Anne Finucane

The effect of fear and anger on selective attention

This experiment examined the effects of two discrete negative emotions, fear and anger, on selective attention. A within-subjects design was used, and all participants (N = 98) experienced the control, anger, and fear conditions. During each condition, participants viewed a film clip eliciting the target emotion and subsequently completed a flanker task and emotion report. Selective attention costs were assessed by comparing reaction times (RTs) on congruent (baseline) trials with RTs on incongruent trials. There was a significant interaction between emotion condition (control, anger, fear) and flanker type (congruent, incongruent). Contrasts further revealed a significant interaction between emotion and flanker type when comparing RTs in the control and fear conditions, and a marginally significant interaction when comparing RTs in the control and anger conditions. This indicates that selective attention costs were significantly lower in the fear compared to the control condition and were marginally lower in the anger compared with the control condition. Further analysis of participants reporting heightened anger in the anger condition revealed significantly lower selective attention costs during anger compared to a control state. These findings support the general prediction that high arousal negative emotional states inhibit processing of nontarget information and enhance selective attention. This study is the first to show an enhancing effect of anger on selective attention. It also offers convergent evidence to studies that have previously shown an influence of fear on attentional focus using the global-local paradigm.

Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care:

Background: Internationally, policy calls for care homes to provide reliably good end-of-life care. We undertook a 20-month project to sustain palliative care improvements achieved by a previous intervention. Aim: To sustain a high standard of palliative care in seven UK nursing care homes using a lower level of support than employed during the original project and to evaluate the effectiveness of this intervention. Design: Two palliative care nurse specialists each spent one day per week providing support and training to seven care homes in Scotland, United Kingdom; after death audit data were collected each month and analysed. Results: During the sustainability project, 132 residents died. In comparison with the initial intervention, there were increases in (a) the proportion of deceased residents with an anticipatory care plan in place (b) the proportion of those with Do Not Attempt Cardiopulmonary Resuscitation documentation in place and (c) the proportion of those who were on the Liverpool Care Pathway when they died. Furthermore, there was a reduction in inappropriate hospital deaths of frail and elderly residents with dementia. However, overall hospital deaths increased. Conclusions: A lower level of nursing support managed to sustain and build on the initial outcomes. However, despite increased adoption of key end-of-life care tools, hospital deaths were higher during the sustainability project. While good support from palliative care nurse specialists and GPs can help ensure that key processes remain in place, stable management and key champions are vital to ensure that a palliative care approach becomes embedded within the culture of the care home.

Basic emotion profiles in healthy, chronic pain, depressed and PTSD individuals

OBJECTIVES To compare self-reports of five basic emotions across four samples: healthy, chronic pain, depressed and post-traumatic stress disorder (PTSD), and to investigate the extent to which basic emotion reports discriminate between individuals in healthy or clinical groups. METHODS In total, 439 participants took part in this study: healthy (n = 131), chronic pain (n = 220), depressed (n = 24) and PTSD (n = 64). The participants completed the trait version of the Basic Emotion Scale. Basic emotion profiles were compared both within each group and between the healthy group and each of the three other groups. Discriminant analysis was used to assess the extent to which basic emotions can be used to classify the participants as belonging to the healthy group or one of the clinical groups. RESULTS In the healthy group, happiness was experienced more than any other basic emotion. This was not found in the clinical groups. In comparison to the healthy participants, the chronic pain group experienced more fear, anger and sadness, the depressed group reported more sadness and the PTSD group experienced all of the negative emotions more frequently. Discriminant analysis revealed that happiness was the most important variable in determining whether an individual belonged to the healthy group or one of the clinical groups. Anger was found to further discriminate between depressed and chronic pain individuals. CONCLUSION The findings demonstrate that basic emotion profile analysis can provide a useful foundation for the exploration of emotional experience both within and between healthy and clinical groups. 

The Effect of Happiness and Sadness on Alerting, Orienting, and Executive Attention

Objective: According to the attention network approach, attention is best understood in terms of three functionally and neuroanatomically distinct networks—alerting, orienting, and executive attention. An important question is whether the experience of emotion differentially influences the efficiency of these networks. Method: This study examines 180 participants were randomly assigned to a happy, sad, or control condition and undertook a modified version of the Attention Network Test. Results: The results showed no effect of happiness or sadness on alerting, orienting, or executive attention. However, sad participants showed reduced intrinsic alertness. Conclusion: This suggests that sadness reduces general alertness rather than impairing the efficiency of specific attention networks. (J. of Att. Dis. 2010; 13(6) 629-639)

The effect of fear on attentional processing in a sample of healthy females

The present experiment examines the effect of fear on efficiency of three attention networks: executive attention, orienting and alerting, in a healthy female sample. International Affective Picture System (IAPS) images were used to elicit both a fear response and a non-emotional response in 100 participants. During the emotion manipulation, participants performed a modified version of the Attention Network Test (ANT). Results showed enhanced executive attention in the fear condition compared to the control condition. Specifically, during a fear experience participants were better able to inhibit irrelevant information resulting in faster response times to a target. There was no effect of fear on orienting while the effect of fear on alerting was inconclusive. It is suggested that enhanced executive attention in fear-eliciting situations may function to focus attention on a potentially threat-related target, thus facilitating subsequent rapid responding.

