Aligned and Divergent Perceptions of Support Persons’ Role in Triadic Gynecologic Cancer Communication

Health care providers routinely advise cancer patients to involve support persons in oncology care to fulfill critical support roles. This qualitative descriptive study explored alignment of triadic perceptions of support person involvement in oncology treatment visits and cancer-related care from the perspectives of patients with gynecologic cancer ( n = 18), regular visit-attending support people ( n = 16), and health care providers ( n = 10), including oncologists, nurses, and medical assistants. Semi-structured interviews ( N = 44) captured perceptions of facilitation and interference of support persons' roles within and outside appointments with oncology providers. Thematic analyses revealed alignment and divergence regarding support persons' instrumental, informational, and emotional support behaviors. Perspectives aligned regarding what support functions companions provide. However, patients and support persons emphasized the significance of instrumental followed by informational and emotional support, whereas oncology providers highlighted informational, followed by emotional and instrumental support. Discussion provides insight into each role’s perspective in the triad.

The Uptalk Downgrade: Comparing age- and gender-based perceptions of uptalk in four highly-skilled professions

<p>Uptalk, or the ‘innovative use of rising intonation on declarative utterances’ (Warren, 2016, p. xiii), is a common intonational contour in New Zealand English that has been assigned an uncommonly large range of meanings. Negative interpretations of uptalk include uncertainty, tentativeness, and lack of expert knowledge (Barr, 2003; Conley et al, 1978; Guy & Vonwiller, 1984; Spindler, 2003; Tomlinson Jr. & Fox Tree, 2010; Warren, 2016), and positive interpretations of uptalk include helpfulness, solidarity, and inclusivity (Borgen, 2000; Britain, 1992; Guy & Vonwiller, 1984; Meyerhoff, 1991; Warren, 2016). There is evidence that a listener’s interpretation of uptalk as positive or negative may depend on their age (Di Gioacchino & Crook Jessop, 2010), and there is also conflicting evidence over whether uptalk users are perceived as more or less suitable for highly-skilled employment (Borgen, 2000; Gorelik, 2016; Guy & Vonwiller, 1984; Steele, 1995). In an earlier study (Wollum, 2016), I found that older female listeners (aged 60-70) were significantly more likely than younger female listeners (aged 18-28) to assess a speaker as less competent and less trustworthy when the speaker was using uptalk, in an IT support context. In a further exploration of the age-based perception differences revealed in my 2016 research, this thesis reports a more extensive study, in which a new group of younger (aged 18-30) and older (aged 60-72) female listeners as well as a group of younger and older male listeners assessed recordings from four different young (aged 22-30) female speakers representing four different highly-skilled professions: IT support person, doctor, lawyer, and librarian. Listeners in this study were asked to assess not only the competence and trustworthiness of the speaker, but also the speaker’s education level. For both competence and trustworthiness, significant interactions were found between the listener’s age group, the profession of the speaker, and the speaker’s use or non-use of uptalk, with the older listeners ranking all four professions significantly lower for competence and trustworthiness in the uptalk condition, and a particularly strong effect of these lower ratings for the speaker representing a lawyer. There was also a recurring significant interaction between listener age group and gender, with younger male participants providing significantly higher ratings than all other demographics for both competence and trustworthiness, and significantly higher ratings than all but the older female group for education level. For education level, there was also a significant simple effect of speaker profession. There was no effect of uptalk on perceptions of education level. As all speakers used in the study were young (aged 22-30) females, part of the demographic that most often uses uptalk in New Zealand (Britain, 1992; Warren & Britain, 2000), the trend of lower competence and trustworthiness ratings from the older listener group is indicative of an out-group effect regarding positive versus negative perceptions of uptalk (House, 2006). In addition, the significant interactions between speaker profession and presence or absence of uptalk suggest that uptalk, considered predominantly a marker of female speech in New Zealand, is perceived more negatively by older listener groups in professions that have been historically male-typed. For competence and trustworthiness, the profession least negatively affected by the use of uptalk was the librarian, a profession that has previously been viewed as predominantly female (Morrissey & Case, 1988; Panek, Rush, & Greenawalt, 1977), and the profession most negatively affected by the use of uptalk was the lawyer, a profession that has previously been described as ‘aggressively male’ (Bolton & Muzio, 2007, p.56), and rewarding of women who adopt more masculine characteristics (Sommerlad & Sanderson, 1998). This research shows that older listeners are less likely than younger listeners to accept uptalk as indicative of competence and trustworthiness, and that these effects are particularly strong for professions in which women have previously been underrepresented. It also shows that a speaker’s perceived profession is more important than the presence or absence of uptalk for a listener assessing the speaker’s education level.</p>

