Patients' information needs and decision-making processes: what can be learned from genetic counselees?

This field study investigated the information needs and decision-making strategies of 161 genetic counselees interviewed just prior to counseling. Patients were interested mostly in information about the outcomes and consequences of the alternative options at their disposal and about measures to defuse the risks. They wanted mainly information stated with certainty and were less interested in probability information. There was no difference in the search for information between the alternative eventually chosen and the one not chosen. There was a difference, however, among types of decisions and the interest in the various categories of information. These findings were interpreted within the theoretical model of decision making in natural risky situations (O. Huber, 1997). Practical implications for shared medical decision making are presented.     

Mediating Effects of Perceived Personal Control in Coping With a Health Threat: The Case of Genetic Counseling1

The potential impact of perceived personal control on coping with a medical threat was investigated in genetic counseling, a clinical setting where issues of personal control are central. Data were collected from 72 counselees at a genetic clinic before, immediately after, and 1 month after initiating genetic counseling. Findings supported the hypothesized mediating model. Higher perceived control (cognitive-interpretive and decisional) and satisfaction with genetic counseling mediated between genetic counseling and the use of less emotion-focused coping strategies. Problem-focused coping was predicted only directly by counselees' knowledge of their problem after genetic counseling. Changes in emotion-focused coping were related to perceived increases in positive affect 1 month later, while changes in use of problem-focused coping were related to perceived decreases in both positive and negative affect.     

Modelling decisions to undergo genetic testing for susceptibility to common health conditions: an ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25-40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

The Role of Spiritual Experiences and Activities in the Relationship Between Chronic Illness and Psychological Well-Being

Our research explores the correlates of spiritual experiences over a 2-year period in a sample of older adults (N = 164; mean age 81.9 years) living in a continuing care retirement community. Utilizing responses to the Daily Spiritual Experiences Scale, scores were analyzed for changes over time and for their hypothesized moderating effect in the relationship between chronic illness impact and markers of psychological well-being (as measured by the Geriatric Depression and Life Satisfaction scales). Repeated measures ANOVA indicated a significant decline (P < .01) in the reported spiritual experiences over a 2-year period of time, and t tests showed a significant difference by gender (P < .01) in years 1 and 2, with women reporting higher levels of spiritual experiences than men. Analyses found low spirituality scores associated with low life satisfaction in all years (baseline: r = ?.288, P < .01; year 1: r = ?.209, P < .05; year 2: r = ?.330, P < .001). Only weak associations were detected between low spirituality and the presence of depressive symptoms at baseline (r = .186, P < .05) and year 2 (r = .254, P < .01). Moderation effects of spirituality on the relationship between chronic illness impact and markers of psychological well-being were explored in all years, with a statistically significant effect found only for the presence of depressive symptoms in year 2. Higher impact of chronic illnesses is associated with more depressive symptoms under conditions of low spirituality. Future research may center upon longer-duration evaluation of reliance upon spiritual practices and their impact in care management models.     

Objects and Levels: Reflections on the Relation Between Time-Consciousness and Self-Consciousness

The text surveys the development of the debate between Zahavi and Brough/Sokolowski regarding Husserl’s account of inner time-consciousness. The main arguments on both sides are reconsidered, and a compromise is proposed.     

Empathy,Embodiment and Interpersonal Understanding: From Lipps to Schutz

When it comes to understanding the nature of social cognition, we have—according to the standard view—a choice between the simulation theory, the theory-theory or some hybrid between the two. The aim of this paper is to argue that there are, in fact, other options available, and that one such option has been articulated by various thinkers belonging to the phenomenological tradition. More specifically, the paper will contrast Lipps' account of empathy—an account that has recently undergone something of a revival in the hands of contemporary simulationists—with various accounts of empathy found in the phenomenological tradition. I discuss the way Lipps was criticized by Scheler, Stein and Husserl, and outline some of the core features of their, at times divergent, alternatives. I then proceed by considering how their basic take on empathy and social cognition was taken up and modified by Schutz—a thinker whose contribution to the analysis of interpersonal understanding has been unjustly neglected in recent years.     

Parenting of 7‐month‐old infants at familial risk for attention deficit/hyperactivity disorder

Patterns of interaction between parents and 7‐month‐old boys at familial risk for attention deficit/hyperactivity disorder (ADHD) and a comparison group were studied during a warm‐up and two play episodes. The sample included 78 (47 at‐risk, 31 comparison) mother–child and 45 (27 at‐risk, 18 comparison) father–child dyads. A coding system developed by G. Kochanska (1997, 1998) was used. Infants in the risk group did not differ from the comparison group in the rate of emission of infant‐related events. However, they received less adequate responsivity from both their fathers and their mothers to these events, and specifically to negative emotions or distress, than did the comparison group. Maternal psychopathology did not account for these findings. Mothers were more adequately responsive than were fathers, especially for physiological needs. The association between nonoptimal interaction in infancy and the development of ADHD is discussed.     

The big carrot: High‐stakes incentives revisited

Using an international dataset of about 35 000 subjects, this paper provides an empirical example of high‐stakes incentives in relation to religious practice. First, we show that incentives (based on absolute belief) play a salient role in religious performance. Second, we find that when both positive (heaven) and negative (hell) incentives are available the former are more effective than the latter. Specifically, it is shown that beliefs in heaven are much more relevant than beliefs in hell when estimating the production of religious commodities (church‐attendance and praying equations). Copyright © 2009 John Wiley & Sons, Ltd.