Physicians' communication styles as correlates of elderly cancer patients' satisfaction with their doctors.

Physician-patient communication style is of utmost importance to patients with life-threatening diseases. This study identifies the most desired physician communication style by older cancer patients; and examines which of the studied communication styles significantly explains cancer patients' satisfaction with family physicians. A total of 200 older cancer patients, with average age of 75 years, participated in the study, yielding a response rate of 42%. Prospective respondents were randomly selected from the list of cancer patients in the central geographical district of Israel's second largest Health Maintenance Organization fund. Respondents rated their satisfaction with physicians as relatively high. All three communication styles studied were found to be associated with patient's satisfaction. Associations were found between self-rated health, time since the diagnosis of cancer and satisfaction. Women were less satisfied than men with their physicians. Two variables emerged as significant predictors of satisfaction: the physician's caring communication style and patient's gender. Intervention programmes should focus on elevating physicians' awareness of the importance of their communication with cancer patients in general, and of the caring communication style in particular.

Domain identification moderates the effect of positive stereotypes on Chinese American women's math performance.

We examined whether an individual difference factor, math domain identification, moderated performance following positive stereotype activation. We hypothesized that positive stereotype activation would improve performance for those more math identified (compared to a control condition), but would hinder performance for those less math identified. We examined 116 Chinese American women (mean age = 19 years). Participants were assigned to the positive stereotype activation condition or to the control condition before completing a math test. Positive stereotype activation led more math identified participants to perform significantly better than the control condition, whereas it led less math identified participants to perform significantly worse than the control condition. Domain identification moderates the effect of positive stereotype activation. Educators should consider how testing situations are constructed, especially when test takers do not identify highly with the domain.

Religiosity Moderates the Link Between Environmental Beliefs and Pro-Environmental Support: The Role of Belief in a Controlling God.

The current research examines differences in what motivates environmentally sustainable behavior between more and less religious people in the United States. We found that religiosity moderates the extent to which environmental beliefs predict pro-environmental support. Specifically, environmental beliefs predicted pro-environmental support less strongly among more religious people than less religious people (Studies 1 and 2). Using a correlational (Study 2) and an experimental (Study 3) design, we further found that one particular aspect of religiosity-believing in a controlling god-reduced the importance of personally held environmental beliefs in shaping one's support for pro-environmental actions. Our findings suggest that motivation to act based on personal beliefs may be attenuated among people who are religious because they believe in an external source of control. Sociocultural factors, such as religion, shape the psychological underpinnings of social actions, and the present research underscores the importance of understanding psychological diversity in promoting support toward environmental sustainability.

Oily fish reduces plasma triacylglycerols: a primary prevention study in overweight men and women.

OBJECTIVE: Previous studies have demonstrated benefits of high-dose long-chain omega-3 polyunsaturated fatty acid (LC omega-3 PUFA) supplements on metabolic risk. Effects of increased dietary omega-3 PUFA, via oily fish and/or plant-derived omega-3 PUFAs, are less clear and may be modulated by the omega-6:omega-3 PUFA of the habitual diet. This study examined the effect on cardiovascular disease risk markers of reducing dietary omega-6:omega-3 PUFA by changes in linoleic acid:alpha-linolenic acid (LA:LNA) and/or increasing LC omega-3 PUFA. It tested whether decreases in LA:LNA modulate effects of LC omega-3 PUFA. METHODS: One hundred forty-two subjects, recruited to a 24-wk randomized study, were assigned to a control group or one of four interventions. Intervention groups received two portions of oily fish (4.5 g eicosapentaenoic acid + docosahexanoic acid) or white fish (0.7 g eicosapentaenoic acid + docosahexanoic acid) per week, and replaced habitual household fats with ones high in sunflower (high LA:LNA) or rapeseed (low LA:LNA) oil. RESULTS: Modest dietary manipulations of omega-6 and omega-3 PUFAs resulted in significant group x time interactions for serum triacylglycerols (TAGs; P = 0.05); at 24 wk the control and two oily fish groups showed lower TAG than did the white fish/sunflower group (P = 0.05). Reductions in TAG, associated with increased oily fish intakes, were maximized when combined with lower dietary LA:LNA. There were no significant changes in several other cardiovascular disease risk markers. CONCLUSIONS: Two portions of oily fish per week led to significant reductions in TAG relative to consumption of two portions of white fish per week. Changes in TAG were maximized when combined with lower LA:LNA.

