Alone but flowing: The effects of autotelic personality and extraversion on solitary flow.

OBJECTIVE/BACKGROUND: Flow, a psychological state of intense engagement in and enjoyment of an activity, can arise during both solitary and socially interactive experiences. In the literature, whereas people high in extraversion have difficulty achieving flow in solitude, those with an autotelic personality-a combination of traits that make people prone to flow-readily experience flow in both solitary and interactive conditions. In this pre-registered experiment, we investigated whether autotelic personality mitigates the negative association between solitary flow and extraversion. METHOD: Participants and their romantic partners (final N = 368) played the game Perfection™ in three conditions (order was counterbalanced): alone (solitary condition), in the presence of their partner without interaction (mere-presence condition), and collaboratively (interactive condition). RESULTS: There were independent, positive main effects of extraversion and autotelic personality on flow experience in mere-presence and interactive conditions. However, the positive effect of extraversion on solitary flow was only significant among participants with high (vs. low) autotelic personality. In all conditions, flow experience was associated with greater low-arousal positive affect and lesser high-arousal negative affect. CONCLUSIONS: The findings shed light on the role of personality in promoting solitary flow experiences, and particularly how traits might interact to determine optimal and non-optimal conditions for achieving flow.

Let the Kid Speak: Dynamics of Triadic Medical Interactions Involving Pediatric Patients.

Communication in healthcare represents the complex interplay between multiple individual and contextual factors unfolding over the course of the medical encounter. Despite significant improvements in patient-centered care delivery, studies of health communication typically focus exclusively on clinical interactions between adult patients and their clinicians. Much less is known about non-dyadic interactions, such as pediatric triads involving a child patient and accompanying parent. Understanding the dynamics of triadic pediatric healthcare communication is the first step toward evaluating and ultimately optimizing these healthcare interactions. Thus, we undertook a mixed-method analysis of 28 audio-recorded triadic medical interactions between healthcare providers, pediatric asthma and allergy patients, and their parents to explore the prevalence of various features of these interactions. Our findings point to mechanisms through which healthcare providers and parents may facilitate or hinder children's involvement in their own asthma and allergy care, including interruptions, unclarified technical medical language, the flow of information exchange, and the formation of dyadic conversational partnerships (coalitions) between providers and parents. Our analyses further reveal that children's participation during their medical visits was minimal (13% of the interaction). Providers in our sample elicited input directly from pediatric patients more often than from parents, though the difference was small. Taken together, these findings provide a foundation on which to develop training and communication interventions to ensure that children have a voice in their medical care.

International optimism: Correlates and consequences of dispositional optimism across 61 countries.

OBJECTIVE: The current exploratory study sought to examine dispositional optimism, or the general expectation for positive outcomes, around the world. METHOD: Dispositional optimism and possible correlates were assessed across 61 countries (N = 15,185; mean age = 21.92; 77% female). Mean-level differences in optimism were computed along with their relationships with individual and country-level variables. RESULTS: Worldwide, mean optimism levels were above the midpoint of the scale. Perhaps surprisingly, country-level optimism was negatively related to gross domestic product per capita, population density, and democratic norms and positively related to income inequality and perceived corruption. However, country-level optimism was positively related to projected economic improvement. Individual-level optimism was positively related to individual well-being within every country, although this relationship was less strong in countries with challenging economic and social circumstances. CONCLUSIONS: While individuals around the world are generally optimistic, societal characteristics appear to affect the degree to which their optimism is associated with psychological well-being, sometimes in seemingly anomalous ways.

Outcomes of Physicians' Communication Goals During Patient Interactions.

During healthcare visits, physicians may set communication goals such as providing their patient with information about treatment; however, no recommendations exist regarding which goals physicians should prioritize during their often-brief interactions with patients. Two studies examined five communication goals (providing information, reducing distress, increasing patient satisfaction, increasing patient adherence, and encouraging hope) in the context of physician-patient interactions and their relationship with patient and physician outcomes. In Study 1, audio-recordings of physician-patient interactions were coded by research assistants for goal-related content. In Study 2, patients reported their physician's use of each goal during the interaction. In both studies, patients and physicians reported visit outcomes. Within-study meta-analyses suggested that the goal of reducing distress, but not the other goals, was consistently related to improved outcomes in Study 1. All goals were related to improved outcomes in Study 2. We then computed sample-size-weighted meta-analytic effects of each goal on each outcome across both studies. These results suggested that all of the goals had similar-sized positive relationships with patient and physician outcomes across studies. These findings suggest that physicians should generally approach consultations with communication goals in mind, but prioritizing efforts to reduce distress may be particularly beneficial.

