Critical reflection about socioeconomic inequalities among White young men from poor and working-class backgrounds.

An intersectional approach to human development emphasizes the multiple social categories individuals occupy, some of which confer privilege (e.g., being White) and some of which confer marginalization (e.g., being poor). This approach is needed especially in critical consciousness scholarship, and particularly in regard to understanding whether and how it may manifest among youth who simultaneously experience privileges due to some aspects of their identities and marginalization due to other aspects of their identities. We explored critical reflection (CR) about socioeconomic inequalities through interviews with 31 White young men from low-income and working-class backgrounds who were attending trade colleges in Pennsylvania. Participants were asked about their understandings of the causes of poverty in the United States and potential solutions. Multiple rounds of qualitative analysis were conducted to understand the potential manifestation of CR in responses. Inductive across-case thematic analysis yielded 11 themes describing participants' understandings of poverty. We then conducted case-based analyses to identify the specific attributions about poverty that each participant made (structural, fatalistic, and/or individual), the ways in which these attributions arose in responses, and how the pattern identified related to CR. Eight participants were identified as having some CR or the potential to develop CR, and their responses were explored for references to experiences that may have been related to CR as well as their membership in a privileged racial and gender group, and more marginalized socioeconomic group. Implications for examining and promoting CR in different groups of youth are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer.

CONTEXT: Unplanned cancer-related hospital admissions often herald entry into the final phase of life. Hospitalized patients with advanced cancer have a high symptom burden and a short life expectancy, which may warrant palliative care intervention. OBJECTIVES: To identify the impact of implementing triggered palliative care consultation (TPCC) as part of standard care for patients admitted to the solid-tumor oncology service with advanced cancer. METHODS: We conducted a prospective, sequential, three-cohort study to evaluate TPCC feasibility and impact using patient-reported outcomes, electronic medical records to identify resource utilization, and surveys of oncologists' perspectives on TPCC. RESULTS: Sixty-five patients were evaluated before TPCC implementation (Cohort 1). Seventy patients (Cohort 2) were evaluated after initiation of TPCC, and 68 patients (Cohort 3) were evaluated after modifications based on implementation barriers identified in Cohort 2. The percentage of patients correctly identifying their cancer as incurable increased from 65% in Cohort 1 to 94% in Cohorts 2 and 3. TPCC had minimal impact on hospice utilization, cost of care, survival, patient-reported symptoms, and patient satisfaction, likely because of the limited nature of the intervention. Implementation was challenging, with only 60% of patients in Cohort 2 and 62% in Cohort 3 receiving TPCC. Overall, the intervention was viewed favorably by 74% of oncologists. CONCLUSION: Although TPCC was viewed favorably, implementation was logistically challenging because of short stays, high-acuity symptoms, and individual provider resistance. TPCC improved patients' understanding of their cancer. This population demonstrates high palliative care needs, warranting further research into how best to deliver care.

An empirical study of surrogates' preferred level of control over value-laden life support decisions in intensive care units.

RATIONALE: Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood. OBJECTIVES: To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions. METHODS: This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection. MEASUREMENTS AND MAIN RESULTS: The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation. CONCLUSIONS: Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.