Let's Talk About Death: Applying the Disclosure Decision-Making Model to Death Planning Disclosure

The disclosure decision-making model (DD-MM) explains an individual's decision-making process regarding whether they disclose personal health information to others and consists of three tenets (i.e., assessment of information, assessment of receiver, and disclosure efficacy). Whereas traditional DD-MM applications have focused on physiological disclosures (e.g., HIV diagnosis), this study investigates the non-visible, non-diagnosis context of disclosing desired death arrangement plans with others (i.e., how individuals wish their body to be memorialized following their death). Data from 467 individuals aged between 18 and 82 were collected through online surveys. Path analysis findings indicate that while perceptions of stigma, prognosis, and relevance to others (i.e., assessment of information) were significantly related to disclosure efficacy and anticipated response, only relevance to others was directly related to relational quality. Additionally, anticipated response and relational quality (i.e., assessment of receiver) as well as disclosure efficacy and anticipated response performed in accordance with the DD-MM. This study provides meaningful conclusions for agencies who aim to craft messages that will help resonate with, inform, and protect consumers from becoming susceptible to unethical practices in the death service industry. Limitations and future research avenues are discussed.

Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure

The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM's boundaries by assessing the model's application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment's end. Limitations, implications, and future directions are discussed.

A descriptive literature review of early research on COVID-19 and close relationships

This in-depth critical review investigates the impact of COVID-19 on personal relationships from the start of the pandemic in early 2020 to September 2021. Research examining six themes are identified and described in detail: the impact of COVID-19 on (1) family and intimate relationships; (2) LGBTQ+ relationships; (3) how COVID-19 is linked to technologically mediated communication and personal relationships; (4) potential shifts in sexual behaviors and desire; (5) potential shifts in relational conflict and intimate partner violence; and (6) constructive aspects of personal relationships, which is a broad theme that includes outcomes such as resilience, relational quality, coping, and social support. Findings for overarching patterns are offered to highlight implications for current research and identify future directions to consider when continuing to study personal relationships during the COVID-19 pandemic and similar future crises.

Assessing Family Caregiver Communication in Chronic Illness: Validation of the FCCT-CI

Background: Chronic illness care demands attention to the unique needs of family caregivers who support care at home, yet few tools exist for family caregiver assessment in the social domain of practice. Objectives: The Family Caregiver Communication Tool (FCCT) assesses caregiver communication as part of the family system and was originally developed for cancer caregivers. The aim of this study was to develop and psychometrically-validate a version of the FCCT for Chronic Illness (FCCT-CI). Methods: We revised the FCCT, including the generation of new items, and psychometrically tested it in 303 family caregivers recruited through Amazon Prime Panels. Item reduction through exploratory factor analysis was conducted, internal consistency was assessed using Cronbach's alpha, and concurrent validity was conducted to demonstrate correlation of the new scale with previously validated instruments. Results: A principal axis analysis with promax rotation initially revealed a five-factor structure of the 27 items initially tested, but, after statistical and theoretical reduction and refinement, a 10 item FCCT-CI emerged. Cronbach's alpha ranged from .74 to .86 for the FCCT-CI instrument. Concurrent validity was supported by bivariate correlation tests. Conclusions: The FCCT-CI is the first psychometrically tested scale designed to assess caregiver communication with chronically ill patients, family members, and palliative care providers about caregiving. The FCCT-CI scale includes but is not limited to cancer caregiving and palliative care contexts and has good reliability and validity. Palliative care providers can use this tool to assess, design, and test interventions to support family caregivers.

Forgive and Forget?: Examining the Influence of Blame and Intentionality on Forgiveness Following Hypothetical Same-Sex Infidelity in the Context of Heterosexual Romantic Relationships

The present study investigated responses to imagined same-sex infidelity committed by a partner in a heterosexual relationship. The motivational theory of infidelity and research on communicative infidelity were used as guiding frameworks for exploring differences in perceptions of blame and intentionality as a result of varying motivations for engaging in same-sex infidelity (i.e., cheating due to attraction, experimentation, sexual preoccupation, sexual depression, sociosexuality, jealousy, vengefulness, or not viewing the infidelity as cheating). It was predicted that greater perceptions of blame and intent would be associated with more negative transgression-related interpersonal motivations (i.e., more revenge and avoidance; less benevolence) and an increased expectation of terminating the relationship due to the partner's same-sex infidelity. Whether these relationships would replicate or differ according to the partner's motive for committing the hypothetical same-sex infidelity was also tested. Results revealed that, in general and across motives, attributions of blame were positively associated with revenge, avoidance, and relationship termination; perceived intentionality was positively associated with avoidance; and blame was negatively associated with benevolence. Furthermore, across most motives, blame was indirectly associated with relationship termination through avoidance and benevolence, and these associations were not moderated by biological sex. These findings and their implications for research on infidelity specifically, and relational functioning more broadly, are discussed.