Correlates of Physicians' and Patients' Language Use during Surgical Consultations.

A multi-method approach was used to explore correlates of technical and complex language use within 145 audio-recorded physician-patient interactions. When discussing the prospect of surgery, physicians used more technical and complex language (more jargon, larger words, longer sentences) than patients on average. Patients' demographic characteristics (education, health literacy, English fluency) and markers of health (condition severity) inconsistently predicted physicians' and patients' use of complex and technical language. Interactions with happier and more hopeful patients involved less technical and complex language, but physicians' language use was unrelated to patients' emotions following the consultation. Finally, physicians' use of more technical language predicted greater patient satisfaction following the consultation, and physicians' use of more complex language at the initial consultation predicted better adherence by patients following surgery. Our results highlight the nuanced role of language use within healthcare interactions and identifies language complexity as a novel target for health communication research.

The Psychological Experience of Awaiting Breast Diagnosis.

BACKGROUND: Each year, over 1 million women in the USA undergo diagnostic breast biopsies, many of which culminate in a benign outcome. However, for many patients, the experience of awaiting biopsy results is far from benign, instead provoking high levels of distress. PURPOSE: To take a multifaceted approach to understanding the psychological experience of patients undergoing a breast biopsy. METHOD: Female patients (N = 214) were interviewed at an appointment for a breast biopsy, just prior to undergoing the biopsy procedure. Pertinent to the current investigation, the interview assessed various patient characteristics, subjective health and cancer history, support availability, outcome expectations, distress, and coping strategies. RESULTS: The findings revealed a complex set of interrelationships among patient characteristics, markers of distress, and use of coping strategies. Patients who were more distressed engaged in more avoidant coping strategies. Regarding the correlates of distress and coping, subjective health was more strongly associated with distress and coping than was cancer history; perceptions of support availability were also reliably associated with distress. CONCLUSION: Taken together, the results suggest that patients focus on their immediate experience (e.g., subjective health, feelings of risk, perceptions of support) in the face of the acute moment of uncertainty prompted by a biopsy procedure, relative to more distal considerations such as cancer history and demographic characteristics. These findings can guide clinicians' interactions with patients at the biopsy appointment and can serve as a foundation for interventions designed to reduce distress in this context.

Even Optimists Get the Blues: Interindividual Consistency in the Tendency to Brace for the Worst.

OBJECTIVE: The present research examined whether the tendency to brace for the worst by becoming pessimistic as news approaches varies across people, namely, people who differ in their trait-like outlooks on the future (dispositional optimism, defensive pessimism). METHOD: Across nine studies in laboratory and field settings, we examined the roles of dispositional optimism and defensive pessimism in the propensity to brace for the worst when awaiting uncertain news. The studies used a variety of paradigms, including predictions about performance on the bar exam, peer ratings of attractiveness, and feedback on an intelligence test. RESULTS: Results from these studies consistently failed to support individual differences in the tendency to brace for the worst. CONCLUSIONS: Trait-like differences in future outlooks seem to influence only the level and not trajectories of outcome predictions, pointing to relative commonalities in the development of the tendency to brace for the worst.

Characteristics and Correlates of Word Use in Physician-Patient Communication.

