Search

Nephrology interdisciplinary guidelines, professional codes of ethics, principle-based ethical standards, and literature promote patient autonomy and self-determination through shared decision making as ethical practice. Healthcare professionals are accountable for practice that is mindful of the impact of cultural diversity and community on the values and beliefs of the patient, an important part of shared decision making (SDM). Despite previous research regarding dialysis decision making, relational autonomy in chronic kidney disease (CKD) and end-stage kidney disease SDM conversations is not well understood. This systematic literature review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for identifying peer-reviewed literature on SDM for CKD. The findings were summarized into four broad themes: (1) promoting autonomy is a foundation of medical caring; (2) providers have a responsibility to respond to their asymmetrical social power; (3) autonomy is situated within the context of the patient; and (4) dialogue is a tool that negotiates clinical recommendations and patient goals. The caring practices of promoting autonomy with a dialogical resolution of a conflict acknowledging the interdependence of the parties and the patient's social–relational situatedness support a perspective of relational autonomy in dialysis decision-making practice and research. [ABSTRACT FROM AUTHOR]

Nephrology social workers are trained to assess and address the ecosystemic splits in nephrology care that threaten the resilience of dialysis patients and their families. Given this training and skills, nephrology social workers are ideally positioned to help center the patient and their decision partner in modality decisions that are increasingly influenced by provider incentives to promote home dialysis and transplant utilization. The Family Resilience Framework provides a paradigm for social work assessment and intervention during the iterative process of dyadic dialysis decision-making to develop an individualized care plan that promotes resilience through attunement to dyadic processes. [ABSTRACT FROM AUTHOR]

Sexual minority persons from religious families may experience low acceptance by parents, however, little is known about the relationship of religiosity and parent relationships on mental health into adulthood. This study sought to test a moderated mediation model predicting depression based on religious fundamentalism, parent acceptance, and parent-child relationship quality. Sexual minority adult participants (n = 384) from across the U.S. completed a web-based, anonymous survey. Results found a conditional indirect effect of religious fundamentalism on depression through parent acceptance with the parent-child relationship quality moderating the relationship between parent acceptance and depression. This was significant up to age 52. Clinical implications and future research with sexual minority adults and their families are explored. [ABSTRACT FROM AUTHOR]

A total of 208 therapists and therapists-in-training were surveyed to better understand if clinical assessments and recommendations regarding "sex addiction" changed based upon a client's gender, relationship status, or exclusivity status. Using clinical vignettes, this study examined the clinical assessment and recommendations of licensed mental health providers (n = 92) and mental health providers in-training (n = 116). Results indicated that professional ratings differed based on relationship exclusivity and gender; specifically, female nonmonogamous behavior was rated more negatively than male nonmonogamous behavior, while male monogamous behavior was rated more negatively than female monogamous behavior. Recommendations for treatment varied, with higher addiction ratings leading to greater odds of recommending individual, group, and community support over relational therapy. Clinical and training implications are discussed. Video abstract accessible by clicking here. [ABSTRACT FROM AUTHOR]

Clinical Issue: Lack of transgender health education for healthcare providers and students is consistently reported as a limitation to providing gender-affirming healthcare. Methods: The purpose of this study was to explore the impact of an Interprofessional Transgender Health Education Day (ITHED) in partnership with a community-based organization on student knowledge and attitudes towards the transgender population. We administered a mixed methods, pretest, post-test survey to students in clinical education programs at a private, Midwestern university. Differences in total and subscale scores of the Transgender Knowledge, Attitudes and Beliefs (T-KAB) were analyzed using independent samples t-tests; qualitative responses were analyzed using a thematic, inductive process. Outcomes: Independent samples t-tests revealed no significant differences in pre- and post-ITHED total and subscale T-KAB scores. Qualitative themes included: enthusiasm for learning about transgender health; need for healthcare providers to provide excellent care for transgender patients; and power of learning directly from the transgender community. Conclusions: Participants demonstrated high baseline T-KAB scores and expressed strong enthusiasm for learning about transgender health. Positioning transgender voices at the forefront of the education can foster a powerful student learning experience and honor ethical guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Caregiver and family engagement in dialysis decisions varies over the end-stage kidney disease treatment trajectory, with family preferences as primary consideration factors for patients starting dialysis. This interpretive phenomenological study explores how dialysis patients and their partners experience dialysis decisions. Methods: Thirteen patient-decision partner dyads (26 participants) were interviewed together about their experience with dialysis decision-making. A 5-step iterative process of data analysis occurred concurrently with data collection. Results: The patients received in-center hemodialysis (n = 6) and home dialysis (peritoneal dialysis or home hemodialysis (n = 7). Decision partner relationships included romantic partners (n = 9) and either parent, sibling, or friend (n = 4). Fifty-7 percent of participants were White; 46% of patients were women, and 76% of decision partners were women. Three interrelated themes were identified: Their body, but not their life; Seeking semiliberation, and Decision-making is caring. Discussion: Dyads were attuned to patient autonomy while managing the collateral effects of dialysis. Shifting the paradigm of dialysis treatment decisions from promoting patient autonomy to dialogues exploring relational autonomy helps providers balance the competing demands of incentivized standards to promote home dialysis with patients and their decision partners realities. Public Significance Statement: This study centers the relational autonomy of patients in demonstrating that while dialysis patients and their decision partners prioritized the autonomy of the person on dialysis, the focus of treatment decisions shifted over time from managing symptoms and treatment side-effects to shared family goals. Health care providers who engage in shared decision-making with people on dialysis should recognize patients are part of relational systems and decisions are influenced by relational context. Attention to relational autonomy in shared decision-making can help health care providers and the patient system navigate complicated dialysis decisions. [ABSTRACT FROM AUTHOR]

