Focusing on Patient Needs and Preferences May Improve Genetic Counseling for Colorectal Cancer

During cancer genetic counseling, different items which counselors consider important are discussed. However, relatively little empirical evidence exists regarding the needs and preferences of counselees. In this study needs and preferences were assessed from counselees with a personal and/or family history of colorectal cancer (CRC), who were referred for genetic counseling regarding CRC. They received a slightly modified version of the QUOTE-GENE^ca questionnaire prior to their first visit to the Hereditary Cancer Clinic. Response rate was 60 % (48/80 participants). Counselees rated the importance of 45 items assessing their needs and preferences regarding the content and process of genetic counseling. Participants rated the items regarding discussion of information about their familial CRC risk (100 %) and preventive options (98 %) as important or very important. Fewer participants rated items concerning general information on genetics as important. Sensitive communication during counseling was considered very important by a large percentage of counselees. Generally, no major differences were seen between participants in relation to individual characteristics. Our data suggest that focusing on familial CRC risk and surveillance options, in combination with sensitive communication may lead to better satisfaction with genetic counseling.     

An analysis of coping profiles and adjustment in persons with rheumatoid arthritis

This study examined dispositional and situative antecedents of vigilant and avoidant coping behavior. Seventy-two subjects were classified in coping style on the basis of their responses to the vigilance and cognitive avoidance scales of the Mainz Coping Inventory (MCI, Krohne, 1989), and alternatively, on their trait anxiety and defensiveness scores (cf. Weinberger, Schwartz, & Davidson, 1979). In a subsequent laboratory task, subjects were exposed to various conditions of predictability of an aversive event. In anticipation of an aversive loud tone, coping behavior was operationally defined as choosing to listen either to a warning channel (i.e., vigilance) or instead to music (i.e., avoidance). Probability of occurrence of a warning signal while listening to the warning channel varied across trials, being either 0%, 33%, 66%, or 100%. Subjects were exposed to each level and were informed about the respective probability in advance. In general, listening to the warning channel increased with an increase in the probability of the warning signal. However, four groups of subjects who differed in their pattern of coping behavior across trials were observed: rigid-avoidant copers (always listening to music), rigid-vigilant copers (always monitoring the warning channel), flexible copers (switching from music to warning channel with increasing probability of warning), and inconsistent copers (vacillating between music and warning channel regardless of probability of warning). Coping style classifications did not show substantial associations with coping behavior. However, subjects demonstrating the inconsistent coping pattern scored high on trait anxiety.     

International Genetic Counseling Students’ Perspective on Their Training Experience in the United States

International students face social, psychological and academic challenges upon moving to a foreign country to pursue higher education. Clinical disciplines such as genetic counseling present additional challenges adapting to an unfamiliar health care system and different interactions and expectations with patients and colleagues. This study used semi-structured interviews to identify challenges that international genetic counseling students face during training in the United States. Eight international genetic counseling alumni who graduated from U.S.-accredited programs were interviewed. Participants stated that the U.S. academic system was unfamiliar—class participation and paper-writing required the greatest adjustment. There was a need for help in understanding social norms in academic settings. Clinically, they were unfamiliar with the dynamics and communication style of U.S. families. Non-native English speakers experienced greater difficulty in all areas. Most participants reported that they were uncomfortable asking for help in transitioning to life, study and work. Participants identified mentorship programs for international students as potentially useful in clarifying expectations in academic and clinical settings. These results may assist international students preparing to study genetic counseling in the U.S. and may help genetic counseling training programs identify the academic and clinical challenges faced by international students.     

Inconsistent child-rearing: A reply to rosenthal

Abstract

In a reply to our paper (Kohlmann, Schumacher, & Streit, 1988), Rosenthal (in a Letter to the Editors, this issue) primarily gives some comments on findings regarding the association of inconsistent child-rearing behavior and anxiety in the child. Results of our study were compared to results from a study by Rosenthal, Finkelstein, Ni, and Robertson (1959).     

Reliability and Validity of the Dyadic Observed Communication Scale (DOCS)

We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.     

