Adrian Musters

Exploring genetic counseling communication patterns: the role of teaching and counseling approaches.

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.

Communication with Breast Cancer Survivors

Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001). Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.

Uncertainty in BRCA1 cancer susceptibility testing

This study investigated uncertainty in individuals undergoing genetic counseling/testing for breast/ovarian cancer susceptibility. Sixty‐three individuals from a single kindred with a known BRCA1 mutation rated uncertainty about 12 items on a five‐point Likert scale before and 1 month after genetic counseling/testing. Factor analysis identified a five‐item total uncertainty scale that was sensitive to changes before and after testing. The items in the scale were related to uncertainty about obtaining health care, positive changes after testing, and coping well with results. The majority of participants (76%) rated reducing uncertainty as an important reason for genetic testing. The importance of reducing uncertainty was stable across time and unrelated to anxiety or demographics. Yet, at baseline, total uncertainty was low and decreased after genetic counseling/testing (P = 0.004). Analysis of individual items showed that after genetic counseling/testing, there was less uncertainty about the participant detecting cancer early (P = 0.005) and coping well with their result (P < 0.001). Our findings support the importance to clients of genetic counseling/testing as a means of reducing uncertainty. Testing may help clients to reduce the uncertainty about items they can control, and it may be important to differentiate the sources of uncertainty that are more or less controllable. Genetic counselors can help clients by providing anticipatory guidance about the role of uncertainty in genetic testing.

Error Producing Conditions in the Intensive Care Unit

Up to 98,000 patients die annually in U.S. hospitals due to human error. One of the areas where error occurs frequently is the Intensive Care Unit. Despite the impact of error, there is very little work that attempts to identify the human factors contributors to error in the ICU. The current study used the framework of error producing conditions to identify factors that are contributing to error. By modifying the method of assessing error producing conditions we were able to identify the extent to which individual conditions contribute to the prevalence of error. Also, we were able to identify the contribution certain devices have in the prevalence of error. Most importantly, the most critical devices for patient care were also identified as the ones that were rated the highest in their prevalence of error producing conditions and potential for hazard. Thus, developing medical devices that are reducing the device related potential for patient harm has to be a main goal for future patient safety work. This is a challenge sound human factors engineering should answer.

Individual differences in interrupted task performance

Two experiments used a spatial navigation task to study the relationship between individual differences in working memory capacity and interrupted task performance. The results of experiment one show that participants with low working memory capacity (WMC) are more susceptible to the negative effects of interruptions than participants with high WMC. The results of additional analyses indicate that both groups differ in their strategies used to memorize material from the primary task. A second experiment manipulated memory strategy use for high and low memory span participants and found that low span participants performed at the level of high spans when using a strategy that is more typically used by high span participants. However, this performance improvement did not show during interrupted tasks. Overall, these results suggest that individual memory capacity differences affect performance during interrupted tasks by determining selection of memory strategies and by limiting performance of participants. A new paradigm was developed to study task interruptions.Memory differences affect strategy selection and success in dealing with interruptions.Individual memory differences affect performance during interrupted tasks.

Environmental factors that influence wildfire protective-action recommendations

Each year wildfire incident commanders (ICs) manage thousands of events throughout the USA that often threaten life and property. In this task they make important decisions to protect both firefighters and citizens, usually under time pressure and uncertainty. Many environmental factors affect the choice and timing of the most effective protective-action in this context (e.g., evacuate, shelter-in-refuge, shelter-in-place). The goal of this research is to identify the critical factors that influence wildfire protective-action recommendations (PARs) and their relative importance. Forty-seven ICs from the western USA were surveyed to produce mean factor-importance scores, where multi-dimensional scaling (MDS) and pathfinder analysis were applied to visually assess factor similarity. The results indicate that more experienced ICs place greater importance on dynamic, fire-related factors, while also differing in their cognitive representation of these factors from less experienced ICs. These results have important practical implications in developing effective training interventions, supporting the process of sense-making, and designing decision support systems.

The Effect of Incongruent Instruction/Execution Pairs on Working Memory

This study tests how information is encoded into working memory when the type of instruction is incongruent with a task. To determine where information is encoded in working memory interruptions will be used to disrupt performance. A spatial Lego® construction task and a verbal letter arrangement task will be compared. Operation Span will be measured against performance. The conclusions drawn from this study will impact the understanding of working memory which will help in discovering effective types of instruction and in dealing with interruptions.

A Bit of Decline An Information Processing Approach to Complexity and Performance Loss

Cell phone use while driving has been shown to significantly impair driving performance. A limitation of current work on driver distraction, however, is that none of the research has been able to clearly measure the cognitive demand of the conversation in which a driver engages. Precise measurement of different levels of cognitive demand will improve our understanding of its impact on driving performance. Here we describe a study that uses information theory to quantify information processing in a simple, predictable way, i.e., performance decline as a function of bits of processing. These data could eventually be turned into a regressive model which matches performance loss to specific levels of cognitive demand. The goal of this experiment was to determine the degree to which performance on a tracking task was compromised when participants engaged in varying degrees of information processing. First analyses of the results indicate a significant and predictable impact of increased information processing demand on tracking performance as demonstrated by an increase in distance to the tracking target, increased response formulation, and a decrease in answer accuracy.

The Effect of Interruption Similarity in Planning Tasks

Previous research on interruptions generally investigates the effect an interruption has during the execution phase of a task. This paper investigates the effects of interruptions which are similar (a planning interruption) or dissimilar (a non-planning interruption) and are presented during the planning phase of a task. Results confirm that interruptions have similar deleterious effects during planning as they do (as in previous research) during the execution phase of a task. Furthermore, this experiment shows a greater decrease in performance when the interruption is a planning task than when it is a non-planning task. Elements of the Fuzzy Trace Theory (Brainerd & Raina, 1990) are used to explain possible reasons for the differences that we found.