Perceived health damages during a physicians' strike in Israel.

This study analyzed the relationship between perceived need for health services and perceived damages to the health of the public due to curtailment of medical services during a physicians' strike. A model describing this relationship was hypothesized and tested in one city in Israel during the course of the strike. Results indicated that significant damage was perceived by the public as a result of the strike, a perception that persisted despite utilization of alternative care centers set up by the strikers. Furthermore, it was shown that financially weaker segments of the population were more likely to perceive damages to their health during a strike than were the more affluent segments of society.

Life-sustaining treatments: what doctors do, what they want for themselves and what elderly persons want.

In view of the current social dilemmas regarding the use of life-sustaining treatments (LST) at the end of life, the purpose of the study was to reveal sources of interpersonal and intrapersonal conflict among the most involved parties, in a society where open doctor-patient communication about end-of-life treatment is rare. Two comparative analyses were conducted: (a) between physicians' practice and elderly persons' preferences regarding the use of different life-sustaining treatments in different illness conditions, and (b) between physicians' hypothetical practice for an elderly person in a metastatic cancer condition, elderly persons' preferences and physicians' preferences for themselves, should they be in the same illness condition. Data were collected in Israel from 339 physicians working in two medical centers, and from a random sample of 987 elderly persons. Attitudes and practice regarding artificial tube feeding, mechanical ventilation and cardiopulmonary resuscitation (CPR) in three different illness conditions were evaluated by close-ended questions. The findings indicate disagreements between the elderly and the physicians on a number of issues: in general, physicians report that they would use more LST than what the elderly report that they would want. Physicians differentiate among different illness conditions and different LST more than elderly persons do. Physicians are more likely to use artificial feeding than CPR, while elderly persons prefer the use of CPR more than artificial feeding. The comparison of physicians' hypothetical practice, the wishes of the elderly, and physicians' wishes for themselves regarding the use of LST in a metastatic cancer condition, shows that physicians would use LST differently from what the elderly want, and that they want less LST for themselves than they would order for elderly patients. The discrepancies found between the physicians' practice and the elderly persons preferences reflect differences in perceptions of artificial feeding and a lack of public knowledge regarding the effectiveness of CPR. They also reflect differences in attitudes regarding the prolongation of life in various illness conditions. The discrepancy between physicians' practice and their preferences for themselves underscores the personal and professional dilemmas related to these issues, which are faced daily by many physicians, and impede their compassionate behavior toward patients. Increasing the awareness of physicians of such discrepancies, and providing them with appropriate behavioral tools, including communication skills, is a timely need which should be addressed by the medical profession, medical services and medical schools.

Behavior, attitudes, and expectations regarding the use of life-sustaining treatments among physicians in Israel: an exploratory study.

The use of life-sustaining treatments (LST) for prolonging lives of terminally ill patients without being able to improve the quality of life is a source of ethical, medical, economic and legal dilemmas for physicians. Although physicians in all Western countries face these dilemmas, they are unique in each society due to the special combination of its dominant religion, and its priorities regarding social values and legislation. This paper presents opinions, attitudes, expectations and behavior regarding the use of LST among 25 physicians attached to one teaching hospital in Israel. The data, which was collected by in-depth, semi-structured interviews, indicate that all of the physicians agree that life does not always have to be artificially prolonged. The general message that the physicians conveyed was that they deal quite effectively with these issues. They are not at all bothered by economic considerations and found ways to deal with the legal, ethical and medical dilemmas. It is suggested that in Israel the core issue is not the current law, but lack of communication among physicians and between physicians and patients/families. The relevance of the dominant model of the doctor-patient relationship and applications for medical education and practice are discussed. A list of hypotheses derived from this exploratory study for future intra-societal and inter-societal research is presented.

The will to live: gender differences among elderly persons.