BACKGROUND: Numerous studies have described and evaluated communication in healthcare contexts, but these studies have focused on broad content and complex units of behavior. Growing evidence reveals the predictive power and importance of precise linguistic characteristics of communication. PURPOSE: This study aims to document characteristics, predictors, and correlates of word use within specific linguistic categories by physicians and patients during a healthcare visit. METHODS: Conversations between patients (n = 145) and their physician (n = 6) were audio recorded, transcribed, and analyzed using Linguistic Inquiry Word Count software. Patients also completed questionnaires prior to and immediately following the visit and (for a subset of patients) at a follow-up visit, which assessed patients' demographics, how much they liked the physician, and self-reported adherence. Physicians completed a questionnaire following the initial visit that assessed the patient's health status, the physician's optimism regarding the upcoming treatment, and satisfaction with the productivity of the visit. RESULTS: Patients and physicians differed in the extent of their word use in key linguistic categories, while also maintaining significant linguistic synchrony. Demographic characteristics and health status predicted variability in patients' and physicians' word use, and word use predicted key visit outcomes. Most notably, patients liked their physician more when physicians used fewer negative emotion words and were less adherent when physicians used more singular first-person pronouns. CONCLUSIONS: These findings reveal patterns in the way physicians speak to patients who vary in their demographic characteristics and health status and point to potentially fruitful targets for linguistic interventions with both physicians and patients.

Is waiting bad for subjective health?

The present study examined the possibility that waiting is bad for one's subjective health. Specifically, we examined longitudinal trends in the self-reported health, self-reported sleep disruption, distress, and emotion regulation strategies of law school graduates waiting for their bar exam results. Multilevel analyses suggest that waiting was particularly detrimental to participants' self-reported health and sleep disruption at the beginning and end of the waiting period. Moreover, distress and most emotion regulation efforts were associated with poorer subjective health on average, and personal increases in distress and emotion regulation were largely associated with personal increases in poor self-reported health and sleep disruption. Our results suggest that waiting periods can take a toll on subjective health and that individual and temporal variations in distress and emotion regulation efforts are associated with these health trajectories.

Expectations in the context of gallbladder and hernia surgery: a descriptive report.

OBJECTIVE: Patients' expectations predict important health outcomes. The goal of this study is to describe the types of expectations that hernia and gallbladder patients have for the outcomes of their surgery and to identify relationships between these expectations and both patient- and surgeon-reported variables. DESIGN: Patients (N = 143) at an out-patient surgery clinic completed self-report questionnaires before and after a pre-surgical consultation in which they learned they would be scheduled for surgery. After indicating their general expectations for their surgical outcomes (positive or negative), patients reported specific outcome expectations, which were coded into eight categories: functional improvement, symptom relief, quality-of-life improvement, emotional improvement, general health, no effect expected, no response (or unsure) and negative expectations. RESULTS: Functional improvement and symptom relief were the most common types of expectations mentioned by patients. A key finding was a significant difference in the pattern of expectations provided by Hispanic versus non-Hispanic patients, as well as between patients across the range of health literacy. CONCLUSIONS: Patients undergoing hernia and gallbladder surgery have a variety of expectations, and these expectations vary across demographic groups. Patients who are particularly vulnerable to poor physician communication have positive but diffuse expectations.

Patients' anxiety and hope: predictors and adherence intentions in an acute care context.

CONTEXT: Good patient-provider interactions promote satisfaction with health care, adherence to treatment recommendations and improved health. However, little research has examined patients' emotions and how they relate to patients' experiences with health care and their adherence intentions in acute care settings. OBJECTIVE: This study examined the predictors and consequences of two emotions pertinent to the uncertainty of acute health-care experiences: anxiety and hopefulness. DESIGN: Patients who arrived at a general surgery clinic for an initial consultation were interviewed before and after the consultation. Prior to the consultation with a physician, patients completed baseline measures of their emotional state. Following the consultation, patients completed measures of understanding of the information provided by the surgeon, perceived control over treatment decisions, adherence intentions and emotional state. RESULTS: Understanding and control predicted less anxiety and greater hopefulness, compared to baseline. Only hopefulness predicted adherence intentions. These relationships remained even after controlling for characteristics of the patients and interactions. DISCUSSION: These findings identify aspects of psychosocial care that are critical for promoting positive (and mitigating negative) emotional states in patients. Even in a brief consultation in a clinic setting, physicians may be able to improve patients' emotional state by promoting a sense of control and clarifying information they convey, and patients' positive emotional states may be critical for raising adherence intentions.

Who is satisfied with general surgery clinic visits?

