What Counts as a Surrogate Decision?

When patients lose decision-making capacity, others must make surrogate decisions on their behalf. What counts as a surrogate decision might seem self-evident. But as clinician-researchers in the field of advance care planning, we have found that it is not always so clear-cut. In this paper, we describe how and why this is a matter of concern, a novel approach for assessing whether a surrogate decision occurred, and findings from this assessment.

The Effects of Emotion, Spokesperson Type, and Benefit Appeals on Persuasion in Health Advertisements: Evidence from Macao

Enhancing public awareness for epidemic prevention is crucial for safeguarding public health. This experimental study investigated the effectiveness of a combined approach involving three persuasive elements in public health advertising. Specifically, the study examined the interplay between emotional appeals (fear messages versus efficacy messages) and spokesperson type on the public's response to health announcements. The results demonstrated that fear messages were more persuasive when conveyed by real human spokespersons (versus animated spokespersons), whereas efficacy messages were more acceptable when conveyed by animated spokespersons (versus real humans). Furthermore, the study revealed that the impact of emotional appeals and spokesperson type is moderated by benefit appeals (self-benefit or other-benefit). The joint effects of these persuasive variables on individuals' intention to adopt preventive measures indicated that the interactions significantly differed across the two types of benefit appeal. Taken together, the findings represent a pioneering contribution to the field of health communication by comparing the persuasive effects of different combinations of emotional appeals, spokesperson types, and benefit appeals on public behavior. These findings offer practical guidance for public communicators to design more appropriate health advertisements based on the results of this study, thereby enhancing public acceptance of disease prevention measures.

Spokespeople in public health: Important characteristics from the perspective of Australian public health professionals

BACKGROUND

Spokespeople play a significant role in communicating public health information yet there is little research understanding the characteristics of those who provide such messaging.

METHODS

One hundred and four health professionals (70% female) recruited through professional association mailing lists in Australia completed a brief online quantitative and qualitative survey.

RESULTS

Participants reported characteristics they believed to be important for spokespeople, those that they believed their organisation considered important, and those they thought engendered public trust. Knowledge of public health issues, public speaking skills, and willingness to speak on behalf of the organisation were identified as important characteristics (by at least 70%). Qualitative results showed some participants distinguished between perceived, as well as actual, expertise, and described the potential for public health university programs to include public speaking and communication skills. Participants also identified an individual's role in the organisation was considered important in their organisation's selection of a spokesperson, particularly in relation to seniority and leadership.

CONCLUSIONS

The study provides an initial description and priority considerations from health professionals about key characteristics of effective spokespeople. Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople. SO WHAT?: Findings suggest possible avenues for training and support for spokespeople and the need for further research regarding the characteristics of who are effective spokespeople.

The Value of Advance Care Planning for Spokespersons of Patients With Advanced Illness

CONTEXT

Advance Care Planning (ACP) has fallen under scrutiny primarily because research has not consistently demonstrated patient-focused benefits.

OBJECTIVES

To better understand how spokespersons regard, engage with, and find value in ACP during decision-making for their loved ones.

METHODS

This qualitative analysis was part of a randomized controlled trial involving spokespersons of patients with advanced illness who had completed ACP. After making a medical decision on behalf of their loved one (or that loved one's death), semi-structured interviews explored spokespersons' experience of decision-making and if (and how) ACP played a role. Thematic analysis was conducted on interview transcripts.

RESULTS

From 120 interviews, five themes emerged: 1) Written advance directives (ADs) helped increase spokespersons' confidence that decisions were aligned with patient wishes (serving as a physical reminder of previous discussions and increasing clarity during decision-making and family conflict); 2) Iterative discussions involving ACP facilitated "In the moment" decision-making; 3) ADs and ACP conversations helped spokespersons feel more prepared for future decisions; 4) Spokespersons sometimes felt there was "no choice" regarding their loved one's medical care; and 5) Regrets and second-guessing were the most common negative emotions experienced by spokespersons.

CONCLUSION

Considering the recent debate about the utility of ACP and ADs, this analysis highlights the value of ACP for spokespersons involved in surrogate decision-making. Reframing the goals of ACP in terms of their benefit for spokespersons (and identifying appropriate outcome measures) may provide additional perspective on the utility of ACP.