The Uptalk Downgrade: Comparing age- and gender-based perceptions of uptalk in four highly-skilled professions

<p>Uptalk, or the ‘innovative use of rising intonation on declarative utterances’ (Warren, 2016, p. xiii), is a common intonational contour in New Zealand English that has been assigned an uncommonly large range of meanings. Negative interpretations of uptalk include uncertainty, tentativeness, and lack of expert knowledge (Barr, 2003; Conley et al, 1978; Guy & Vonwiller, 1984; Spindler, 2003; Tomlinson Jr. & Fox Tree, 2010; Warren, 2016), and positive interpretations of uptalk include helpfulness, solidarity, and inclusivity (Borgen, 2000; Britain, 1992; Guy & Vonwiller, 1984; Meyerhoff, 1991; Warren, 2016). There is evidence that a listener’s interpretation of uptalk as positive or negative may depend on their age (Di Gioacchino & Crook Jessop, 2010), and there is also conflicting evidence over whether uptalk users are perceived as more or less suitable for highly-skilled employment (Borgen, 2000; Gorelik, 2016; Guy & Vonwiller, 1984; Steele, 1995). In an earlier study (Wollum, 2016), I found that older female listeners (aged 60-70) were significantly more likely than younger female listeners (aged 18-28) to assess a speaker as less competent and less trustworthy when the speaker was using uptalk, in an IT support context. In a further exploration of the age-based perception differences revealed in my 2016 research, this thesis reports a more extensive study, in which a new group of younger (aged 18-30) and older (aged 60-72) female listeners as well as a group of younger and older male listeners assessed recordings from four different young (aged 22-30) female speakers representing four different highly-skilled professions: IT support person, doctor, lawyer, and librarian. Listeners in this study were asked to assess not only the competence and trustworthiness of the speaker, but also the speaker’s education level. For both competence and trustworthiness, significant interactions were found between the listener’s age group, the profession of the speaker, and the speaker’s use or non-use of uptalk, with the older listeners ranking all four professions significantly lower for competence and trustworthiness in the uptalk condition, and a particularly strong effect of these lower ratings for the speaker representing a lawyer. There was also a recurring significant interaction between listener age group and gender, with younger male participants providing significantly higher ratings than all other demographics for both competence and trustworthiness, and significantly higher ratings than all but the older female group for education level. For education level, there was also a significant simple effect of speaker profession. There was no effect of uptalk on perceptions of education level. As all speakers used in the study were young (aged 22-30) females, part of the demographic that most often uses uptalk in New Zealand (Britain, 1992; Warren & Britain, 2000), the trend of lower competence and trustworthiness ratings from the older listener group is indicative of an out-group effect regarding positive versus negative perceptions of uptalk (House, 2006). In addition, the significant interactions between speaker profession and presence or absence of uptalk suggest that uptalk, considered predominantly a marker of female speech in New Zealand, is perceived more negatively by older listener groups in professions that have been historically male-typed. For competence and trustworthiness, the profession least negatively affected by the use of uptalk was the librarian, a profession that has previously been viewed as predominantly female (Morrissey & Case, 1988; Panek, Rush, & Greenawalt, 1977), and the profession most negatively affected by the use of uptalk was the lawyer, a profession that has previously been described as ‘aggressively male’ (Bolton & Muzio, 2007, p.56), and rewarding of women who adopt more masculine characteristics (Sommerlad & Sanderson, 1998). This research shows that older listeners are less likely than younger listeners to accept uptalk as indicative of competence and trustworthiness, and that these effects are particularly strong for professions in which women have previously been underrepresented. It also shows that a speaker’s perceived profession is more important than the presence or absence of uptalk for a listener assessing the speaker’s education level.</p>