The purpose of the study was to investigate the will to live by evaluating its association with the wish to prolong life and with indicators of well-being among men and women. First were assessed the strength of the will to live, and its relationship to the wish to prolong life in hypothetical illness conditions. Next, association between the will to live and explanatory factors, such as religious beliefs, fear of death and dying, physical and psycho-social dimensions of well-being were comparatively evaluated among men and women. Data were collected from a random sample of 987 Israeli elderly persons by structured interviews at the participants' homes. Findings indicated that women express a significantly weaker will to live than men, and less desire to prolong life by medical interventions in all the hypothetical health conditions presented to them. Gender differences were also found on the variables which contribute to the explanation of the will to live: For both genders, psycho-social indicators of well-being had more explanatory power than health indicators of well-being, but this finding was more striking among women. The implications of these findings for the study of the perceived meaningfulness of life, and the potential use of the will to live as an indicator of well-being are discussed.

Medical students' attitudes regarding the use of life-sustaining treatments for themselves and for elderly persons.

This study investigated students' wishes regarding the use of life-sustaining treatments (LST) in different health conditions compared with their evaluations of the wishes of elderly people, and with reports of a group of elderly people about themselves. Data were collected from two consecutive classes of first year medical students (n = 101), and a random sample of Israeli elderly aged 70+ (n = 987) who responded to fixed-choice questions regarding their will to live and wishes for three kinds of LST in a number of hypothetical illness conditions. The students were also asked to assess elderly's wishes. Students ranked the will to live of elderly persons significantly lower than their own. The elderly ranked their will to live significantly lower than did the students, but higher than the students assumed about them, indicating that although the will to live is weaker among older people, it is stronger than young persons believe. With regard to the use of LST, students believe that old people want less LST than themselves, but the elderly want even less LST than assumed by the students. The best predictors of students' wishes for themselves were fear of dying and religiosity. Fear of dying, the students' self-esteem and religiosity were the best predictors of their evaluations of the elderly's wishes. The results indicate that both the elderly and the students have a relatively strong will to live, but this desire is dependent on quality of life. The implications of this study for medical education are discussed.

Satisfaction with hospitalization: a comparative analysis of three types of services.

A study of patient's satisfaction with hospital services was undertaken. The purpose of the study was to explore whether and to what extent patients' satisfaction with three types of hospital services (medical, nursing and supportive) is differentially explained by patient's sociodemographic, psychosocial, situational and attitudinal characteristics. To achieve this, 476 patients were interviewed. The results of the analysis of their general satisfaction with hospitalization and a comparative analysis of satisfaction with the three types of services are presented. The best predictors of satisfaction with all three types of services (in order of their importance) are found to be: perceived improvement in health, size of social networks, satisfaction with organizations in the past, and age. The type of ward (medical vs surgical) is found to be a powerful predictor of satisfaction with physicians and nurses only. Ward effect is also interactive--improvement in one's health predicts significantly more satisfaction with medical services in medical wards than in surgical wards. The findings of this study suggest that when clients perceive that their main goal has been achieved (i.e. improvement in health), they tend to attach little importance to deficiencies in the process of achieving it (i.e. the provision of services).

Wishes regarding the use of life-sustaining treatments among elderly persons in Israel: an explanatory model.

This study investigates the wishes of Israeli elderly concerning the use of life-sustaining treatments (LST) at the end of life, and suggests an explanatory causal model for these wishes. The data include 1138 Israeli elderly (70+) respondents. The results indicate that most of the elderly want to prolong their life in mild health conditions, including having cancer with a relatively good prognosis, while only a small percentage want LST in severe illness. Structural equation analysis (LISREL) of wishes for LST in severe illness conditions revealed that personal experience with other people's illnesses is the single most powerful explanatory factor affecting choice regarding LST directly and indirectly, channeled through fear of death and fear of dying. The results of such experiences whether positive or negative affect wishes for LST in the same direction; however, since they are mostly negative, past experience mostly weakens the will to prolong life by LST. Beliefs and feelings regarding life and death, such as fear of death, fear of dying, the will to live and religiosity, are also good predictors of wishes for LST. Those who fear death, have a strong will to live, and those who are more religious are more likely than others to want to prolong their life by LST, while those who fear dying want it less. Religiosity affects these wishes directly and indirectly through fear of death, fear of dying, and the will to live. Health status and social support have only a minor effect on wishes for LST: the higher the present quality of life, the more likely are the elderly to want LST. Most of the socio-demographic characteristics have no significant effect on elderly persons' wishes for LST. Only gender has a minor direct and indirect effect, channeled through the fear of dying and the will to live. Women in comparison to men want less LST because they fear dying more and have a weaker will to live. The results of this study shed some light on the explanatory factors of wishes for LST in severe illness conditions. More research is needed in order to promote social understanding of the concerns and wishes of the most relevant parties regarding the use of LST. This is a necessary condition for the formulation of new societal guidelines for general policy and daily behavior.

