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.     

Acceptance of Genetic Counseling and Testing in a Hospital-Based Series of Patients with Gynecological Cancer

Referral of patients with endometrial (EC) and/or ovarian cancer (OC) for genetic counseling is based on age at diagnosis and family history. Many patients with hereditary cancers are missed by following this strategy. We determined acceptance and mutation detection rate of offering genetic counseling and testing to unselected EC and OC patients. Therefore, in 2007, EC and OC patients were invited for genetic counseling and testing. Patients were asked for their reasons to accept or decline. Nineteen out of fifty-two EC patients (36 %) and twenty-two out of thirty-five OC patients (63 %) accepted genetic counseling, mainly to receive risk assessment for themselves and relatives. Counseling was declined mainly because patients did not want more tests or had no relatives for whom it was relevant. Eighteen out of nineteen EC patients (95 %) and twenty out of twenty-two OC patients (91 %) underwent genetic testing. One EC patient carried an MSH6 mutation (mutation detection rate: 6 %). BRCA1/2 mutations were found in two out of twenty OC patients (10 %). Eleven patients (29 %) received surveillance recommendations for themselves and their relatives. Finally, family history recorded by the gynecologist was compared to that taken by the clinical geneticist. Gynecologists reported family history in ten out of forty-one participants (24 %). In conclusion, genetic counseling and testing are acceptable to patients with OC and/or EC. The 10 % BRCA1/2 mutation detection rate and underreporting of family history by gynecologists warrant referral for genetic counseling for all OC patients, followed by BRCA1/2 testing if indicated. We recommend that microsatellite instability and immunohistochemical analysis be performed in all EC patients, followed by genetic counseling if appropriate. These strategies will lead to better cancer prevention in gynecological cancer patients and their relatives.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

Faculty Members’ Perceptions of How Academic Work is Evaluated: Similarities and Differences by Gender

A questionnaire about how academic performance is evaluated and the importance of teaching and research was completed by 265 faculty at a UK research university. Factor analysis followed by t-tests showed that male faculty had a more realistic understanding of how their research is evaluated, rate the importance of research to their careers more highly, and are more likely than women to work over hours through choice. Women faculty are more likely than men to work over hours because of teaching workload and rate the importance of a teaching qualification more highly, despite giving similar ratings as men to the importance of teaching to their career. The implications for differential rates of promotion are discussed.     

Career and employer change in the age of the ‘boundaryless’ career

This study examined the direct effect of individual career concerns on career and employer change intention, as well as the buffering influence of organisational commitment on this relationship, based on the AMO model of behavioural change intention. Survey data, collected from 341 employees across industry sectors in Australia, showed that ‘exploration’ concerns related positively to both employer and career change intentions; the impact of exploration concerns on career change intention was buffered by affective commitment, however, and reinforced by normative commitment. ‘Establishment’ concerns related negatively to career change intention, and this effect was also buffered by level of affective commitment. The results point towards the distinct nature of employer and career change, and prompt calls for further research on the interplay of the myriad of factors that influence boundary-crossing career behaviour.     

Career adapt-abilities scale — Netherlands form: Psychometric properties and relationships to ability,personality, and regulatory focus

The Career Adapt-Abilities Scale (CAAS) — Netherlands Form consists of four scales, each with six items, which measure concern, control, curiosity, and confidence as psychosocial resources for managing occupational transitions, developmental tasks, and work traumas. Internal consistency estimates for the subscale and total scores ranged from satisfactory to excellent. The factor structure was quite similar to the one computed for the combined data from 13 countries. The Dutch version of the CAAS-Netherlands Form is identical to the International Form 2.0. The convergent validity of the CAAS-Netherlands was established with relating the CAAS subscales to self-esteem, Big Five personality measures, and regulatory focus. Relations between the subscales and these stable personality factors were largely as predicted. The discriminant validity of the CAAS-Netherlands was established by relating the CAAS scores to general mental ability; no significant relationship between career adaptability and general mental ability was found.     

Women’s Regrets About Their Lives: Cohort Differences in Correlates and Contents

In this paper we test hypotheses about the importance of life stage in moderating the relationship between acknowledging regrets and concurrent well-being, as well as how changes in women’s social roles during the post-war period affected the content of the regrets they develop. We examine the relationship between women’s life regrets and life satisfaction, and the content of life regrets, using data from 313 predominately white, college-educated women who graduated from the same university in the United States in 1951/2 (age 66), 1972 (age 46) and 1992 (age 26). Analyses revealed that the more types of regrets middle-aged and older women reported (the 1972 and 1951/2 cohorts respectively), the lower their life satisfaction; this pattern did not hold for the youngest women. In terms of the specific content of regrets, exact logistic regressions showed that women in the oldest cohort reported more regrets about prioritizing family over career compared with the later cohorts. Overall, few women reported regrets about prioritizing their careers over families; however, women in the middle cohort were most likely to report these regrets. Results are discussed in terms of both developmental and socio-historical frameworks.     

Body Appraisal,Weight Management Goals,and Well-Being Among Midlife Men and Women

In this paper, we assess the extent to which subjective and objective body appraisals relate to weight management goals and ultimately to life satisfaction in midlife men and women. The sample consisted of 141 midlife men and women (aged 55–59) from the Foley Longitudinal Study of Adulthood. We used both logistic and hierarchical linear regressions to examine relationships among and between variables. Both men and women expressed similar levels of body appraisal, and similar weight management goals; lower body appraisal and the presence of a weight management goal were both related to lower well-being. This study suggests that subjective and objective body appraisals may motivate the setting of weight management goals, and are significant contributors to well-being in midlife. Results are discussed in the context of aging, as well as gender.