Browsing School, Graduate by Subject "Families"
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Advance Care Planning and Family Structure in Late LifeBackground: Currently, 10 - 15% of individuals over age 65 have no living biological or stepchildren, and 41% are unmarried. By 2030, the proportion of those without partners or surviving children will likely exceed 30%. With no close relatives to participate in advance care planning, older persons may be vulnerable to unwanted medical procedures. Only half of those over age 50 have an advance directive. Methods: Data were drawn from the 2012 Health and Retirement Study (HRS) (N = 18,613), and exit interviews from 2000 - 2012 with proxies of HRS decedents (N = 8,658). Multinomial logistic regression was used to predict the odds of advance care planning by parental status, adjusting for covariates, and testing for interaction by marital status and gender. Results: Overall, 14.4% of respondents over age 50 were biologically childless (13.71%), or had outlived all children (0.69%). If biologically childless, 4.85% had living stepchildren. 15.54% of men and 13.43% of women were childless (p < 0.01). Childlessness was highest among never married men, 80.12% (p < 0.0001). Nearly 53% of childless women lived in a nursing home/long-term-care setting at the time of final illness, compared with 39.93% of women with living children, 37.38% of childless men, and 28.50% of men with children living (p < 0.0001). In the unadjusted model, childless persons were 28% less likely than those with living children to engage in end-of-life discussion only, OR = 0.782 (p < 0.05). Advance care planning was not related to childlessness in the adjusted model. Never married childless men were least likely of all family status groups to engage in end-of-life discussion only, OR = 0.358 (p < 0.05); advance directive completion only, OR = 0.613 (p < 0.10, non-significant); or both, OR = 0.537 (p < 0.05). Divorced men with living children were less likely to engage in end-of-life discussion only, OR = 0.733 (p < 0.05). Significance: Never married childless men and divorced men with living children are at risk of failing to discuss end-of-life issues. These findings point toward a need for new approaches to advance care planning relative to gender and family structure.
Physical punishment as purposive behaviorThis dissertation examines the relationship between physical punishment and indices of family functioning as derived from the tenets of social exchange theory. There appear to be significant differences in the amount and severity of physical punishment parents mete out to their children. In a sample of 91 residents of a substance abuse treatment center surveyed via a questionnaire, with an average age of 32, 63 percent reported rare or no punishment, 22 percent reported being punished more than once a week or on a daily basis, with 15 percent indicating they were punished approximately once a week. Twenty-seven percent reported never being hit, 14 percent reported only being spanked, 42 percent reported being hit with an object and 17 percent reported being hit in the face and/or beaten by their parents/caretakers while they were between the ages of 6 and 18. Fifty-two percent of the sample indicated that alcohol or drug abuse had been a problem in their family of origin. However, the alcohol or other drug use and abuse by the parents, while the respondents were children, did not prove to have any significant relationship to the patterns of punishment. The parent's geographical and emotional closeness to grandparents and other relatives, their involvement in the community and the family economic status also had little significant predictive power. The manner in which parents valued their children, structured the family to facilitate democratic communication, shared power with their children and spent time with them involved in outside activities, all believed to be indicators of social exchange theory, did show significant relationships to the amount of total punishment as well as the severity of punishments respondents reported having experienced. Utilizing stepwise regression, social exchange theory variables accounted for over 34 percent of the variation in the severity of physical punishment.
Psychosocial Care Needs of Children with Cancer and Their Families: Perceptions and Experiences of Omani Oncologists and NursesBackground: Much evidence demonstrates the psychosocial impact of childhood cancer on children and their families. While many health care systems are evolving to integrate psychosocial services into clinical care, barriers exist that must be understood before changes can be implemented in systems new to this care. Oncologists and nurses are on the front lines of care and have unique perspectives about the needs of their patients and families. Objectives: The purposes of this study were: 1) describe the experiences and perceptions of pediatric oncology physicians and nurses in Oman regarding the psychosocial care needs of children with cancer and their families; and 2) describe the barriers and facilitators to providing psychosocial care. Methods: A qualitative, phenomenological study was conducted. Purposive sampling strategy was used to recruit 26 oncologists and nurses with experience caring for children with cancer and their families. Individual, semi-structured interviews were conducted and recorded. Colaizzi's method of data analysis was utilized to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodical rigor was established. Result: Four themes emerged from the data. The first was “perceived need for care beyond medicine.” The oncologists and nurses recognized that more psychosocial assessment, care, and services were needed. The second theme was “recognition of pediatric oncology as a challenging clinical practice area,” which had two subthemes: emotional burden and challenging situations. Participants described the challenges they faced trying to meet the needs of children and extended families. The third theme was “barriers to providing effective psychosocial care,” which had three subthemes: barriers related to the health care system, barriers related to health care providers, and barriers related to infrastructure and environment. The fourth theme was “providing optimal supportive care within the available facilities,” which had two subthemes: supportive care and facilitating factors. Cultural and community factors were highlighted. Conclusion: As the pediatric oncology services in Oman mature, clinicians are eager to develop the psychosocial assessments and needed services. Future research is needed to elicit the perspectives of Omani children with cancer and their families. Resources will be needed from higher authorities to design, implement, and evaluate the recommended changes.