Cancer Family History Reporting: Impact of Method and Psychosocial Factors

Family history is one the greatest risk factors for disease and one of the most important informational tools in medical genetics for the purpose of diagnosis, risk assessment, prevention and treatment. However, research is needed on the comparability of different methods of cancer family history assessment and the influence of psychosocial factors in family history reports. The purpose of this study was to determine if individuals had discrepancies between written and interview reports of cancer family history and the role of psychosocial factors in these discrepancies. Oncology patients (n=104) were administered a survey to assess psychosocial factors (i.e., information-seeking, worry, perceived risk, and health literacy) and were asked to provide family history in a written and an interview form. Randomization determined which form individuals received first. No differences in the amount of missing data or the amount of unspecified data were noted between the written and interview method. Psychosocial factors did not differentiate between those who had discrepancies in family history reports and those who did not have discrepancies in family history reports; although there was a trend for those with lower literacy and those who were blunters to be more discrepant on type of cancer diagnosis. In sum, this preliminary study indicates that written and interview methods of family history assessment for first degree relatives may be used interchangeably. The ability to use written methods will facilitate collection of basic family history information in the oncology clinic.     

Recommendation Recall and Satisfaction After Attending Breast/Ovarian Cancer Risk Counseling

This study examined women’s recall of physician recommendations as well as patient satisfaction following participation in a breast/ovarian cancer risk and prevention program. Participants were 41 high risk women who attended a cancer risk program 4–6 months earlier. Two-thirds of women who received recommendations for tamoxifen treatment and genetic testing did not recall these recommendations upon follow-up. A number of women misunderstood recommendations and a quarter of the sample recalled recommendations that were not made during the consultation. Although these high risk women were generally satisfied with their counseling visit, those individuals who received particularly complex sets of recommendations reported feeling less understood and were less satisfied with the counseling. Findings underline the importance of examining recommendation recall, in addition to perceptions of cancer risk, when evaluating the clinical implications of cancer risk assessment.     

Increasing Utilization of Cancer Genetic Counseling Services Using a Patient Navigator Model

Rarely has utilization of genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) been studied separately from utilization of testing. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic counseling. To increase the volume of genetic counseling appointments, a patient navigator approach was pilot tested in a randomized-controlled trial over 3 months. A total of 125 members were referred for HBOC genetic counseling (55 randomized to PN, 70 randomized to usual care). Utilization of referrals for Navigator-assisted members was 44%, compared to 31% in the usual care arm (p=0.16). The patient navigator significantly decreased time to appointment, with over 80% of Navigator-assisted members seen for genetic counseling less than three months from referral date, compared to 32% in usual care (p=0.002). patient navigator assistance shortens time from referral to appointment for HBOC genetic counseling, and may increase utilization of such services.     

Risky Communication: Pitfalls in Counseling About Risk,and How to Avoid Them

A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them.     

Hypothetical Retrospection

Moral theory has mostly focused on idealized situations in which the morally relevant properties of human actions can be known beforehand. Here, a framework is proposed that is intended to sharpen moral intuitions and improve moral argumentation in problems involving risk and uncertainty. Guidelines are proposed for a systematic search of suitable future viewpoints for hypothetical retrospection. In hypothetical retrospection, a decision is evaluated under the assumption that one of the branches of possible future developments has materialized. This evaluation is based on the deliberator’s present values, and each decision is judged in relation to the information available when it was taken. The basic decision rule is to choose an alternative that comes out as morally acceptable (permissible) from all hypothetical retrospections.

两种社会交换对组织公民行为的影响: 组织认同和自尊需要的不同作用

从社会交换理论的角度探讨了组织支持感(POS)和组织外在声望感知(PEP)对组织公民行为的影响, 以及在这一影响过程中组织认同和自尊需要的角色和地位。采用结构方程建模和层次回归分析的方法, 通过对23家企业的员工和主管的配对问卷调查所获取的234份有效数据进行分析, 结果表明: (1)POS对组织认同有着直接的显著影响, 并完全通过组织认同的中介作用对两种组织公民行为(注重个体的和注重组织的组织公民行为)产生间接的影响; (2)PEP对组织认同也有着直接的显著影响, 并完全通过组织认同的中介作用对两种组织公民行为产生间接的影响; (3)个体的自尊需要对POS和组织认同的关系有调节作用, 但对PEP和组织认同的关系没有调节作用。     

自然灾难后身心反应的影响因素:研究与启示

所有经历自然灾难的人都会出现应激反应。随着时间的推移, 这些反应或消退, 或转化为一种创伤后成长(PTG), 或恶化为创伤后应激障碍(PTSD)等。根据危险因素模型, 这一过程受三类因素影响:(1)前灾难因素, 如性别、年龄等;(2)当下灾难因素, 如创伤暴露程度等;(3)后灾难因素, 如社会支持、复原特征等。其中, 后灾难因素得到了更多的关注。在危险-保护因素模式及机体主动模式的基础上, 分析了后灾难因素的作用机制, 通过研究的整合, 探讨了其对于灾后研究和干预的启示。     

防治血管剩留风险的决策探讨

针对冠心病和（或）2型糖尿病患者,已有许多有效的防治措施。然而,尽管接受了当前的标准治疗,这类患者仍会反复发生许多大血管和微血管事件,这种现象称之为血管剩留风险。有许多因素影响血管剩留风险的存在,其中最为重要的是致动脉粥样硬化性血脂异常。因此,采取积极的全面干预措施如改善生活方式、联合降脂以改善所有的脂质异常指标,是最大程度降低血管剩留风险的动向。     

产后抑郁相关危险因素分析

本文通过分析引发产后抑郁的相关危险因素及其对健康的影响,为探索干预措施提供依据。危险因素重要性的分析显示“夫妻关系不佳”位居危险因素之首;产妇的性格特征和孕期心理状态是产后抑郁发生的重要心理影响因素。因此,丈夫角色不容忽视,社会支持系统的建立意义重大,干预效果显著的因素应作为研究重点。     

ICU患者外出检查风险分析与对策

为了探讨ICU危重患者外出检查风险的原因,从而降低ICU危重患者外出检查风险,本文通过对312例ICU患者外出检查风险因素进行讨论分析,研究降低风险的对策,即在规范ICU患者外出检查流程、做好检查前准备和注意途中安全及返回后的护理,结果提示285例患者无意外发生,安全返回病房,其余27例患者存在一定风险,但在相应处理措施下均安全返回病房。