Emotionally focused therapy (EFT) is an evidence‐based treatment for relational distress based on experiential, humanistic, and attachment theories. Despite the empirical support for EFT, there are no studies on EFT delivered via teletherapy. In this study, we aimed to understand therapists' experiences delivering EFT through teletherapy using open‐ended questions on a web‐based survey of certified EFT therapists (n = 69). Reflexive thematic analysis identified five themes: (1) Delivering EFT via teletherapy is similar to in‐person therapy, (2) Delivering EFT via teletherapy is more challenging than in‐person therapy, (3) Delivering EFT via teletherapy is more challenging with certain clients, (4) therapists adapted EFT for teletherapy, and (5) teletherapy and the COVID‐19 pandemic changed therapy practice. The themes illustrated the mixed experiences of EFT therapists using teletherapy. Whereas some found it straightforward to use EFT via teletherapy with couples, others experienced exhaustion and barriers. Practice recommendations for delivering EFT via teletherapy are outlined, including modifying assessment strategies, implementing new safety protocols, and providing additional psychoeducation. [ABSTRACT FROM AUTHOR]

Nephrology interdisciplinary guidelines, professional codes of ethics, principle-based ethical standards, and literature promote patient autonomy and self-determination through shared decision making as ethical practice. Healthcare professionals are accountable for practice that is mindful of the impact of cultural diversity and community on the values and beliefs of the patient, an important part of shared decision making (SDM). Despite previous research regarding dialysis decision making, relational autonomy in chronic kidney disease (CKD) and end-stage kidney disease SDM conversations is not well understood. This systematic literature review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for identifying peer-reviewed literature on SDM for CKD. The findings were summarized into four broad themes: (1) promoting autonomy is a foundation of medical caring; (2) providers have a responsibility to respond to their asymmetrical social power; (3) autonomy is situated within the context of the patient; and (4) dialogue is a tool that negotiates clinical recommendations and patient goals. The caring practices of promoting autonomy with a dialogical resolution of a conflict acknowledging the interdependence of the parties and the patient's social-relational situatedness support a perspective of relational autonomy in dialysis decision-making practice and research., (© 2021 National Association of Social Workers.)

Minority stress impacts the mental health of bi+ individuals (e.g., bisexual, pansexual, queer), similar to gay and lesbian individuals. Bi+ individuals may have difficulty accessing social supports for mitigating minority stress. A religious upbringing may complicate this process. This study sought to compare a survey sample of bi+ individuals ( n = 153) and their gay/lesbian ( n = 231) peers from religious families on minority stress factors, depression, and partnering. Results highlighted differences between gay/lesbian and bi+ individuals in partnering and LGB community connection with bi+ group reporting more minority stressors. Bi+ individuals in same-gender partnerships reported lower parent rejection and being more out than those who were single or in different-gender partnerships. Family religiosity was associated with family rejection; however, it did not directly predict minority stress factors or depression for bi+ individuals. Implications for future research are discussed in light of the distinctions emerging between gay/lesbian and bi+ adults.

Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants ( n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.

Background: Health disparities for gay and lesbian individuals are well documented in survey research. However, a limitation throughout the existing literature is the reliance on self-reported health conditions. This study used medical record diagnoses for gay and lesbian patients seen in primary care clinics., Methods: This study used medical records of primary care patients (n = 31,569) seen at Midwestern, university-affiliated primary care clinics. First, all records with information about the sexual partnering of the patient were identified (n = 13,509). Then, opposite-sex-partnered and same-sex-partnered (SSP) patients were compared for prevalence of common chronic conditions and clinic utilization., Results: Only 44.20% of medical records included information about patients' sexual partners. Both male and female SSP patients were more likely to be lower socioeconomic status, be a current or former smoker, and be diagnosed with substance abuse/dependence and depression., Conclusions: The findings suggest the need for more consistent screening of the sexual partnering of patients for identifying patients who are at greater risk of poorer health outcomes. However, identifying the sexual partnering of patients may not occur systematically in primary care, and there may be a lack of disclosure by SSP patients to their physicians given the social stigma about same-sex relationships., (© Copyright 2016 by the American Board of Family Medicine.)