An Exploration of Family Problem-Solving and Affective Involvement as Moderators Between Disease Severity and Depressive Symptoms in Adolescents with Inflammatory Bowel Disease

Little is known about how family functioning relates to psychosocial functioning of youth with inflammatory bowel disease (IBD). The study aim was to examine family problem solving and affective involvement as moderators between adolescent disease severity and depressive symptoms. Participants were 122 adolescents with IBD and their parents. Measures included self-reported and parent-reported adolescent depressive symptoms, parent-reported family functioning, and physician-completed measures of disease severity. Disease severity was a significant predictor of adolescent-reported depressive symptoms, but not parent-reported adolescent depressive symptoms. Family affective involvement significantly predicted parent-reported adolescent depressive symptoms, while family problem-solving significantly predicted adolescent self-report of depressive symptoms. Neither affective involvement nor problem-solving served as moderators. Family affective involvement may play an important role in adolescent emotional functioning but may not moderate the effect of disease severity on depressive symptoms. Research should continue to examine effects of family functioning on youth emotional functioning and include a sample with a wider range of disease severity to determine if interventions aimed to enhance family functioning are warranted.     

Student perceptions of school efforts to facilitate student involvement, school commitment, self-determination, and high school graduation

This study examined the relationship between student perceptions of school efforts to facilitate student involvement, school commitment, self-determination skills, and ontrack indicators for graduation in 10th grade and actual graduation outcomes two years later. The participants were 154 primarily minority students in a large, urban school district. Student perceptions of higher levels of school efforts to facilitate student involvement was related to an increased likelihood that students had passed a state high stakes assessment and were on-track for graduation at the end of 10th grade and an increased likelihood of actual graduation. Implications for facilitating student involvement in educational planning are discussed.     

Context effects in recognition memory: the role of familiarity and recollection

A variant of the process dissociation procedure was coupled with a manipulation of response signal lag to assess whether manipulations of context affect one or both of the familiarity and search processes described by the dual process model of recognition. Participants studied a list of word pairs (context+target) followed by a recognition test with target words presented in the same or different context, and in the same or different form as study (singular/plural). Participants were asked to recognize any target word regardless of changes to form (inclusion), or to only recognise words that were presented in the same form (exclusion). The standard context reinstatement effect was evident even at the short response lags. Analyses of the estimates of the contributions of familiarity and search processes suggest that the context effect demonstrated here can be attributed in part to the influence of familiarity on recognition, whereas the effect on recollection was less clear.     

Investment in body image among patients diagnosed with or at risk for malignant melanoma

We examined investment in body image among 48 patients diagnosed with, or at risk for malignant melanoma (MM), as well as factors hypothesized as related to increased investment, such as gender, perceived stress, mood, fatigue, and personality characteristics. Investment in body image was evaluated using the Measure of Body Apperception [Carver, C. S., Pozo-Kaderman, C., Price, A. A., Noriega, V., Harris, S. D., Derhagopian, R. S., Robinson, D. S., & Moffat, F. L. Jr. (1998). Concern about aspects of body image and adjustment to early state breast cancer. Psychosomatic Medicine, 60, 168–174]. Results showed that women reported more concerns about physical appearance than men, and patients with MM exhibited more concerns about body integrity than at-risk patients. Concerns about body integrity were related to more compulsive personality characteristics, whereas concerns about appearance were associated with more histrionic personality characteristics. Body image investment was related to poorer adjustment as indicated by heightened symptoms of fatigue and stress. This study suggests that further research on investment in body image in this patient population is warranted.     

Talking about Homosexuality: The Views of Mainline Protestant Clergy

Homosexuality is one of the most divisive issues within mainline Protestantism today. In this article we portray the many sides of mainline Protestantism's debates about homosexuality through the lens of statements clergy made about the issue in early 2000. In interviews with 62 mainline Protestant clergy across the United States, 40 volunteered their views on homosexuality without being prompted. We describe the frames through which clergy understand and articulate issues related to homosexuality in the midst of contentious denominational debate about the subject. The majority of clergy who discussed homosexuality focused on the issue in their churches instead of in society at large, and in their denominations rather than in their own congregations. Moreover, virtually none of the clergy interviewed took hard and fast stands on the issue of homosexuality. Most approach the issue in a pragmatic, rather than prophetic, way. Our interviews also show that pastors who choose to speak on homosexuality tend to frame the issue in terms of the diffuse notion of "homosexuality," rather than talking about gay men and lesbians as people.