Adapting Montessori Programming for Aging and Dementia With Implementation Strategies

There is a need to translate research findings to support the wider adoption of person-centered care into typical long-term care environments across the world. Montessori for Aging and Dementia is one mechanism to support person-centeredness, dignity and autonomy of older adults living in long-term care environments. In this presentation, strategies used to support the implementation of Montessori for Aging and Dementia in a long-term care community of 20 people living with severe dementia will be highlighted. Implementation support was provided through capturing and sharing local knowledge, ongoing training and consultation, and tailoring communication supports. Through the use of these iterative strategies, the program was successfully adapted to include people living with severe dementia. While key findings of the project included improvements on a variety of observational and staff administered measures, the focus of this presentation will be on the relationships between the Montessori program’s fidelity, local needs and implementation strategies.

Partnering with Hospital Providers to Facilitate Handoff for Persons with Dementia in the Acute Care Setting

Practice Problem: Individuals with Alzheimer's disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay. PICOT: The PICOT question that guided this project was: With the assistance of family nurse consultants (P), how does the implementation of standardized care needs communication tool for support persons of persons with dementia (I) vs. no standardized process (C) enhance the ability for the support person to communicate care needs during TOC (O) within 5 weeks (T)? Evidence: The review of high-quality studies reveals evidence that supports clinician-home caregiver communication as an approach to bridge gaps for the person with dementia (PWD) across health care settings. Intervention: The clinician-home caregiver communication checklist was used as an evidence-based tool to enhance the HC’s ability to communicate care needs for the PWD during care transitions. Outcome: There was a clinically significant improvement with the family nurse consultants’ utilization of the tool, and HCs who were offered the tool benefited from that time of preparation for their loved ones. There was a statistically significant improvement in family nurse consultants’ perception of the value and usefulness of the tool after they were introduced to it. Conclusion: The project findings revealed that using the standardized care needs communication tool, HCs can be crucial members to strengthen TOC for the cognitively impaired individual.

Protections for vulnerable accused in Malaysian criminal trials: Are they sufficient? Proposal for reform

<p>This dissertation argues that the protections for vulnerable accused in Malaysian criminal trials are not sufficient. It is crucial to ensure that vulnerable accused receive proper treatment when dealing with the court. After thoroughly scrutinising the law and practice in several other jurisdictions, this dissertation proposes several amendments to the Criminal Procedure Code and the Evidence Act 1950 to provide clear guidelines as to how to deal with vulnerable accused in a criminal trial. It is ultimately recommended that the right to give an unsworn statement be modified so that it is more effective and fair in its operation. This dissertation further recommends the introduction of an adverse inference clause for the right to remain silent at trial so accused person can better understand the effect of their choice. Recommendations are also made to introduce an intermediary service for those vulnerable accused who choose to give sworn evidence in court, and to allow a support person to accompany a vulnerable accused during trial. These amendments aim to assist vulnerable accused persons physically and emotionally, and to protect their fair trial rights.</p>

Protections for vulnerable accused in Malaysian criminal trials: Are they sufficient? Proposal for reform

<p>This dissertation argues that the protections for vulnerable accused in Malaysian criminal trials are not sufficient. It is crucial to ensure that vulnerable accused receive proper treatment when dealing with the court. After thoroughly scrutinising the law and practice in several other jurisdictions, this dissertation proposes several amendments to the Criminal Procedure Code and the Evidence Act 1950 to provide clear guidelines as to how to deal with vulnerable accused in a criminal trial. It is ultimately recommended that the right to give an unsworn statement be modified so that it is more effective and fair in its operation. This dissertation further recommends the introduction of an adverse inference clause for the right to remain silent at trial so accused person can better understand the effect of their choice. Recommendations are also made to introduce an intermediary service for those vulnerable accused who choose to give sworn evidence in court, and to allow a support person to accompany a vulnerable accused during trial. These amendments aim to assist vulnerable accused persons physically and emotionally, and to protect their fair trial rights.</p>