BACKGROUND: Patient satisfaction is an important patient outcome because it informs researchers and practitioners about patients' experience and identifies potential problems with their care. Patient satisfaction is typically studied through physician-patient interactions in primary care settings, and little is known about satisfaction with surgical consultations. METHODS: Participants responded to questionnaires before and after a surgical consultation. The study was conducted in a diverse outpatient clinic within a county hospital in Southern California. Participants were patients who came to the surgery clinic for their first appointment after referral from a primary care provider for a surgical consultation. RESULTS: Patients' ethnicity, educational attainment, and insurance status predict their satisfaction, and patients reliably differed in their satisfaction with care providers and with the hospital where they received their care. CONCLUSIONS: These findings add to knowledge about patient care by highlighting associations between patients' demographic characteristics and patients' differential satisfaction with particular entities within the context of surgical care.

Predictors of genetic testing decisions: a systematic review and critique of the literature.

Genetic testing is increasingly available in medical settings and direct-to-consumer. However, the large and growing literature on genetic testing decisions is rife with conflicting findings, inconsistent methodology, and uneven attention across test types and across predictors of genetic testing decisions. Existing reviews of the literature draw broad conclusions but sacrifice nuanced analysis that with a closer look reveals far more inconsistency than homogeny across studies. The goals of this paper are to provide a systematic review of the empirical work on predictors of genetic testing decisions, highlight areas of consistency and inconsistency, and suggest productive directions for future research. We included all studies that provided quantitative analysis of subjective (e.g., perceived risk, perceived benefits of testing) and/or objective (e.g., family history, sociodemographic variables) predictors of genetic testing interest, intentions, or uptake, which produced a sample of 115 studies. From this review, we conclude that self-reported and test-related (as opposed to disorder-related or objective) predictors are relatively consistent across studies but that theoretically-driven efforts to examine testing interest across test types are sorely needed.

The effects of expectation disconfirmation on appraisal, affect, and behavioral intentions.

People's risk perceptions can have powerful effects on their outcomes, yet little is known about how people respond to risk information that disconfirms a prior expectation. We experimentally examined the affective, cognitive, and behavioral consequences of expectation disconfirmation in the context of risk perceptions. Participants were randomly assigned and then prompted toward either a high or low personal risk estimate regarding a fictitious health threat. All participants then received the same risk feedback, which presented either a negative disconfirmation experience (i.e., worse than expected) in the high-risk estimate condition or a positive disconfirmation experience (i.e., better than expected) in the low-risk estimate condition. Participants who experienced the negative disconfirmation reported stronger intentions to prevent the threat in the future compared to participants who experienced the positive disconfirmation. This effect was mediated by both disappointment about the risk feedback and perceptions of the severity of the threat. These findings have implications for risk communication, suggesting that the provision of objective risk information may improve or diminish the likelihood of behavior change depending on people's initial expectations and their emotional and cognitive reactions to the information.

Causes and consequences of expectation trajectories: "high" on optimism in a public ballot initiative.

Although expectations are key theoretical antecedents of emotion and behavior, expectations are typically examined as static properties without deep consideration of their temporal dynamics. We surveyed residents of California over five time points, during the month preceding a public ballot initiative on cannabis legalization (California Proposition 19) and after the election, to examine both the causes and the consequences of residents' expectation trajectories regarding the vote's outcome. Our results point to the importance of changes in individuals' expectations over time. Specifically, well-informed voters were likely to lower their expectations regarding the measure's passage as the vote neared, in line with polling results, but being informed about the initiative had less impact on expectation trajectories among voters who favored the measure than among those who opposed it. Furthermore, supporters who maintained their optimism about the initiative's outcome over time were more likely to vote and were more disappointed following the measure's failure, compared with supporters who became more pessimistic. The findings suggest that temporal changes in people's optimism and expectations play a unique role in social behavior.

The goals of communicating bad news in health care: do physicians and patients agree?

BACKGROUND: Communicating bad news serves different goals in health care, and the extent to which physicians and patients agree on the goals of these conversations may influence their process and outcomes. However, we know little about what goals physicians and patients perceive as important and how the perceptions of physicians and patients compare. OBJECTIVE: To compare physicians' and patients' perceptions of the importance of different communication goals in bad news conversations. DESIGN: Survey-based descriptive study. PARTICIPANTS: Physicians in California recruited via a medical board mailing list (n = 67) and patients (n = 77) recruited via mailing lists and snowball recruitment methods. MEASUREMENTS: Physicians reported their experience communicating bad news, the extent to which they strive for various goals in this task and their perceptions of the goals important to patients. Patients reported their experience receiving bad news, the goals important to them and their perceptions of the goals important to physicians. MAIN RESULTS: Physicians and patients were quite similar in how important they personally rated each goal. However, the two groups perceived differences between their values and the values of the other group. CONCLUSIONS: Physicians and patients have similar perceptions of the importance of various goals of communicating bad news, but inaccurate perceptions of the importance of particular goals to the other party. These findings raise important questions for future research and clinical practice.