Who Is Listening? Spokesperson Effect on Communicating Social and Physical Distancing Measures During the COVID-19 Pandemic

Effective communication during a pandemic, such as the current COVID-19 crisis, can save lives. At the present time, social and physical distancing measures are the lead strategy in combating the spread of COVID-19. In this study, a survey was administered to 705 adults from Switzerland about their support and practice of social distancing measures to examine if their responses depended on (1) whether these measures were supported by a government official or an internationally recognized celebrity as a spokesperson, (2) whether this spokesperson was liked, and (3) the respondent's age. We also considered several attitudinal and demographic variables that may influence the degree to which people support and comply with social distancing measures. We found that the government official was more effective in eliciting responses supportive of social distancing, particularly as manifested in the stated current compliance with social distancing measures. The effect was substantially stronger among older respondents, although these respondents expressed a lower risk perception. Although there was a general trend for greater endorsement of the social distancing measures among participants who liked the spokesperson, this was non-significant. In addition, respondents' greater support and compliance was positively associated with (1) higher concern for the current situation, (2) higher concern for the well-being of others, and (3) greater belief that others were practicing social distancing, and negatively with (4) greater self-reported mobility. Current compliance correlated negatively with (5) household size. Since different parts of the population appear to have different perceptions of risk and crisis, our preliminary results suggest that different spokespersons may be needed for different segments of the population, and particularly for younger and older populations. The development of evidence-based knowledge is required to further identify who would be the most effective spokesperson, and in particular to groups with low risk perception and low compliance.

Surrogate Decision Maker Stress in Advance Care Planning Conversations: A Mixed-Methods Analysis From a Randomized Controlled Trial

CONTEXT

Spokespersons serving as surrogate decision makers for their loved ones report high levels of stress. Despite known benefits, advance care planning (ACP) conversations often do not occur. More information is needed to understand spokesperson stress during ACP.

OBJECTIVES

To explore if and how spokespersons perceive stress related to ACP conversations; compare factors related to stress; and assess whether ACP intervention impacted stress.

METHODS

Secondary and mixed-methods analysis with data transformation of semistructured interviews occurring during a 2 × 2 factorial (four armed) randomized controlled trial that compared standard online ACP to a comprehensive online ACP decision aid. Tools were completed by patients with advanced illness (n = 285) alone or with their spokesperson (n = 285). About 200 spokesperson interviews were purposively sampled from each of the four arms (50 per arm).

RESULTS

ACP conversations were reported as stressful by 54.41% (74 of 136) and nonstressful by 45.59% (62 of 136). Five themes impacting spokesperson stress were the nature of the relationship with their loved one; self-described personality and belief systems; knowledge and experience with illness and ACP conversations; attitude toward ACP conversations; and social support in caregiving and decision making. No significant differences in stress were associated with arm assignment.

CONCLUSION

Identifying what factors impact spokesperson stress in ACP conversations can be used to help design ACP interventions to more appropriately address the needs and concerns of spokespersons.

Enrique Pichon Rivière's conception of reality in psychoanalysis

The author places the subject of his paper in the context of the original views of a school of Argentinian psychoanalysts that differed from traditional conceptions of man and his relationship with the sociocultural context - that is, with reality. These were the analysts who followed Enrique Pichon Rivière and further developed his ideas - namely, Madeleine and Willy Baranger, José Bleger, and David Liberman. The author begins his exposition with a discussion of Pichon Rivière and culture. He then offers an outline of Pichon Rivière's particular conception of man, followed by a section on the Internal Group as the nexus between the psyche and reality. Further sections address the idea of reality in the analytic situation as a dynamic field and the operative definition of the transference; the distinction between perceptual reality and the reading of reality, with a consideration of the notion of 'critical judgement'; and lastly the issue of health and illness in terms of adaptation to reality. In addition, on the basis of a quotation from Antonio Damasio, the author draws a parallel between these psychoanalytic thinkers' 'psychosocial' approach to man and the findings of contemporary neuroscience as presented by one of its paradigmatic protagonists.

Perception of spokespersons' performance and characteristics in crisis communication: experience of the 2003 severe acute respiratory syndrome outbreak in Taiwan

Background/Purpose

To explore perception of spokespersons' performance and characteristics in response to the 2003 severe acute respiratory syndrome (SARS) outbreak.

Methods

This study was conducted from March to July, 2005, using semi-structured in-depth interviews to collect data. All interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was employed to analyze the transcribed data. Interviewees included media reporters, media supervisors, health and medical institution executives or spokespersons, and social observers.

Results

Altogether, 35 interviewees were recruited for in-depth interviews, and the duration of the interview ranged from 1 hour to 2 hours. Results revealed that the most important characteristics of health/medical institutions spokespersons are professional competence and good interaction with the media. In contrast, the most important behaviors they should avoid are concealing the truth and misreporting the truth. Three major flaws of spokespersons' performance were identified: they included poor understanding of media needs and landscape; blaming the media to cover up a mistake they made in an announcement; and lack of sufficient participation in decision-making or of authorization from the head of organization.

Conclusion

Spokespersons of health and medical institutions play an important role in media relations during the crisis of a newly emerging infectious disease.