Coping with the Gulf war: subculture differences among ischemic heart disease patients in Israel.

The purpose of this study was to assess short term effects of the Gulf war on ischemic heart disease patients of different ethnic origin. Three dimensions of patients' reactions to the war situation were studied: psychological, physical and behavioral. The study first focused on changes in patients' responses on these dimensions over three stages of the war, differentiated according to degree of threat. Second, differences stemming from ethnic origin were examined among patients who live in the same geographical region, use the same health services and were exposed to the same threatening life event. One hundred ischemic heart disease patients were interviewed while waiting in outpatient hospital clinics for a regular examination at the end of the war. The results of intrapersonal comparisons showed that the intensity of responses, as expected, increased significantly on the three dimensions from the week before the war started to the first week of the war, which was the most stressful period for Israelis. During the last week of the war, however, when stress was significantly reduced, the expected change was found primarily with regard to psychologic responses. That is, worries were significantly reduced, but no significant reduction in frequency of anginal pain and in drug consumption followed, indicating differences in the adjustment process on the psychologic and physical levels. Subcultural differences were found in the studied responses: Patients of Asian or North African countries of origin reported having more frequent anginal pains, and consuming more drugs than patients from Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Stability of elderly persons' expressed preferences regarding the use of life-sustaining treatments.

The purpose of the study was to assess the stability of expressed preferences for the use of life-sustaining treatments (LST) in severe illness conditions over two years. The two year longitudinal study included three structured interviews with a one-year interval (1994, 1995, and 1996). At baseline, 1138 Israeli elderly persons (70+) were interviewed, 802 and 638 were interviewed in the following stages. Stability over time was assessed on the basis of score differences on two different indices that measured the wish to prolong life. Overall 70% of the respondents had stable preferences for the use of LST over time. This result was similar on both indices. The large majority of those with stable preferences (86%) did not want to prolong life already in the baseline interview. This was the most stable group. Among those who changed their wishes, the group that wanted LST less at stage 3 (20%) was twice as large as the group that wanted LST more (10%). These findings, which are similar to those reported in a study of an American sample, indicate a high level of stability in elderly persons' expressed preferences for LST at the end of life, and, therefore, strengthen the ethical basis for using advance directives. They also indicate that elderly persons of different cultural backgrounds may face similar problems regarding the prolongation of life and respond to them similarly.

Compassionate-empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern.

Compassionate-empathic physicians (CEPs) are desired by patients, but rarely found in medical settings. The purpose of this study was to promote our understanding of this gap by determining personal characteristics that distinguish CEPs from other physicians, and organizational factors that might enhance or inhibit physicians' compassionate-empathic behavior (CEB). In the first stage of the study, three groups of physicians who differed in their compassionate-empathic pattern of behavior toward patients were identified by a sociometric questionnaire distributed to 324 physicians in a general hospital. In the second stage, almost all of these physicians (N = 308) were asked to fill out a self administered structured questionnaire, and 214 (69.5%) responded. Comparisons among the three groups show that the physicians identified as CEPs, more than other physicians, are younger, have fewer years in medical practice, and score higher on pro-social, non-stereotypic attitudes toward patients and on empathy measures. Their self-esteem is, however, similar to that of the non-CEPs. The CEPs express similar levels of satisfaction with work on most dimensions, but they report more emotional exhaustion (burnout) than other physicians. A consensus among all physicians was found with regard to two rank orders: (a) the important qualities for being "a good physician"; and (b) the important qualities for being promoted in the hospital. However, while empathic behavior was considered the most important quality for being "a good physician", it was ranked as the least important for being promoted in the hospital. The conclusions can serve as a scientific base for improving methods of selection of medical students, and for re-evaluating the existent criteria for promoting medical staff in general hospitals.