Links between well-being and sleep while awaiting breast biopsy results.

Poor sleep is associated with several negative consequences, including poor health, depression, anxiety, and memory deficits, among others. Although the link from sleep to health and well-being is well-established, fewer studies have examined the reverse relationship. The current study examined the role of one particular challenge to well-being, stressful uncertainty, in the association between well-being and sleep quantity and quality. Female patients (n = 120 for the purpose of analyses) awaiting the results of a breast biopsy participated in an initial interview at their biopsy appointment and then completed daily surveys at home each day until they received their results. Patients who reported poorer well-being on various measures also reported poorer and less sleep on average during the wait for biopsy results, even after controlling for individual differences and well-being at the biopsy appointment. However, when patients experienced positive emotions on a given day, they tended to sleep better that night. Our findings suggest that stressful uncertainty about one's health may have detrimental effects on sleep, but positive emotions may improve sleep during stressful waiting periods.

Volatility in Expectations While Awaiting Important News.

Waiting for important news is uniquely anxiety provoking, and expectations for one's outcome fluctuate throughout the wait. Emotional volatility is typically associated with negative outcomes, but little is known about volatility in expectations. In Study 1, law graduates (N = 248) estimated their chances of passing the bar exam every 2 weeks during the wait for results. Greater volatility in expectations, operationalized as the frequency with which outcome expectations changed during the wait, was associated with greater worry and more negative emotionality throughout the wait. Study 2 partially replicated these findings in a sample of Trump and Biden supporters (N = 444) awaiting the result of the 2020 presidential election. Study 2 also demonstrated a causal link between constrained (vs. volatile) expectations and worry. Our findings have implications for how best to manage one's expectations while awaiting important news, with the goal of minimizing worry and other negative emotions.

The role of uncertainty, worry, and control in well-being: Evidence from the COVID-19 outbreak and pandemic in U.S. and China.

Uncertainty about the future often leads to worries about what the future will bring, which can have negative consequences for health and well-being. However, if worry can act as a motivator to promote efforts to prevent undesirable future outcomes, those negative consequences of worry may be mitigated. In this article, we apply a novel model of uncertainty, worry, and perceived control to predict psychological and physical well-being among four samples collected in China (Study 1; during the early COVID-19 outbreak in China) and the United States (Studies 2-4, during 4 weeks in May 2020, 4 weeks in November 2020, and cross-sectionally between April and November 2020). Grounded in the feeling-is-for-doing approach to emotions, we hypothesized (and found) that uncertainty about one's COVID-19 risk would predict greater worry about the virus and one's risk of contracting it, and that greater worry would in turn predict poorer well-being. We also hypothesized, and found somewhat mixed evidence, that perceptions of control over 1's COVID-19 risk moderated the relationship between worry and well-being such that worry was related to diminished well-being when people felt they lacked control over their risk for contracting the virus. This study is one of the first to demonstrate an indirect path from uncertainty to well-being via worry and to demonstrate the role of control in moderating whether uncertainty and worry manifest in poor well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

On near misses and completed tasks: the nature of relief.

What is the nature and function of relief? Relief has been studied little in psychological science despite its familiarity and pervasiveness. Two studies revealed that relief can result from two distinct situations: the narrow avoidance of an aversive outcome (near-miss relief) and completion of an onerous or aversive event (task-completion relief). Study 1 found that recollections of near-miss relief were marked by more downward counterfactual thoughts and greater feelings of social isolation than recollections of task-completion relief. Study 2 experimentally elicited the two types of relief and found mediational evidence that relief following near misses elicits feelings of social isolation via its stimulation of counterfactual thinking. That near-miss relief is characterized by counterfactual thinking suggests that it prompts people to contemplate how to avert similar experiences in the future, whereas task-completion relief may serve to reinforce endurance during difficult tasks.