How are important life events disclosed on facebook? Relationships with likelihood of sharing and privacy

This study examined an aspect of Facebook disclosure that has as yet gone unexplored: whether a user prefers to share information directly, for example, through status updates, or indirectly, via photos with no caption or relationship status changes without context or explanation. The focus was on the sharing of important positive and negative life events related to romantic relationships, health, and work/school in relation to likelihood of sharing this type of information on Facebook and general attitudes toward privacy. An online survey of 599 adult Facebook users found that when positive life events were shared, users preferred to do so indirectly, whereas negative life events were more likely to be disclosed directly. Privacy shared little association with how information was shared. Implications for understanding the finer nuances of how news is shared on Facebook are discussed.

Interpersonal conflict and health perceptions in long-distance caregiving relationships

With job markets expanding globally and life expectancy continually increasing, more demands are being placed on distant relatives to provide care for their aging family members, creating a health care situation known as long-distance caregiving. An online survey explored the relations between negative health perceptions by long-distance caregivers and conflict frequency and conflict strategy usage. The authors observed positive significant relations between distant caregiver negative health perceptions and conflict frequency and usage of the distributive and avoidance conflict strategies. However, they observed no significant associations between distant caregiver negative health perceptions and usage of the two integrative strategies. Implications for long-distance caregiving communication are discussed.

Communication in the context of long-distance family caregiving: an integrated review and practical applications

OBJECTIVE

Understanding how geographic distance impacts how individuals communicatively negotiate family caregiving is important for a number of reasons. Though long-distance caregiving (LDC) is a growing phenomenon with serious relational and health implications, this topic has yet to be approached from a communication perspective. In this review, LDC is thus considered as a communication context to offer caregiving scholars practical applications for contributing to this emerging research area.

METHODS

Review of the literature from 1999 to 2009 that studied aspects of distance caregiving communication obtained through searching Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsycArticles, PsycInfo, PubMed/Medline, and Health Source: Nursing/Academic Edition online databases.

RESULTS

Eight published original research studies were included in the review.

CONCLUSION

The extent to which LDC communication is studied by caregiving researchers has the potential to provide helpful guidance for distant caregivers and care recipients to achieve successful health and relational outcomes.

PRACTICE IMPLICATIONS

Upon reviewing distance caregiving communication research findings, four applications are discussed: (1) defining distance as a subjective experience; (2) encouraging the use of mediated communication in LDC; and examining (3) interpersonal conflict and (4) topic avoidance processes in the LDC context.

Understanding the impact of family caregiver cancer literacy on patient health outcomes

OBJECTIVE

Family caregivers play a significant role in the diagnosis, treatment, and recovery of individuals with cancer. This position paper reviews and links the research on family caregiving and health information with the importance of cancer literacy.

METHOD

Review of literature obtained through searching in Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsychArticles, PsycInfo, and Health Source: Nursing/Academic Edition library databases.

RESULTS

Family members are important sources of health information, informal caregivers who learn and enact medical procedures, and influential aspects of patients' healthcare and treatment decision-making, but are not seriously considered by healthcare practitioners or researchers in terms of assessing and improving health literacy. Further, very few studies have directly examined or acknowledged the potential importance of family caregiver health literacy.

CONCLUSION

The extent to which family caregivers can comprehend the health information they receive along with the patient is crucial for the patient to achieve the most successful health outcome.

PRACTICE IMPLICATIONS

To acknowledge the impact that family caregiver health literacy could have on patient health outcomes, targeted practical recommendations for understanding family caregiver health literacy in the cancer context are proposed: (1) family member health literacy should be assessed; (2) close relational partners should be trained as peer health educators; (3) written cancer information should be provided directly to family caregivers; (4) health interactions between family caregivers and patients should be improved; (5) theoretical perspectives into the understanding of family caregiver health literacy should be integrated into practice; and (6) patient and family caregiver health literacy should be improved.

