posted 09/07/04

Student-Parent Living Will Study
Living Will (or Advance Directive):  Written document that expresses a person’s preferences for medical care in serious or end-of-life situations.  Family members and doctors use the living will to guide treatment decisions if the person cannot make decisions for herself

Research question:  Do living wills help the family member predict the patient’s preferences accurately? Under what circumstances are living wills most helpful?

Study design:

• Student-parent pairs
• Parent plays the “patient” role – completes a living will and a questionnaire with hypothetical medical scenarios
• Student plays the “family member” role – reads parent’s living will (or not), and predicts parent’s responses to the medical scenarios

• decisionstudy.rutgers.edu
• Or www.rci.rutgers.edu/~mdmlab/ADstudy
• Sign up on web page
• Parent will be mailed a questionnaire
• Later you get your questionnaire in class or via mail
• 1 in 5 participants gets $50 gift certificate
• Response feedback to students and parents
• Results presented in class

Seeking Care

• The next 3 classes will be address questions such as:
• How do patients decide whether to ___________________?
• How can we ______________ them to seek care?
• Why they do some patients fail to follow the doctors prescribed treatment?
• How do patients think about illness, and how can that help to explain their behavior?

Theories of Health Behavior

• ________ __________ Model
• Theory of Reasoned Action
• Theory of Planned Behavior
• Transtheoretic Model
• Precaution Adoption Process Model

• Seeking health care (or taking other preventive action) depends on:
• cues to action
• susceptibility
• __________
• __________
• barriers and costs

• Cue to action: a soar throat
• _________ : likelihood that this is the flu
• _________: if it is the flu, how severe will it be?
• _________: effectiveness of treatment doctor could offer
• _________: time and expense of doctor visit, cost and side-effects of treatment

• Cue to action: buy a warranty with your toaster oven?
• Susceptibility:
• Severity:
• Benefits:
• Costs:

• Questionnaires distributed to Rutgers and UMDNJ employees in Fall 1999 - Spring 2004
• ___% had received a flu shot
• What predicts who gets the flu shot?

• _______:  How effective do you think the flu shot is in reducing a person's chances of getting the flu? (not at all - very)
• _______:  How likely do you think it is that the flu vaccine would cause a person to have a severe reaction? (not at all - very)
• _______:  Imagine that the flu shot for this year is unavailable and you are therefore unable to get the shot. Given that you have had no shot, how likely do you think you would be to get the flue? (very unlikely - very likely)
• _______: Once again, imagine that the flu shot for this year is unavailable and you are therefore unable to get the shot. Given that you have had no shot, how severe would your flu be, if you were to get on this winter? (not at all - very severe)

• Correlations with getting the flu shot:
• Benefits (perceived effectivness of shot): r = ____
• Costs (risk of reaction): r = ____
• Susceptibility (likelihood of flu): r = ____
• Severity (severity of flu): r = ____
• All 4: r= ____

• Emphasize susceptibility, severity, & _______
• Remove ___________

More Flu Shot Results
(Predictors assessed in Fall 2002; intention assessed Spring 2003.  N=431, all ps <.0001)

• Correlations with intention to get the flu shot:
• Benefits (perceived effectivness of shot): r = ____
• Costs (risk of reaction): r = ____
• Susceptibility (likelihood of flu): r = ____
• Severity (severity of flu): r = ____
• All 4: r= ____
• Correlation between intention and _________: r=0.72
• After statistically controlling for ________, the correlation between predictors and ________ is much reduced.

                          ______
                 /                          \
            0.68                         0.72 (0.55)
              /                                \
Attitude---------0.58 (0.17)----->Behavior

Precaution Adoption Model

• 1.  _______of hazard
• 2.  _______ bias (only others are at risk)
• 3. Acknowledge susceptibility
• 4.  Decide to ______________  or
• 5. Decid not to _____________
• 6. Action taken
• 7. _____________________

(See Figure 3.3 on page 52 of textbook)
 

Delay in Seeking Care

• Treatment Delay
• Has 3 stages (Safer, Tharps, Jackson, & Leventhal, 1979)

• 1. __________  delay: time to interpret symptom as indication of illness
• 2. __________ delay: time between recognizing one is ill and deciding to seek medical attention
• 3. __________ delay: time after deciding to seek medical attention until actually getting it.

•  __________  delay: benefits and cost, pain, expense, beliefs that illness can be cured
• __________ delay: Influenced by sensory experience of symptom, especially pain or bleeding
• _______ of symptom
• severity of symptom
• interferes with person's life
• _________ or _________ of symptom
•  __________ delay: shorter if symptom is new, little time thinking about symptom

• On Sunday you wake up with a sore throat. By Tuesday you decide you are sick. On Wednesday you decide to see your doctor, and on Saturday you actually see the doctor
• Appraisal delay = ___ days
• Illness delay = ___ days
• Utilization delay = ___ days
• Treatment delay = ___ days

• Kasl & Cobb (1966) defined the sick role as a sort of social contract
• Lack of ______ -- patient not responsible for being sick
• Relief from ________________
• Desire to get well
• Limitations of this view
• Not entirely supported empirically (some patients are blamed for their illnesses).
• Doesn't fit ___________ diseases well.
• Segall (1997) modified the sick role concept:
• Rights
• Right to make ________ about health care
• Right to be exempt from ___________
• Right be become __________ on others
• Duties:
• Duty to maintain health and get well
• Duty to perform ____________________
• Duty to use a range of health care ___________

• Sick role studied by Lorber (1975) by interviewing surgery patients with statements like
• The best thing to do in the hospital is to keep quiet and do what youre told.
• I cooperate best as a patient when I know the reason for what I have to do.
• When Im sick, I expect to be pampered and catered to.
• Patients categorized as passive/conforming or active.
• _________ patients less likely to argue or complain.
• Hospital staff asked to rate patients: good (25%) average (50%) and problem (25%).
• Hospital staff see ________ patients as good patients.
• Good patient behavior may actually be an indication of ________________
• Problem patients are
• (1) those with ___________ conditions that require a lot of attention and
• (2) those not seriously ill who take up more time and attention than warranted.
• Could be reactance an angry response to loss of freedom.
• If  "problem patient" behavior is reactance to loss of control, the solution may be to give patients more ______.
• No studies showing that _______ interventions actually reduce problem patient behavior.
• But several studies have found that ________ interventions improve adjustment to hospitalization (e.g., Langer & Rodin, 1976).