Shared decision making and autonomy preferences of pediatric health care providers and parents of pediatric patients

INTRODUCTION

The aim of the current study was to determine whether parents of pediatric patients and health care providers (i.e., physicians and nurse practitioners) have different preferences for shared decision making (SDM) and whether these preferences vary across medical situations.

METHOD

Participants consisted of parents of children presenting to pediatric clinics (n = 164) and their matched pediatric health care providers (n = 18). Parents and providers completed measures of preferred autonomy for decision-making in general and across specific medical scenarios.

RESULTS

Preferences for autonomy were not uniform and varied across situations among providers and among parents. Further, parents and their providers differed from one another in their autonomy preferences across most scenarios, but not in general preferences.

DISCUSSION

The results of this study provide evidence of the complex nature of the provider-parent relationship in pediatric practice. This study highlights the need for providers to consider contextual factors that impact parents' preferences for autonomy when making shared medical decisions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Unsupported and Stigmatized? The Association Between Relationship Status and Well-Being Is Mediated by Social Support and Social Discrimination

Single adults, on average, experience worse well-being compared to coupled adults. But why? The current research bridged interpersonal and intergroup perspectives to examine the influence of social support and social discrimination on single versus coupled adults’ well-being. We drew on a nationally representative prospective study from New Zealand (Study 1, N = 4,024) and an integrative data analysis of three North American data sets examining peoples’ general (Study 2, N = 806) and day-to-day (Study 2, N = 889 and 9,228 observations) social experiences. The results demonstrated that single adults reported lower life satisfaction compared to coupled adults, and this may be partly due to single adults reporting lower perceptions of social support availability and greater experiences of negative treatment and discrimination compared to coupled adults. These novel findings move away from stereotypical assumptions about singlehood and highlight the important role of social relationships and interactions in determining single adults’ happiness and well-being.

The Attachment Dynamic: Dyadic Patterns of Anxiety and Avoidance in Relationship Functioning

Whereas attachment dimensions (i.e., anxiety and avoidance) are generally associated with lower levels of relationship evaluations (e.g., satisfaction, commitment), research has not yet fully incorporated how partner attachment is related to these evaluations, nor how dyadic patterns (actor × partner attachment interactions) are associated with evaluations. Across two dyadic studies (N = 185, 123 dyads), we examine how actor, partner, and actor × partner interactions of attachment anxiety and avoidance are associated with reports of trust, satisfaction, and commitment. Results generally revealed that actor effects of attachment anxiety on lower relationship evaluations were weaker when partners were more anxious and stronger when partners were more avoidant. Moreover, actor effects of attachment avoidance on lower trust and satisfaction were stronger when partners were more anxious. Finally, own avoidance was more strongly negatively related to commitment in the presence of a more avoidant partner. These results suggest that the combination of attachment within relationships is important to consider for both close relationships researchers and clinicians.

Seeking and Ensuring Interdependence: Desiring Commitment and the Strategic Initiation and Maintenance of Close Relationships

The current research offers and examines the concept of commitment desirability, defined as the subjective desire to be involved in a committed romantic relationship at a given time. In pursuing their desire for a committed romance, how do individuals high in commitment desirability strategically ensure success? We suggest that high perceived partner commitment is sought by individuals who themselves desire to be involved in a committed relationship. In three studies involving individuals both currently involved and not involved in a relationship, we found support for the hypothesized interactive effect of commitment desirability and perceived partner commitment, such that greater commitment desirability was associated with more positive relationship outcomes, especially when partners were perceived to be high in commitment. The present research suggests that commitment desirability is a meaningful predictor of relationship attitudes and behaviors. Implications for understanding relationship commitment as well as future research directions are discussed.

Do You See What I See? Actor and Partner Attachment Shape Biased Perceptions of Partners

The present research examined how actor and partner attachment insecurity relates to biases in perceptions of partners' core relationship-relevant constructs. Across three dyadic studies ( Ncouples = 333, Nindividuals = 666), we examined attachment anxiety and avoidance as predictors of over- or underestimation of partners' relationship satisfaction, commitment, and responsiveness, using partners' own reports as the reference point for evaluating bias. Actors higher in avoidance and actors with partners higher in avoidance perceived their partners to be less satisfied and committed. In addition, actors higher in avoidance and actors higher in anxiety displayed a pessimistic bias, perceiving their partners to be less satisfied and committed than their partners reported being. Finally, actors with partners higher in avoidance displayed an optimistic bias, perceiving their partners to be more satisfied and committed than their partners reported being. Results underscore the importance of adopting a dyadic perspective on perceptual biases in romantic relationships.