The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: an integrative literature review.

To explore the experiences of caregivers of terminally ill patients with delirium, to determine the potential role of caregivers in the management of delirium at the end of life, to identify the support required to improve caregiver experience and to help the caregiver support the patient.

Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners

Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs’ views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors. Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses. Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.

Delivering preference for place of death in a specialist palliative care setting

Abstract Over the last 10 years, one of the key themes of public policy in palliative care has been achievement of choice in place of death. In Marie Curie Hospice Edinburgh a baseline audit conducted in 2006 showed that only a small proportion (18%) of patients referred to hospice services died at home. The audit also revealed that only 31% of those who expressed a preference to die at home were able to do so, whereas 91% of those who chose a setting other than home achieved their preference. Overall achievement of preferred place of death was 56%. However a significant number of patients (29%) did not have a recorded preference. A programme of quality improvement has continued over the last 7 years to improve identification, communication and achievement of preferred place of death for all patients. The mechanisms to change practice have been: changes to documentation; changes to clinical systems to support use of documentation; support for clinical staff to recognise the value of discussing preferences; and support for clinical staff to develop new skills. In addition the programme has been incorporated into local clinical strategy and this has enabled gaps in service to be addressed with a new service to support early discharge of those patients who wish to die at home. A recent audit showed that all patients had a recorded preference or a documented reason why their preference was unclarified. One third of patients died at home – nearly double the proportion that died at home in the baseline audit. Seventy one per cent of patients who wished to die at home actually died at home - a substantial increase from 31% at baseline. Achievement of preferred place of death for patients wishing to die in the hospice remained high at 88%. The focus on assessment of preference for place of death has led to substantial improvements in the identification and achievement of preference for patients dying under the care of the hospice. Furthermore, it has been associated with an increase in the overall proportion of patients who die at home.

Positive emotions induced by massage do not broaden attention and cognition

The broaden-and-build theory of positive emotions proposes that positive emotions broaden an individual’s scope of attention and cognition and build personal resources over time (Fredrickson, 1998). In this experiment, the broadening facet of the theory was examined. It was hypothesised that compared with a neutral state, positive emotions would result in; a) broadened scope of attention and b) improved performance on a divergent thinking task. Massage therapy was used to elicit positive emotion. A global-local visual processing task was used to examine scope of attention and an Alternative Uses Test assessed divergent thinking. Massage therapy was found to increase the participants’ experience of serenity, contentment, and happiness. However, no differences in scope of attention or performance on the divergent thinking task were found. The results suggest that not all positive emotions lead to cognitive broadening.

Palliative care for people with advanced liver disease: A feasibility trial of a supportive care liver nurse specialist:

Background: Liver disease is an increasing cause of death worldwide but palliative care is largely absent for these patients. Aim: We conducted a feasibility trial of a complex intervention delivered by a supportive care liver nurse specialist to improve care coordination, anticipatory care planning and quality of life for people with advanced liver disease and their carers. Design: Patients received a 6-month intervention (alongside usual care) from a specially trained liver nurse specialist. The nurse supported patients/carers to live as well as possible with the condition and acted as a resource to facilitate care by community professionals. A mixed-method evaluation was conducted. Case note analysis and questionnaires examined resource use, care planning processes and quality-of-life outcomes over time. Interviews with patients, carers and professionals explored acceptability, effectiveness, feasibility and the intervention. Setting/participants: Patients with advanced liver disease who had an unplanned hospital admission with decompensated cirrhosis were recruited from an inpatient liver unit. The intervention was delivered to patients once they had returned home. Results: We recruited 47 patients, 27 family carers and 13 case-linked professionals. The intervention was acceptable to all participants. They welcomed access to additional expert advice, support and continuity of care. The intervention greatly increased the number of electronic summary care plans shared by primary care and hospitals. The Palliative care Outcome Scale and EuroQol-5D-5L questionnaire were suitable outcome measurement tools. Conclusion: This nurse-led intervention proved acceptable and feasible. We have refined the recruitment processes and outcome measures for a future randomised controlled trial.