Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

Personality Dysfunction and the Management of Chronic Medical Illness: A Community Health Sample

The purpose of this study was to determine the influence of personality disorders on perceived health status, self-efficacy for management of the chronic illness, and physician perception of patient health. A total of 607 patients with self-identified chronicillness(es) volunteered to participate in the study. Out of this sample, 147 had collaborative physician data indicating a chronic illness. The final sample was 143 due to incomplete data. Results suggested that maladaptive personality characteristics, as measured by the Short-Form of the Coolidge Axis II Inventory (SCATI), were related to a number of important factors that influence self-management of chronic illnesses. When the personality constellations were broken into 3 groups (normal, subclinical, and clinical) significant differences were found on the 3 groups of dependent variables (Subjective Health, Self-Efficacy, Physician Appraisal) for the different personality disorders. These data provide useful information on several factors that influence effective disease management. Clinical implications and directions for future research are provided.     

Eliciting salient beliefs in research on the theory of planned behaviour: The effect of question wording

The authors of the theory of reasoned action (TRA) and its extension, the theory of planned behaviour (TPB) recommend that researchers who use these theories to investigate the determinants of a given behaviour should first conduct an elicitation study to identify the modal salient beliefs in the target population. In spite of the importance accorded to salient beliefs by the TRA/TPB, the elicitation stage has received little research attention. This paper reports a detailed analysis of beliefs about “being more physically active in the next 12 months.” A general population sample of 213 adults completed a questionnaire while attending a research centre for a series of tests. The findings showed that the beliefs that were elicited by questions designed to prompt affective outcomes (like or enjoy, dislike or hate) differed systematically from those that were elicited by the traditional questions designed to prompt instrumental out-comes (advantages and disadvantages). Whether this resulted in different final sets of modal salient beliefs was found to depend on the particular decision rule that was employed. An alternative decision rule is proposed, based on maximizing the degree of overlap between the modal set and the full set of salient beliefs generated by the sample. The index of overlap can be used to gauge the adequacy of using a modal set of a given size to represent the salient beliefs of the whole sample. In the current dataset, the optimal modal set for “advantages and disadvantages” was associated with only 26 percent overlap with the salient beliefs of the whole sample, which was judged to be insufficient. In such cases, a better strategy may be to ask participants to generate and rate their own beliefs.     

The body in analysis: authentic movement and witnessing in analytic practice

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.     

When to Self-Correct?: A Comparison of Two Procedures on Spelling Performance

We compared the effects of two self-correction procedures on the spelling performance of 5 elementary school students with learning disabilities. Previous studies consistently have demonstrated self-correction to be more effective than traditional approaches to spelling instruction. However, we could find no single-subject design experiments analyzing the procedural details of how or when self-correction should be conducted to be most effective. For 4 days each week students practiced a list of 20 spelling words by listening to an audiotape on which the weekly list was dictated and writing the words. For half of each week's words, students checked and self-corrected after attempting each word; for the other half of the list, the students self-corrected after attempting all 10 words. An alternating treatments design showed self-correction after each word to be more effective for acquisition of new spelling words as measured by end-of-the-week tests for all 5 students, and maintenance of previously studied spelling words as measured by 1-week maintenance tests for 4 of the 5 students.     

An integrated model for guiding the selection of treatment components for problem behavior maintained by automatic reinforcement

We evaluated the usefulness of 2 assessments to guide treatment selection for individuals whose prior functional analysis indicated that automatic reinforcement maintained their problem behavior. In the 1st assessment, we compared levels of problem behavior during a noncontingent play condition and an alone or ignore condition. In the 2nd, we assessed participants’ relative preferences for automatic reinforcement and social reinforcers in a concurrent‐operants arrangement. We used the results of these 2 assessments to assign 5 participants to a treatment based on noncontingent access to social reinforcers or to a treatment based on differential access to social reinforcers. We conducted monthly probes with the participants over 10 to 12 months to evaluate the effects of the treatment procedures. All participants showed reductions in problem behavior over this period.     

Cultural worldviews and climate change: A view from China

We investigated the association between cultural worldviews and climate change risk perceptions, support for climate friendly policies and climate change mitigation behaviours in a large Chinese sample. Items from Dake's cultural theory scales and Kahan's cultural cognition scale were presented to a Qualtrics online panel consisting of 515 Mandarin‐speaking residents of Beijing. A series of factor analyses revealed that the combined item sets were best represented by four‐dimensions: hierarchism, individualism, egalitarianism and fatalism. Mediation analysis revealed that respondents with egalitarian and non‐fatalist worldviews perceived greater risk associated with climate change, which in turn predicted greater support for policies to manage climate change and increased mitigation behaviour. In addition, respondents who scored high on individualism were less likely to support climate change policies, but this effect was not mediated by risk perceptions. Overall, our results suggest cultural worldviews may influence policy support both directly and indirectly through risk perceptions.