Emergency department utilization by two subcultures in the same geographical region.

An exploratory study of emergency department (ED) utilization, comparing Israeli adult Jews and Bedouin Arabs was conducted. The data interpretation derived from the premise that health services utilization reflects not only morbidity patterns but characteristics of both subcultures and the structure of health services. The Bedouins in the study are a Moslem traditional society going through a rapid process of urbanization and modernization, with a relative deficiency in primary health services. Data were collected from the general ED admissions registry. Patients (17+) who arrived at the ED during the first week of every even month of one calendar year were selected for this study (6815 Jews and 583 Bedouins). The findings indicate that, in general Bedouins use the ED significantly less than Jews. They adjust to the structure of the ED services and use them, more than Jews, as a primary service. Yet, the hospitalization rates of the two populations are similar. In both subcultures the pattern of gender differences changes after the age of 45. The change, however, is in the opposite direction. Differences in ED usage among Bedouin age-sex groups are discussed in terms of changes in social status during a period of socio-cultural transition.

Life events, sense of coherence and health: gender differences on the kibbutz.

The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

Autonomy, job satisfaction and professional self-image among nurses in the context of a physicians' strike.

This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.

Nurses' autonomy and job satisfaction.

Nurses' autonomy is structurally limited by physicians' close supervision and control. A prolonged physicians' strike in Israel in 1983 created a special situation where for 3 months nurses had to provide primary health care services without physicians. This study, undertaken at the end of the strike, focuses on nurses' comparative perceptions of autonomy and job satisfaction with relation to role performance during the strike and in usual work conditions. Data were collected by means of a self-administered questionnaire. Sixty one percent (n = 1144) of the primary health care nurses in Israel responded. The strike situation increased the normal work load of the nurses, but it also gave many nurses the opportunity to initiate and carry out special programs in their clinics and communities. The majority of nurses report that in general they are satisfied with their work and perceive it as autonomous. The increase in routine as well as self-initiated activities was found to be positively but weakly correlated with an increase in job satisfaction and in the perception of role autonomy during the strike. These findings suggest that even after, or perhaps because of, being exposed to a significant change in contextual autonomy (working without physicians for a prolonged period of time) most Israeli primary care nurses do not appear to desire increased autonomy in the work place.

Left ventricular performance in patients with normal coronary arteries: hemodynamic characteristics and clinical follow-up.

Of 111 patients with normal coronary angiograms, 68 patients had elevated left-ventricular end diastolic pressure and 'low-normal' ejection fraction (Group I) while the other 43 patients had normal left ventricular end diastolic pressure and 'high normal' ejection fractions (Group II). Although the number of patients was too small for meaningful statistical analysis, systematically a higher percentage of patients with diabetes mellitus, hypertension, hypercholesterolemia and smoking history was found in Group I. In contrast to the patients in Group II, patients in Group I tended to have more angina and ischemic events.

Coronary collaterals in patients with normal and impaired left ventricular systolic function.

One hundred and twenty consecutive patients with significant coronary artery disease, normal left ventricular systolic function and coronary collaterals (group A) were compared to 120 patients with the same characteristics but with left ventricular systolic dysfunction (group B). No significant differences were found between the two groups on age, hypertension, diabetes mellitus and smoking. The left ventricular end diastolic pressure was 16+/-7 in group A, and 24+/-9 in group B (P<0.01). The number of diseased vessels was similar in both groups. More completely occluded vessels were found in group B (155 vs. 101 in group A). No significant difference was detected between the two groups in the distribution of the diseased vessels. In both groups, the richest collateral supply was to the right coronary artery, followed by collaterals to the left anterior descending. The poorest supply was to the left circumflex. In conclusion, patients with normal and abnormal left ventricular systolic function have similar coronary collateral characteristics.