It’s About Time: Readiness, Commitment, and Stability in Close Relationships

Timing matters in relationships. People vary in their sense of when they think the time is right to be involved in a committed relationship. We propose and examine the construct of commitment readiness and its role in predicting important relationship outcomes including commitment level, maintenance processes, and stability among involved intimates. Data from five independent samples obtained with various methods revealed, as hypothesized, that readiness (a) predicts commitment, maintenance processes, and actions toward ending a relationship; (b) serves to moderate commitment in predicting maintenance processes (self-disclosure, accommodation, sacrifice); and (c) serves to moderate commitment in predicting leave behavior, with those reporting both higher commitment and higher readiness being more likely to enact maintenance behaviors and least likely to enact leave behavior. We discuss the importance of considering one’s readiness for commitment within ongoing involvements.

Commitment Readiness and Relationship Formation

The concept of being ready for a relationship is pervasive in popular culture, but theoretical and empirical research on readiness is lacking. We offer a conceptualization of commitment readiness and provide some of the first empirical work examining readiness among single individuals-specifically how this construct shapes various aspects of relationship formation. Using data from five independent samples of individuals not involved in romantic relationships, we first establish that commitment readiness is associated with more interest in developing a close romantic relationship (Studies 1a, 1b, 2) and with active pursuit of relationship initiation (Study 2). We then test whether readiness among single individuals longitudinally predicts both the likelihood of later entering a relationship and, ultimately, how committed individuals are to a future relationship (Studies 3a, 3b, 3c). Implications of commitment readiness specifically, and perceived personal timing more generally, for the social psychology of relationships are discussed.

What Do I Call Us? The Investment Model of Commitment Processes and Changes in Relationship Categorization

The investment model of commitment has been used to understand relationship maintenance and dissolution across a variety of populations and relationship types. The current study used data from the Project on Partner Dynamics (POPD), a cohort study of young adults involved in nonmarital sexual relationships in the Los Angeles area, to test whether and how the investment model of commitment processes predicts individuals' self-reported categorizations of their relationships over time. We examined (1) how relationship categorizations are associated with variables outlined by the investment model and (2) whether model variables predict changes in relationship categorization over time. We found that changes in relationship self-categorization were associated with simultaneous changes in investment model variables, and that the model largely predicts the likelihood of future changes in relational self-categorization. These results are the first to examine how the investment model prospectively predicts the progression or regression of relationships beyond relationship dissolution.

Let it go: Relationship autonomy predicts pro-relationship responses to partner transgressions

OBJECTIVE

The purpose of the present research is to better understand how relationship autonomy-having more self-determined reasons for being committed to a relationship-contributes to pro-relationship responses to transgressions in romantic relationships (e.g., forgiveness and accommodation).

METHOD

Study 1 employed a cross-sectional design (N = 350) and Study 2 used a weekly diary (N = 121) to test associations between relationship autonomy and pro-relationship responses to transgressions. Studies 3 and 4 utilized dyadic designs (Study 3: N = 200 couples, 400 individuals; Study 4: N = 275 couples, 550 individuals) to determine how both partners' relationship autonomy is associated with pro-relationship responses.

RESULTS

Results revealed that relationship autonomy is robustly associated with pro-relationship responses to transgressions, both as general tendencies and as responses to idiosyncratic transgressions. Results of actor-partner interdependence model (APIM) analyses in Studies 3 and 4 provide evidence that one's partner's relationship autonomy is important for promoting pro-relationship responses as well. Study 4 also found that people perceive that partners respond better to transgressions if their partner is high in relationship autonomy.

CONCLUSIONS

This research provides consistent and compelling evidence that the degree of self-determination underlying commitment is important for understanding how people respond to transgressions in their relationships, beyond their current levels of commitment.

An Actor–Partner Interdependence Model of Attachment and Need Fulfillment in Romantic Dyads

The present research tested the unique associations between attachment and basic psychological need fulfillment in relationships. Past research shows that anxious and avoidant attachment are associated with distinct patterns of relationship behaviors, wherein anxious attachment is related to excessive attention to the relationship and avoidant attachment is related to detachment from the relationship. Specifically, we explored the role of romantic partner’s attachment in predicting each other’s experiences of relatedness, autonomy, and competence. Across two samples of undergraduate romantic couples ( nsample 1 = 156, nsample 2 = 264), one’s own anxious and avoidant attachment predicted generally lower basic psychological need fulfillment. Having a more anxiously attached partner predicted higher relatedness but lower autonomy, whereas having a more avoidantly attached partner predicted lower relatedness but higher autonomy need fulfillment. These results extend prior research, suggesting that one’s partner’s anxious and avoidant attachment has distinct implications for one’s own outcomes.

