Most patients felt incompletely heard and understood at the time of referral to palliative care consultation, and more than half of the patients improved after consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience.
Objective
Clinicians frequently overestimate survival time among seriously ill patients, and this can result in medical treatment at end of life that does not reflect the patient's preferences. Little is known, however, about the sources of clinicians' optimistic bias in survival estimation. Related work in social networks and experimental psychology demonstrates that psychological states—such as optimism—can transfer from one person to another.
Methods
We directly observed and audio recorded 189 initial inpatient palliative care consultations among hospitalized patients with advanced cancer. Patients self‐reported their level of trait optimism and expectations for survival prognosis prior to the palliative care consultation, and the palliative care clinicians rated their expectations for the patient's survival time following the initial conversation with the patient. We followed patient mortality for 6 months.
Results
Patient optimism was associated with clinician overestimation of their survival in a dose–response relationship. Clinicians were approximately three times as likely to overestimate the survival of patients endorsing both high trait optimism and optimistic ratings of their survival time compared with neither (OR: 2.95; 95% CI: 1.24‐7.02). This association was not attenuated by adjustment for age, gender, race, ethnicity, education, income, cancer type, functional status, quality of life, or white blood cell count (ORadj: 3.45; 95% CI: 1.24‐9.66).
Conclusion
Patients' optimism may have some influence over their clinicians' prognostic judgments.
This study used a quasi-experimental design to compare the effects of an intercultural development program on students' Cultural Intelligence (CQ) compared with students in a summer research program who did not receive the intervention. Social Learning Theory guided a 9-week student-centered cultural learning course focused on attention, retention, and reproduction of each CQ domain. After the course, students had opportunities to practice their CQ abilities while studying abroad. Pre-assessment CQ determined an
individualized learning plan. Reflective journaling and cultural mentoring were used to maximize student CQ growth. Using multi-level modeling, we observed a statistically significant increase in three CQ domains compared to the comparison control group: cognitive (p<.01), metacognitive (p<.01), and behavioral CQ (p<.01). Motivation CQ scores did not significantly improve (p=0.08). Our results suggest that a university intercultural
development program that intentionally combines a cultural learning course with a study abroad experience may improve students’ CQ.
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