrahumans.     

Maternal employment,anxiety, and sex differences in college students' self-descriptions

This study sought to determine if a relationship exists between maternal employment during childhood, anxiety, and gender in college students. A questionnaire incorporating the Adjective Generation Technique (AGT) was administered to undergraduate psychology students from intact, two-parent families. Subjects were grouped into four categories: males whose mothers worked during their childhood (n=33), males whose mothers remained home (n=49), females whose mothers worked (n=54), and females whose mothers remained home (n=49). Data were analyzed using a 2×2 analysis of variance. Results indicated no differences in anxiety for subjects of either sex in relationship to the employment status of the mothers. A pronounced sex difference was found, with females scoring significantly higher in anxiety than males.