Why Is Cancer Genetic Counseling Underutilized by Women Identified as at Risk for Hereditary Breast Cancer? Patient Perceptions of Barriers Following a Referral Letter

Family history information comprises an important tool in identifying and referring patients at risk for hereditary breast and ovarian cancer (HBOC) to cancer genetic counseling. Despite recommendations and support provided by numerous professional organizations, cancer genetic counseling services are underutilized by atrisk patients. This study aimed to: (1) determine the rate of genetic counseling utilization following a referral letter, (2) characterize factors (barriers and supports) which influenced uptake of services, and (3) identify potential strategies for increasing utilization. This study evaluated the uptake of cancer genetic counseling among 603 screening mammography patients identified as having an increased risk for HBOC based on National Comprehensive Cancer Network (NCCN) guidelines. At risk individuals and their primary care providers were mailed a referral letter recommending genetic counseling. Three focus groups (N = 24) were conducted to identify responses to receiving a letter recommending genetic counseling, barriers to seeking genetic counseling, and facilitating factors to utilizing these services. Participant responses were qualitatively analyzed using thematic and cross case analysis. Within one year, 50/603 (8 %) of the identified at-risk women completed a genetic counseling appointment. Participant-perceived barriers which influenced their decision not to seek genetic counseling included lack of relevance and utility, limited knowledge about genetic counseling, concerns about the genetic counseling process, and concerns about cost and insurance coverage. Participant-perceived facilitating factors which would support a decision to seek genetic counseling included greater awareness and education about genetic counseling services when receiving a referral, and improved follow up and guidance from their provider. Findings from this study support the need for patient and primary care provider education, and improved provider-patient communication to increase uptake of genetic counseling services.     

Static balance in children with developmental coordination disorder

The purpose of this study was to compare the postural sway profiles of 9/10-year-old children with developmental coordination disorder and balance problems (DCD-BP, n=64) with those of non-DCD children (n=71). We measured center of pressure excursions in conditions with and without vision for 30s while standing still on the dominant leg, the non-dominant leg, or both legs. Sway area, total path length, and Romberg's quotient were analyzed. Most measures differed significantly between groups, except sway area when the children stood with vision on either the dominant leg or both legs. When standing on the dominant leg or both legs, DCD-BP children demonstrated greater total path length in all conditions and a greater sway area in without-vision conditions. DCD-BP children showed more difficulty standing on the non-dominant leg with eyes both open and closed. While boys showed results similar to the total group, the girls with DCD-BP only exhibited significant differences in three conditions with eyes closed, but not with eyes open. Analysis of Romberg's coefficient also indicated that children with DCD-BP did not over-rely on visual information.     

Effects of amount of information on judgment accuracy and confidence

When a person evaluates his or her confidence in a judgment, what is the effect of receiving more judgment-relevant information? We report three studies that show when judges receive more information, their confidence increases more than their accuracy, producing substantial confidence–accuracy discrepancies. Our results suggest that judges do not adjust for the cognitive limitations that reduce their ability to use additional information effectively. We place these findings in a more general framework of understanding the cues to confidence that judges use and how those cues relate to accuracy and calibration.     

Learning what feelings to desire: socialization of ideal affect through children's storybooks

Previous findings suggest that cultural factors influence ideal affect (i.e., the affective states that people ideally want to feel). Three studies tested the hypothesis that cultural differences in ideal affect emerge early in life and are acquired through exposure to storybooks. In Study 1, the authors established that consistent with previous findings, European American preschoolers preferred excited (vs. calm) states more (indexed by activity and smile preferences) and perceived excited (vs. calm) states as happier than Taiwanese Chinese preschoolers. In Study 2, it was observed that similar differences were reflected in the pictures (activities, expressions, and smiles) of best-selling storybooks in the United States and Taiwan. Study 3 found that across cultures, exposure to exciting (vs. calm) storybooks altered children's preferences for excited (vs. calm) activities and their perceptions of happiness. These findings suggest that cultural differences in ideal affect may be due partly to differential exposure to calm and exciting storybooks.     

Change in ethnic identity across the college transition

This article examined changes in ethnic identity as a function of college type and residential status and whether differences due to college type could be explained by involvement in extracurricular activities and college ethnic composition. Although no changes in ethnic labeling or belonging were found, there was a normative decrease in ethnic search, independent of residential status. Moreover, the decline in ethnic search was significantly greater at 2- than 4-year colleges, and this difference was mediated by higher rates of participation in extracurricular activities at 4-year colleges. Ethnic identity did not vary by college ethnic composition. There were no ethnic or generation differences in ethnic identity change; however, women were more likely to include an American term in their ethnic label than were men, over time. Averaging across time, students at 4-year colleges also had a greater preference for the American term in their ethnic labels. Findings illuminate the importance of context in shaping ethnic identity.     

Depletion manipulations decrease openness to dissent via increased anger

We investigated a potential outcome of ego depletion manipulations and an important factor behind cooperative failure: a lack of openness to others’ dissenting opinions. Across five studies in a variety of task settings, we examined the effect of depletion manipulations on openness to dissent and investigated two negative emotions as potential mediators of this process: fatigue and anger. The results demonstrated a negative effect of depletion manipulations on openness to dissent through increased anger rather than fatigue (Studies 1–5). In Studies 3 and 4, we also eliminated perceived trust towards a task counterpart as a significant mediator of the relationship between depletion manipulations and openness to dissent. These findings help clarify the nature of ego depletion manipulations and shed light on why individuals may fail to consider others’ dissenting opinions and, thus, fall short of achieving cooperation.     

Gender differences in emotional response among European Americans and Hmong Americans

The present study examined the effects of gender on the emotional responses (physiology, self-reports of emotion, and emotional facial behaviour) of European Americans (EA) and Hmong Americans (HA) while they relived past emotional events. Women were more emotionally reactive than men: They demonstrated greater changes in electrodermal reactivity overall, reported experiencing more intense emotion while reliving anger and love, and smiled more while reliving happiness and love. The pattern and magnitude of these differences were similar for EA and HA, suggesting that to some degree, the effects of gender on emotional response may hold across ethnic groups.