Coreen Farris

Sexual coercion and the misperception of sexual intent

Misperceiving a womans platonic interest as sexual interest has been implicated in a sexual bargaining process that leads to sexual coercion. This paper provides a comprehensive review of sexual misperception, including gender differences in perception of womens sexual intent, the relationship between sexual coercion and misperception, and situational factors that increase the risk that sexual misperception will occur. Compared to women, men consistently perceive a greater degree of sexual intent in womens behavior. However, there is evidence to suggest that this gender effect may be driven largely by a sub-group of men who are particularly prone to perceive sexual intent in womens behavior, such as sexually coercive men and men who endorse sex-role stereotypes. Situational factors, such as alcohol use by the man or woman, provocative clothing, and dating behaviors (e.g., initiating the date or making eye contact), are all associated with increased estimates of womens sexual interest. We also critique the current measurement strategies and introduce a model of perception that more closely maps on to important theoretical questions in this area. A clearer understanding of sexual perception errors and the etiology of these errors may serve to guide sexual-assault prevention programs toward more effective strategies.

Perceptual Mechanisms That Characterize Gender Differences in Decoding Women's Sexual Intent

Men and women often disagree about the meaning of womens nonverbal cues, particularly those conveying dating-relevant information. Men perceive more sexual intent in womens behavior than women perceive or report intending to convey. Although this finding has been attributed to gender differences in the threshold for labeling ambiguous cues as sexual in nature, little research has been conducted to determine etiology. Using a model that differentiates perceptual sensitivity from decisional bias, we found no evidence that men have lenient thresholds for perceiving womens nonverbal behavior as indicating sexual interest. Rather, gender differences were captured by a relative perceptual insensitivity among men. Just as in previous studies, men were more likely than women to misperceive friendliness as sexual interest, but they also were quite likely to misperceive sexual interest as friendliness. The results point to the promise of computational models of perception in increasing the understanding of clinically relevant social processes.

Assessing the Feasibility of the American College of Surgeons' Benchmarks for the Triage of Trauma Patients

OBJECTIVE To test the feasibility of accomplishing the American College of Surgeons Committee on Trauma benchmarks of less than 5% undertriage (treatment of patients with moderate to severe injuries at nontrauma centers [NTCs]) and less than 50% overtriage (transfer of patients with minor injuries to trauma centers [TCs]) given current practice patterns by describing transfer patterns for patients taken initially to NTCs and estimating volume shifts and potential lives saved if full implementation were to occur. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of adult trauma patients initially evaluated at NTCs in Pennsylvania (between April 1, 2001, and March 31, 2005). We used published estimates of mortality risk reduction associated with treatment at TCs. MAIN OUTCOME MEASURES Undertriage and overtriage rates, estimated patient volume shifts, and number of lives saved. RESULTS A total of 93,880 adult trauma patients were initially evaluated at NTCs in Pennsylvania between 2001 and 2005. Undertriage was 69%; overtriage was 53%. Achieving less than 5% undertriage would require the transfer of 18,945 patients per year, a 5-fold increase from current practice (3650 transfers per year). Given an absolute mortality risk reduction of 1.9% for patients with moderate to severe injuries treated at TCs, this change in practice would save 99 potential lives per year or would require 191 transfers per year to save 1 potential life. CONCLUSIONS Given current practice patterns, American College of Surgeons Committee on Trauma recommendations for the regionalization of trauma patients may not be feasible. To achieve 5% undertriage, TCs must increase their capacity 5-fold, physicians at NTCs must increase their capacity to discriminate between moderate to severe and other injuries, or the guidelines must be modified.

Alcohol alters men's perceptual and decisional processing of women's sexual interest.

The current investigation examines the etiology of mens errors in sexual perception after moderate alcohol use. Sensitivity and bias estimates, derived from multidimensional signal detection analysis, revealed that mens alcohol-influenced performance was associated with declining sensitivity to the distinction between womens friendliness and sexual interest. However, sensitivity to the distinction between conservative and provocative clothing was unaffected. Similarly, an alcohol dose led to an increased bias to respond that womens ambiguous cues were sexual interest (rather than friendliness) but did not influence response thresholds for clothing style. Thus, there was specificity to the perceptual and decisional changes associated with alcohol use rather than a simple degradation of mens capacity to process all dating-relevant cues in the environment. Given the link between alcohol use, sexual misperception, and acquaintance-initiated sexual coercion, understanding the etiology of sexual misperception in the context of alcohol use may inform sexual coercion prevention efforts.

Heterosocial Perceptual Organization Application of the Choice Model to Sexual Coercion

Luces (1959, 1963) choice model was used to characterize individual differences in mens perception of womens affect as friendly, sexually interested, sad, or rejecting. Womens clothing styles were associated with differences in the models parameters. Sensitivity to sadness, rejection, and friendliness declined when women were dressed provocatively, whereas sensitivity to sexual interest increased. Provocative clothing was also associated with an increased bias to assume that positive affect was sexual interest rather than friendliness. Men at risk for perpetrating sexual aggression were less sensitive to womens affect than low-risk men were. They were also more likely than low-risk men to associate provocative clothing with sexual interest, and conservative clothing with friendliness. Results indicate that heterosocial perception may help to predict sexually coercive behavior and may be an important target for intervention.

Advance care planning norms may contribute to hospital variation in end-of-life ICU use: a simulation study.