The green eyed monster in the bottle: Relationship contingent self-esteem, romantic jealousy, and alcohol-related problems

Previous research suggests that both jealousy and relationship contingent self-esteem (RCSE) are related to alcohol use and alcohol-related problems. No work, however, has examined these two constructs together as they relate to motives for alcohol use and alcohol-related problems. The current study aims to build upon emerging literature examining different types of jealousy (i.e., emotional, cognitive, and behavioral), relationship quality (i.e., satisfaction, commitment, closeness), RCSE, and alcohol use. More specifically, the current study aimed to examine the associations between RCSE and drinking to cope and RCSE and alcohol-related problems, in the context of the different types of jealousy. Moreover, the current study aimed to assess whether the associations between RCSE, jealousy, and drinking outcomes vary as a function of relationship quality. Two hundred and seventy seven individuals (87% female) at a large southern university participated in the study. They completed measures of RCSE, relationship satisfaction, commitment, closeness, and jealousy as well as alcohol-related outcomes. Using PROCESS, moderated mediational analyses were used to evaluate different types of jealousy as mediators of the association between RCSE and drinking to cope/alcohol-related problems. Further, we aimed to examine whether relationship quality moderated the association between RCSE and jealousy in predicting alcohol-related variables. Results indicated that cognitive jealousy mediated the association between both RCSE and drinking to cope and RCSE and alcohol-related problems. Further, relationship satisfaction, commitment, and closeness were all found to moderate the association between RSCE and cognitive jealousy such that at lower, but not higher levels of satisfaction, commitment, and closeness, cognitive jealousy mediated the association between RCSE and drinking to cope and RCSE and alcohol-related problems.

Not All Ideals are Equal: Intrinsic and Extrinsic Ideals in Relationships

The ideal standards model suggests that greater consistency between ideal standards and actual perceptions of one's relationship predicts positive relationship evaluations; however, no research has evaluated whether this differs across types of ideals. A self-determination theory perspective was derived to test whether satisfaction of intrinsic ideals buffers the importance of extrinsic ideals. Participants (N=195) in committed relationships directly and indirectly reported the extent to which their partner met their ideal on two dimensions: intrinsic (e.g., warm, intimate) and extrinsic (e.g., attractive, successful). Relationship need fulfillment and relationship quality were also assessed. Hypotheses were largely supported, such that satisfaction of intrinsic ideals more strongly predicted relationship functioning, and satisfaction of intrinsic ideals buffered the relevance of extrinsic ideals for outcomes.

Relationship duration moderates associations between attachment and relationship quality: meta-analytic support for the temporal adult romantic attachment model

Although research has examined associations between attachment dimensions and relationship outcomes, theory has ignored how these associations change over time in adult romantic relationships. We proposed the Temporal Adult Romantic Attachment (TARA) model, which predicts that the negative associations between anxious and avoidant attachment on one hand and relationship satisfaction and commitment on the other will be more negative as relationship durations increase. Meta-analyses largely confirmed that negative associations between both insecure attachment dimensions and both relationship outcomes were more negative among longer relationship durations in cross-sectional samples. We also explored gender differences in these associations. The present review not only integrates the literature on adult attachment and romantic relationship satisfaction/commitment but also highlights the importance of relationship duration as a key moderator of the associations among these variables. We discuss the broad implications of these effects and our meta-analytic findings for the TARA model, attachment theory, and romantic relationships.

Self-Determination Theory and Romantic Relationship Processes

Self-determination theory can be viewed as a theory of optimal relationship development and functioning. We examine the concept of self that is employed in self-determination theory and explain how its unique definition allows an important and novel characterization of investing one’s “self” in romantic relationships. A self-determined perspective on romantic relationships integrates several theories on romantic relationship development, but also goes beyond them by explicitly articulating the personality, developmental, and situational factors that facilitate optimal self-investment and relational functioning. Self-determination promotes openness rather than defensiveness and facilitates perspective-taking, authenticity, and support of close others. The dyadic context of romantic relationships affords great opportunity for theoretical development and integration of self-determination theory with current theories of interdependence and relational well-being.

Autonomy in the obstetrician/gynecologist-patient relationship as a predictor of patient satisfaction

A considerable amount of recent medical research focuses on factors involving patient satisfaction. This study attempts to examine the role of autonomy in the gynecologist-patient relationship as it relates to patient satisfaction. Fifty-five patients at a women's clinic completed measures assessing autonomy preference (API) before the medical visit and patient-perceived autonomy support (HCCQ) and patient satisfaction (MISS) after the visit. Analyses revealed patients prefer a more equal level of decision making with their doctor (a medium level of autonomy) when asked general questions about medical decisions but preferred less autonomy when presented with actual scenarios. Results show a significant relationship between scenario-based autonomy preference level and visit satisfaction for both satisfaction measures. A significant relationship between perceived autonomy support and visit satisfaction was also found for both satisfaction measures. The findings of this study suggest autonomy is important to the gynecologist-patient relationship and worthy of future study.