Development and Implementation of an Individualized Turning Program for Pressure Injury Prevention Using Sensor Technology in Nursing Homes: A Quality Improvement Program

BACKGROUND: Turning nursing home residents every 2 hours has been a long-held standard for pressure injury (PrI) prevention in individuals with mobility impairments although evidence to substantiate this practice is limited. New guidelines recommend personalizing turning schedules to support person-centered care but lack specific recommendations about which turning frequencies are appropriate for various risk levels. PURPOSE: This quality improvement program aimed to determine the feasibility and outcomes of using individualized turn schedules for newly admitted nursing home residents. METHODS: An expert panel of wound clinicians developed, tested, and implemented a turn frequency tool that allowed staff in 2 nursing homes to select a turning schedule of 1, 2, 3, or 4 hours based on resident risk factors. Turning schedules were operationalized using a wearable sensor-based visual cueing technology that alerted staff to resident repositioning needs. Nonparticipating resident data were collected for comparison of PrI incidence. Descriptive statistics were calculated for all covariates. Significance of differences tests were performed as appropriate. RESULTS: Over 7 months, 154 residents had their turn period individualized, with 56% qualifying for 3-hour (Q3H) or 4-hour (Q4H) schedules. Facility-acquired PrI incidence was 94% lower in participants than in nonparticipants (P < .0001). Use of 3-hour and 4-hour intervals saved roughly 21 and 35 minutes of staff time, respectively, per resident per shift. CONCLUSION: Individualizing turning schedules is feasible. Residents with longer turning intervals did not develop PrIs, supporting previous studies about safely extending turning periods for most residents.

Study Protocol for “Psilocybin as a Treatment for Anorexia Nervosa: A Pilot Study”

Background: Anorexia nervosa (AN) is a serious and life-threatening psychiatric condition. With a paucity of approved treatments, there is a desperate need for novel treatment avenues to be explored. Here, we present (1) an overview of the ways through which Public Patient Involvement (PPI) has informed a trial of psilocybin-assisted therapy for AN and (2) a protocol for a pilot study of psilocybin-assisted therapy in AN currently underway at Imperial College London. The study aims to assess the feasibility, brain mechanisms and preliminary outcomes of treating anorexia nervosa with psilocybin.Methods: (1) PPI: Across two online focus groups, eleven individuals with lived experience of AN were presented with an overview of the protocol. Their feedback not only identified solutions to possible barriers for future participants, but also helped the research team to better understand the concept of “recovery” from the perspective of those with lived experience. (2) Protocol: Twenty female participants [21–65 years old, body mass index (BMI) 15 kg/m2 or above] will receive three oral doses of psilocybin (up to 25 mg) over a 6-week period delivered in a therapeutic environment and enveloped by psychological preparation and integration. We will work with participant support networks (care teams and an identified support person) throughout and there will be an extended remote follow-up period of 12 months. Our two-fold primary outcomes are (1) psychopathology (Eating Disorder Examination) across the 6-month follow-up and (2) readiness and motivation to engage in recovery (Readiness and Motivation Questionnaire) across the 6-week trial period. Neurophysiological outcome measures will be: (1) functional magnetic resonance imaging (fMRI) brain changes from baseline to 6-week endpoint and (2) post-acute changes in electroencephalography (EEG) activity, including an electrophysiological marker of neuronal plasticity.Discussion: The results of this pilot study will not only shed light on the acceptability, brain mechanisms, and impression of the potential efficacy of psilocybin as an adjunct treatment for AN but will be essential in shaping a subsequent Randomised Control Trial (RCT) that would test this treatment against a suitable control condition.Clinical Trial Registration: identifier: NCT04505189.