Patient-provider care goal concordance: implications for palliative care decisions

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients’ care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers’ predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.

Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N?=?492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients’ care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.

Results: For 28% of providers, their own care goals differed from their patients’. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients’ goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.

Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.     

Goal Commitment Buffers the Negative Effects of Perceived Abusive Supervision

Abstract

The effects of abusive supervision may be more intricate than what reason would suggest. To examine why individuals may respond differently to perceptions of supervisor abusive, this study relies on goal-setting theory to present a model that accounts for the influence of abusive supervision on job performance and organizational deviance. To be precise, motivation control and self-defeating cognition are proposed to mediate the interaction of perceived abusive supervision with goal commitment in predicting organizational deviance and job performance. In particular, the extent to which goal commitment alleviates the deleterious effects of abusive supervision is examined such that when goal commitment is high, the indirect effects of perceived abusive supervision on job performance and organizational deviance via motivation control and self-defeating cognition were predicted to be weaker. The proposed model was supported by multisource and multiwave data. The understanding of when the deleterious effects of supervisor abuse as perceived by followers are likely might help the human resource personnel to adopt measures that buffer against such outcomes.     

The Stochastic Goal Programming Model: Theory and Applications

Supported by a network of researchers and practitioners, the goal programming (GP) model is alive today more than ever and is continually fed with theoretical developments and new applications with resounding success. The standard formulation of the GP model was introduced in the earliest of 1960s, and since then, important extensions and numerous applications have been proposed. One of these variants is the stochastic GP model that deals with the uncertainty of some decision‐making situations by using stochastic calculus. In such a situation, the decision maker is not able to assess with certainty the different parameters. However, he or she can provide some information regarding the likelihood of occurrence of the decision‐making parameter values. The aim of this paper is to highlight the main methodological developments of the stochastic GP model and to present an overview of its applications in several domains. Copyright © 2012 John Wiley & Sons, Ltd.     

Homeless mothers: is there a relationship between coping strategies,mental health and goal achievement?

This study examined the relationship between coping, mental health and goal achievement among homeless mothers. Seventy-two women took part and 44 were re-interviewed 4 months later. The Family Crisis Oriented Personal Evaluation Scales (F-COPES) were used to identify their coping strategies at the time of homelessness; the General Health Questionnaire (GHQ) measured mental health problems; and a semi-structured questionnaire identified their goals. Outcome measures at follow-up were goal achievement and mental health. A variety of coping strategies were used, with some differences ascertained according to reason for homelessness and age of respondent. Lower use of problem-focussed coping was associated with poorer mental health at the time of homelessness. Mental health problems improved over time, but levels of psychopathology remained high at follow-up. Most women had achieved their primary goal of resettlement, and this was associated with use of problem-focussed coping. Lower use of problem-focussed coping, in particular, acquiring social support, was associated with continuation of mental health problems at follow-up, however the greatest predictor of mental health at follow-up was mental health status whilst homeless. Despite exposure to major stressors and poor mental health, mothers experiencing homelessness can maintain their ability to cope effectively, in order to achieve their goals. Copyright © 2007 John Wiley & Sons, Ltd.     

Instinct: A biologically inspired reactive planner for intelligent embedded systems

The Instinct Planner is a new biologically inspired reactive planner, based on an established behaviour based robotics methodology and its reactive planner component — the POSH planner implementation. It includes several significant enhancements that facilitate plan design and runtime debugging. It has been specifically designed for low power processors and has a tiny memory footprint. Written in C++, it runs efficiently on both Arduino (Atmel AVR) and Microsoft VC++ environments and has been deployed within a low cost maker robot to study AI Transparency. Plans may be authored using a variety of tools including a new visual design language, currently implemented using the Dia drawing package.     

A soft-contact model for computing safety margins in human prehension

The soft human digit tip forms contact with grasped objects over a finite area and applies a moment about an axis normal to the area. These moments are important for ensuring stability during precision grasping. However, the contribution of these moments to grasp stability is rarely investigated in prehension studies. The more popular hard-contact model assumes that the digits exert a force vector but no free moment on the grasped object. Many sensorimotor studies use this model and show that humans estimate friction coefficients to scale the normal force to grasp objects stably, i.e. the smoother the surface, the tighter the grasp. The difference between the applied normal force and the minimal normal force needed to prevent slipping is called safety margin and this index is widely used as a measure of grasp planning. Here, we define and quantify safety margin using a more realistic contact model that allows digits to apply both forces and moments. Specifically, we adapt a soft-contact model from robotics and demonstrate that the safety margin thus computed is a more accurate and robust index of grasp planning than its hard-contact variant. Previously, we have used the soft-contact model to propose two indices of grasp planning that show how humans account for the shape and inertial properties of an object. A soft-contact based safety margin offers complementary insights by quantifying how humans may account for surface properties of the object and skin tissue during grasp planning and execution.     

A Riemannian geometry theory of human movement: The geodesic synergy hypothesis

Mass-inertia loads on muscles change with posture and with changing mechanical interactions between the body and the environment. The nervous system must anticipate changing mass-inertia loads, especially during fast multi-joint coordinated movements. Riemannian geometry provides a mathematical framework for movement planning that takes these inertial interactions into account. To demonstrate this we introduce the controlled (vs. biomechanical) degrees of freedom of the body as the coordinate system for a configuration space with movements represented as trajectories. This space is not Euclidean. It is endowed at each point with a metric equal to the mass-inertia matrix of the body in that configuration. This warps the space to become Riemannian with curvature at each point determined by the differentials of the mass-inertia at that point. This curvature takes nonlinear mass-inertia interactions into account with lengths, velocities, accelerations and directions of movement trajectories all differing from those in Euclidean space. For newcomers to Riemannian geometry we develop the intuitive groundwork for a Riemannian field theory of human movement encompassing the entire body moving in gravity and in mechanical interaction with the environment. In particular we present a geodesic synergy hypothesis concerning planning of multi-joint coordinated movements to achieve goals with minimal muscular effort.     

Reducing car use by volitional strategy of action and coping planning enhancement

Personalized travel plans have been regarded as potentially effective soft measures in mobility management. This research conducted a randomized social experiment aiming at citizen car-use reduction, and examined the effect of implementing two personalized travel plans: action plans and coping plans. The two types of plans were designed respectively for enhancing action planning and coping planning as the volitional factors of behavior change. The results supported the effectiveness of the combined action-plus-coping plan intervention in reducing car use, but not of the action plan alone intervention. In addition, the influence of intervention on behavioral intention, action planning, and coping planning, were also presented.