Warranted concerns, warranted outlooks: a focus group study of public understandings of genetic research

This paper discusses how the American public accounts for the concerns that they have about genetic research and the benefits that they foresee. We develop a general framework for discussing public claims about genetic technology based on Stephen Toulmin's model of warrants in argumentation. After a review of the results from public opinion polls about genetic research, we present a focus group study of public understandings of genetics. We outline the warrants, or publicly accepted "good reasons", that this group offers for accepting some aspects of genetic technology and for rejecting other aspects. The warrants presented by the public in their discussion of genetic research indicate that the public has a complex, informed understanding of genetic research, albeit a non-technical one. The paper concludes with a discussion of the importance of public participation in debates over genetic research and the ways that researchers and policymakers could adapt to public concerns about genetics.

Attitudinal barriers to delivery of race-targeted pharmacogenomics among informed lay persons

OBJECTIVES

To ascertain attitudes of prospective patients relevant to the delivery of race-based pharmacogenomics.

METHODS

Written anonymous survey and qualitative responses in two sets of reactance format focus groups over-sampled for minority groups in urban, suburban, and rural communities conducted from February through April, 2002 [N = 104] and August through November, 2002 [N = 120].

RESULTS

Participants do not associate "races" exclusively with continental clusters. They have incomplete knowledge of their recent ancestors (39.6% do not know all their biological grandparents). They would be highly suspicious of race-labeled drugs; with 47.5% saying they would be very suspicious of their safety and 40.6% indicating they would be very suspicious of their efficacy. A substantial minority of African-American participants (13.2%) would prefer to take the drugs designated for European Americans. Effect of discussion of race-based medicine on racial attitudes is ambiguous.

CONCLUSIONS

Patient knowledge of ancestry and suspicion of race-designated drugs constitute substantial barriers that need to be incorporated in judging the likely effectiveness of race-based pharmacogenomics.

Lay Understandings of Race: Cultural and Genetic Definitions

OBJECTIVE

To examine lay understandings of race.

METHOD

Fifteen focus groups were held in the southeastern United States from July to October of 2001.

RESULTS

The lay understanding of race is multifactorial, conceptualizing race as defined in part by genetics and in part by culture.

CONCLUSIONS

The multifactorial understanding of race used by lay people is important to geneticists for two reasons. First, within the multifactorial definition of race, genetic variation is interpreted as phenotypic differences among individuals. Second, racial differences are apparent in understandings of race. African-American participants held a more fluid understanding of race that included ideas of self-definition and culture, while European-Americans were more likely to rely on physical characteristics to understand race.

Informed lay preferences for delivery of racially varied pharmacogenomics

OBJECTIVES

To understand public perceptions and opinions of three options for prescribing medicine: individualized genetic testing, race-based prescription, and traditional prescription.

METHODS

Focus groups in urban, suburban, and rural communities over-sampled for minority groups conducted from February through April, 2001 in Georgia.

RESULTS

Group members (N = 102) identified individualized genetic testing as providing the best quality of care (60% of talk turns; 75% in postdiscussion anonymous survey), but stipulated the need for protection from the invasion of privacy, discrimination, and prohibitive cost. Most individuals chose genetic testing because it provided individualized attention, and African-Americans indicated they would choose genetic testing even if the costs were high. Overall, individuals were suspicious of race-based prescription. Analyses for degree of suspicion revealed a main effect for race and an interaction effect for race and gender.

CONCLUSIONS

If issues of cost, discrimination, and privacy are addressed, lay individuals prefer genetic testing as the basis for prescription of medicines that exhibit racially patterned response variation.

Purification of porcine phospholamban expressed in Escherichia coli

Phospholamban (PLB) is a small hydrophobic protein that regulates contractility in the heart. This membrane protein expressed in bacterial cells is resistant to purification by conventional strategies that have been used to isolate expressed soluble proteins. Therefore, in order to obtain both wild-type and mutant PLB proteins, we have amplified the PLB gene by the polymerase chain reaction from genomic DNA of porcine heart and inserted it into the pGEX-2T plasmid expression vector. In this vector, the gene product fused to glutathione S-transferase has been expressed in JM109 Escherichia coli cells. The expressed fusion protein was found associated predominantly with insoluble cellular constituents. However, most of the fusion protein was readily extracted with SDS. PLB was subsequently purified by a simple procedure consisting of isolation of the fusion protein by preparative SDS-gel electrophoresis, followed by a second electrophoretic separation of PLB after its cleavage from the fusion protein by thrombin. This isolation method yields 3-4 mg of PLB per liter of cells, in a form which is capable of functional interaction with the Ca-ATPase in reconstituted proteoliposomes.