Background. There is wide variation in end-of-life (EOL) intensive care unit (ICU) use among academic medical centers (AMCs). Our objective was to develop hypotheses regarding medical decision-making factors underlying this variation. Methods. This was a high-fidelity simulation experiment involving a critically and terminally ill elder, followed by a survey and debriefing cognitive interview and evaluated using triangulated quantitative-qualitative comparative analysis. The study was conducted in 2 AMCs in the same state and health care system with disparate EOL ICU use. Subjects were hospital-based physicians responsible for ICU admission decisions. Measurements included treatment plan, prognosis, diagnosis, qualitative case perceptions, and clinical reasoning. Results. Sixty-seven of 111 (60%) eligible physicians agreed to participate; 48 (72%) could be scheduled. There were no significant between-AMC differences in 3-month prognosis or treatment plan, but there were systematic differences in perceptions of the case. Case perceptions at the low-intensity AMC seemed to be influenced by the absence of a do-not-resuscitate order in the context of norms of universal code status discussion and documentation upon admission, whereas case perceptions at the high-intensity AMC seemed to be influenced by the patient’s known metastatic gastric cancer in the context of norms of oncologists’ avoiding code status discussions. Conclusions: In this simulation study of 2 AMCs, hospital-based physicians had different perceptions of an identical case. We hypothesize that different advance care planning norms may have influenced their decision-making heuristics.

Validating a vignette-based instrument to study physician decision making in trauma triage.

Background . The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. Methods . We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the retest reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of undertriage (the proportion of severely injured patients not transferred to trauma centers) and overtriage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. Results . Physicians made similar transfer decisions for cases (κ = 0.42, P < 0.01) on 2 administrations of the instrument. Responses were internally consistent (Kuder-Richardson, 0.71–0.91). Surgeons had lower rates of undertriage than emergency physicians (13% v. 70%, P < 0.01). No correlation existed between individual rates of under- or overtriage on the vignettes and in practice (r = −0.17, P = 0.4; r = −0.03, P = 0.85). Conclusions . The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However, it did not predict individual physician performance.

Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study

BackgroundUnited States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making.MethodsWe conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions).ResultsWe recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds.ConclusionsOn a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians’ cognitive processes contributed to the under-triage of trauma patients.

Primary Care Providers' Initial Treatment Decisions and Antidepressant Prescribing for Adolescent Depression

Objective: Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. This study examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network. Methods: A cross-sectional survey was administered to 58 PCPs within a large pediatric practice network. PCP reports of initial treatment decisions were compared in response to 2 vignettes describing depressed adolescents with either moderate or severe symptoms. PCP depression knowledge, attitudes toward addressing psychosocial concerns, demographics, and practice characteristics were measured. Results: Few PCPs (25% for moderate, 32% for severe) recommended an antidepressant. Compared with treatment recommendations for moderate depression, severe depression was associated with a greater likelihood of child psychiatry referral (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.47–12.2] p < .001). Depression severity did not affect the likelihood of antidepressant recommendation (OR, 1.58 [95% CI, 0.80–3.11] p = .19). Antidepressants were more likely to be recommended by PCPs with greater depression knowledge (OR, 1.72 [95% CI, 1.14–2.59] p = .009) and access to an on-site mental health provider (OR, 5.13 [95% CI, 1.24–21.2] p = .02) and less likely to be recommended by PCPs who reported higher provider burden when addressing psychosocial concerns (OR, 0.85 [95% CI, 0.75–0.98] p = .02). Conclusion: PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity. Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs’ antidepressant prescribing.

Trauma triage in the emergency departments of nontrauma centers: An analysis of individual physician caseload on triage patterns

BACKGROUND Treatment at Level I/II trauma centers improves outcomes for patients with severe injuries. Little is known about the role of physicians’ clinical judgment in triage at outlying hospitals. We assessed the association between physician caseload, case mix, and the triage of trauma patients presenting to nontrauma centers. METHODS A retrospective cohort analysis of patients evaluated between January 1, 2007, and December 31, 2010, by emergency physicians working in eight community hospitals in western Pennsylvania. We linked billing records to hospital charts, summarized physicians’ caseloads, and calculated rates of undertriage (proportion of patients with moderate-to-severe injuries not transferred to a trauma center), and overtriage (proportion of patients transferred with a minor injury). We measured the correlation between physician characteristics, caseload, and rates of triage. RESULTS Of 50 eligible physicians, 29 (58%) participated in the study. Physicians had a mean (SD) of 16.8 (10.1) years of postresidency clinical experience; 21 (72%) were board certified in emergency medicine. They evaluated a median of 2,423 patients per year, of whom 148 (6%) were trauma patients and 3 (0.1%) had moderate-to-severe injuries. The median undertriage rate was 80%; the median overtriage rate was 91%. Physicians’ caseload of patients with moderate-to-severe injuries was inversely associated with rates of undertriage (correlation coefficient, −0.42; p = 0.03). Compared with physicians in the lowest quartile, those in the highest quartile undertriaged 31% fewer patients. CONCLUSION Emergency physicians working in nontrauma centers rarely encounter patients with moderate-to-severe injuries. Caseload was strongly associated with compliance with American College of Surgeons’ Committee on Trauma guidelines. LEVEL OF EVIDENCE Therapeutic/care management, level IV.