Palliative Care in the Emergency Department

As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in communication strategies that support shared decision making and familiarity with medicolegal terminology increase physician confidence about addressing complaints at the end of life. Familiarity with evidence-based recommendations for symptom management of pain at the end of life aids the emergency physician in creating a positive experience for the patient and their loved ones.

To end life or to save life: ageism moderates the effect of message framing on attitudes towards older adults' suicide

BACKGROUND

Global suicide rates among older adults are very high. Public attitudes towards older adults' suicide may affect older adults upon their contemplating such an act. Previous research has demonstrated that message framing affects persons' judgments and decision making. Thus, message framing may have particular significance in the context of attitudes towards end-of-life phenomena, such as physician-aided suicide. This study examined the possible role of ageism in moderating the effect of message framing on attitudes towards older adults' suicide.

METHODS

Two studies examined the association between ageism and attitudes towards older adults' suicide. Study 1 assessed both variables by self-administered questionnaires; Study 2 further examined these variables, incorporating participants' responses to a suicide-related vignette, and evaluating the possible effect of message framing, using a between-participants design.

RESULTS

High-ageism participants expressed greater acceptance for older adults' suicide, whereas low-ageism participants expressed a less permissive approach to it (Study 1). In addition, ageism moderated the effect of message framing on attitudes towards older adults' suicide: High-ageism participants revealed a more permissive attitude towards older adults' suicide when the issue was presented in positive terms of not prolonging life, relative to a negative presentation of ending life; a similar effect was not found for low-ageism participants (Study 2).

CONCLUSIONS

The moderating effect of ageism on attitudes towards older adults' suicide has both theoretical and practical implications. We discuss these implications with respect to suicide prevention among older adults, and suggest future research.

Voluntary or Mandatory? The Valence Framing Effect of Attitudes Regarding HPV Vaccination

This study addresses the issue of valence framing effect in the context of immunization, a preventive behavior often addressed by the equation of benefit versus risk. The authors examined how framing (support vs. oppose) the issue of HPV vaccination in Israel's immunization routine affects attitudes regarding vaccine regulations. The study also examined issue involvement as a moderator of valence framing effect. The results demonstrate that participants in the positive framing condition tended to express greater support for voluntary immunization than participants in the negative framing condition (77.5% and 48.5%, respectively). Among those who supported the mandatory HPV immunization policy, the negative framing condition was more prominent than the positive condition (51.5% and 22.5%, respectively). The analysis of interaction between valence framing and issue involvement showed that the latter tends to moderate the direct effect of framing on attitudes towards vaccination. Findings indicate that even attitudes towards such consequential preventive behaviors as vaccination could be affected by different framing of the issue, especially for those who are less involved. Implications of predilection for freedom of choice regarding vaccination are also discussed.

The attitude-behavior discrepancy in medical decision making

Background:

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions.

Objectives:

This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description.

Patients and Methods:

A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\attitude to risky plan\attitude to conservative plan (3).

Results:

A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t _behavior = -3.24, P < 0.01；t _{attitude to surgery} = 4.08，P < 0.01；t _{attitude to radiation} = -2.15，P < 0.05).

Conclusions:

A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.