Preferred Level Of Involvement Research Articles

Preferences for involvement in medical decision making: Comparing British and German views

Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control – Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R 2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role.

Stability of decisional role preference over the course of cancer therapy

Cancer patients vary in their preferred level of involvement in medical decision making, and responding to patients' desired level of involvement is a key element of good medical care. While the literature has clearly demonstrated heterogeneity among cancer patients' preferences, less is known about how the preferences of any given patient may change over time. This longitudinal study compared cancer patients' preferences for involvement in medical decision making from the time of diagnosis to the time of completion of therapy. Data from 729 cancer patients with mixed diagnoses were analyzed. Most patients reported a change in preferred level of involvement over time, and multivariate analysis demonstrated that patients tend to prefer a decreasing level of involvement over time (p<0.0001). Stability of patients' preferences was also associated with type of cancer, but not with other sociodemographic characteristics. The results from this study highlight the importance of reevaluating patients' preferences for involvement in medical decision making throughout the course of cancer therapy, as such preferences are likely to change.

Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey

BackgroundLittle is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD), and mood disorders; and to identify factors associated with GP/FPs' involvement, comfort and skill.MethodsPostal survey of a representative sample of 801 GP/FPs in British Columbia, Canada, which enquired about level of involvement (from primarily refer out to deal with case oneself); ratings of comfort/skill with assessment/diagnosis and management; beliefs regarding psychosocial problems in children; basic demographics; and practice information.ResultsSurveys were completed by 405 of 629 eligible GP/FPs (64.4%). Over 80% of respondents reported collaborative arrangements with specialists across problem and condition types, although for children with behavior problems or ADHD, more physicians primarily refer (χ2 (1) = 9.0; P < 0.005; and χ2 (1) = 103.9; P < 0.001, respectively). Comfort/skill levels (mean ± s.d) were higher for mood disorders (4.4 ± 1.3) than behavior problems (3.6 ± 1.1; F [3, 1155] = 84.0, P < .0001; effect size = 0.67), but not different from social-emotional difficulties (3.8 ± 1.1) or ADHD (3.9 ± 1.3). Taking primary responsibility for a case was consistently related to self-reported comfort/skill with each condition type (34% to 61% of variance across condition types), while comfort/skill ratings for each condition were related to exposure to relevant continuing medical education (all P ≤ 0.001), and beliefs that these problems are significant and that GP/FPs have a role to play in dealing with them (P values ranged from 0.01 to <0.001).ConclusionSupporting GP/FPs in their care for children with common psychosocial and mental health problems should include efforts to bolster their confidence and modify attitudes in relation towards these problems, especially behavior problems and ADHD, possibly within innovative continuing education programs.

New venture teams' assessment of learning assistance from venture capital firms

Prior research examining whether venture capital firms (VCs) add value to the ventures in their portfolios by advising their new venture teams (NVTs) has led to inconclusive results. Whereas most prior studies have assumed that NVTs value VC assistance, this study tests for the possibility that they differentially value two different types of VC assistance-business management and operational. We collected data by surveying 837 firms identified in the Venture Capital Journal that had received financing from venture capital firms. Only firms that received first-round financing were included in our analysis, which reduced our sample size to 205 firms. Our central finding is that systematic differences exist among NVTs in their evaluation of learning assistance from VCs. Even though VCs can chose their own level of involvement with an NVT, successfully improving venture performance through nonfinancial assistance at least partially depends upon the extent to which the NVT values VC input. Our results indicate that NVTs with more industry experience and longer team tenure in the current venture are negatively related to both business management advice and operational assistance offered by their VCs. However, when an NVT has previously worked together and when its primary experience is from another industry, it tends to welcome business management advice from its VC. One interpretation of this finding is that an advanced level of operational specialization already exists in such a team, which reinforces established operating patterns. Changing established operating patterns could make it more costly to adopt VC input on operational issues. However, business management advice may be more welcome, because the NVT is still learning how to compete in a new industry. These findings add to the growing literature that suggests that VCs play a particularly important role in entrepreneurial ventures when they pursue the development of new technologies (Ehrlich et al. 1994; Sapienza 1992). However, business management advice is not highly valued by NVTs that pursue more technical innovations. These findings in combination with those of Sapienza and Amason (1993) suggest that conflict in the VC-NVT relationship may be the greatest when the parties attempt to resolve critical differences, which ironically appear to be the ones where the NVT could derive the greatest benefit from listening to its VC. Finally, current firm performance is not related to the NVT's evaluation of VC assistance. Although cross-sectional measures of performance have obvious limitations, particularly with new ventures, these results indicate that the NVT evaluation of VC assistance is not driven by short-term performance. Past research has shown that VCs vary widely in their preferred level of involvement with the managers of firms in their portfolio. Some VCs prefer a laissez-faire approach, whereas others think that they must be more involved if they are to ultimately receive high rewards. The central finding from this study is that significant differences exist among NVTs in their evaluation of business management and operational assistance. For VCs that are more involved, these findings suggest that the optimal level of involvement is also partially contingent upon the NVTs openness to learning. Ignoring the contingent nature of the VC-NVT relationship, VCs could reduce their influence as a tool to improve firm performance and to ensure the ultimate survival of the venture.

Maternal Employment: Impact on Maternal Behavior

A psychologist analyzed data on 60 mother-infant pairs living in Indiana to examine the relationship between maternal employment and maternal separation anxiety during the infants first year of life. Overall maternal employment did not affect maternal behavior. Yet women who worked more hours/week experienced less separation anxiety than those who worked fewer hours/week (p < .05 at 6 months and p < .1 at 12 months). Specifically they were able to leave their infant with little delay and to provide effective verbal and physical reassurance to their infant (i.e. more autonomous). On reunion with their infants mothers who returned to work for financial reasons or claimed that the return to work was difficult were less autonomous and more anxious than those mothers who were satisfied with their roles (p < .01 at 12 months). The hours of maternal employment did not affect the quality of the infants attachment to the mother. On the other hand lower levels of maternal autonomy were associated with an anxious-resistant pattern of attachment (i.e. infant both seeks and resists contact with the mother) (p < .05). This suggested that role dissatisfaction may cause mothers to be less sensitive and responsive to their infants. One implication of these findings is that day-care providers need to support mothers and assure then that their infants are receiving high-quality day care so the mothers can reduce worry and stress and deal more effectively with their roles. Another implication is that family therapists and family life educators should stress the fathers role in child care and greater communication between parents as they examine child care activities. This would contribute to a decrease in maternal role dissatisfaction. These professionals also need to support the mothers preferred role and preferred level of involvement in her roles.