Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

Background and aims. In pediatrics receiving a diagnosis of a chronic condition is a matter that involves caregivers at first. Beyond the basic issues of caring for the physical body of the ill child, caregivers’ manners of facing and making sense of the disease orient and co-construct their children’s sensemaking processes of the disease itself. The aim of this article is to explore the experience of a rare chronic illness, Hereditary Angioedema (HAE), in pediatrics, from the caregivers’ perspective. Hereditary Angioedema (...) is characterized by subcutaneous swellings that can involve the mucosal tissues of external as well as internal parts of the body, manifesting in a highly variable and unpredictable way in terms of localization, severity, and frequency. Materials and methods. Within a qualitatively-driven research design, we conducted a qualitative narrative semiotic analysis of n.28 mothers’ narratives on their children’s disease experience. Narratives were collected by an ad hoc interview on three domains of the disease experience: A. interpretation of the disease variability; B. dialogical processes; C. management of the disease. Subsequently, we executed a TwoStep cluster analysis for categorical data to detect cross-sectional profiles of the maternal sensemaking processes of the disease. Results. The coding grid was built analyzing the characteristic of the narrative links that orient the connection between the elements of the experience within each domain: A. the connection among events, for the domain of the interpretation of the disease variability; B. the connection between self and other, for the domain of the dialogue; C. the connection among sensemaking and actions, for the domain of the management of the disease. Results from cluster analysis show three narrative profiles: 1. adempitive; 2. reactive; 3. dynamic. Discussion. Profiles will be discussed in the light of the general conceptual framework of the Sense of Grip on the Disease (SoGoD) highlighting the importance of those sensemaking processes which, instead of relying on a coherent and close interpretation of the disease, are characterized by a degree of tolerance for the uncertainty and the unknowingly. (shrink)

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants described 219 unique ethical experiences that spanned many of (...) the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting. (shrink)

In this article we ask what it means for sociologists to practice intersectionality as a theoretical and methodological approach to inequality. What are the implications for choices of subject matter and style of work? We distinguish three styles of understanding intersectionality in practice: group-centered, process-centered, and system-centered. The first, emphasizes placing multiply-marginalized groups and their perspectives at the center of the research. The second, intersectionality as a process, highlights power as relational, seeing the interactions among variables as multiplying oppressions at (...) various points of intersection, and drawing attention to unmarked groups. Finally, seeing intersectionality as shaping the entire social system pushes analysis away from associating specific inequalities with unique institutions, instead looking for processes that are fully interactive, historically co-determining, and complex. Using several examples of recent, highly regarded qualitative studies, we draw attention to the comparative, contextual, and complex dimensions of sociological analysis that can be missing even when race, class, and gender are explicitly brought together. (shrink)

This study proposes two identification cuing factors (i. e., CSR associations and CSR participation) to understand how corporate social responsibility (CSR) relates to employees' identification with their firm.The results reveal that a firm's CSR initiatives increase employee-company identification (E-C identification).E-C identification, in turn, influences employees' commitment to their company. However, CSR associations do not directly influence employees' identification with a firm, but rather influence their identification through perceived external prestige (PEP). Compared to CSR associations, CSR participation has a direct influence (...) on E-C identification. On the basis of these findings, it is argued that CSR performance can be an effective way for companies to maintain a positive relationship with their employees. (shrink)

This study proposes two identification cuing factors to understand how corporate social responsibility relates to employees’ identification with their firm. The results reveal that a firm’s CSR initiatives increase employee–company identification. E–C identification, in turn, influences employees’ commitment to their company. However, CSR associations do not directly influence employees’ identification with a firm, but rather influence their identification through perceived external prestige. Compared to CSR associations, CSR participation has a direct influence on E–C identification. On the basis of these findings, (...) it is argued that CSR performance can be an effective way for companies to maintain a positive relationship with their employees. (shrink)

Four Daoist texts illustrate the dynamic image of the Daoist immortal world on which a Daoist environmental ethics can be built. The first text is the Daodejing with two of the oldest commentaries. The second is Tao Hongjing’s Diagram of Rank and Functions of True Spirits. The third is the collection of poems by Immortal Changchun, titled Panxiji. The fourth is the Morning and Evening Liturgical Prayer Book of the Quanzhen Order, which represents Daoist ecological concerns for the natural world. (...) Daoism not only accords with the impetus and spirit of environmental ethics but can also make a concrete contribution to its implementation. (shrink)

This article explores the gendered construction of South Korean citizenship through the lens of North Korean settlers' experiences in South Korea. Drawing on ethnographic research, the author delves into the citizen-making process, critically examining the impact of gendered modernizing projects on North Korean settlers' daily lives. North Korean settlers are expected to get rid of their ethnic markers and transform themselves into modern citizen-subjects of South Korea. The author demonstrates that the overall frame of perception of North Korean settlers is (...) deeply gendered, with modernity as a powerful ethnic marker. The notion of ethnicized citizenship in the context of two Koreas offers a concrete account of how ethnicities are created and employed in stratified structure of citizenship. (shrink)

A growing literature looks at how the design of the electoral system shapes the voting behavior of politicians in parliaments. Existing research tends to confirm that in mixed-member systems the politicians elected in the single-member districts are more likely to vote against their parties than the politicians elected on the party lists. However, we find that in South Korea, the members of the Korean National Assembly who were elected on PR lists are more likely to vote against their party leadership (...) than the members elected in single-member districts (SMDs). This counterintuitive behavior stems from the particular structure of candidate selection and politicians' career paths. This suggests that any theory of how electoral systems shape individual parliamentary behavior needs to look beyond the opportunities provided by the electoral rules for voters to reward or punish individual politicians (as opposed to parties), to the structure of candidate selection inside parties and the related career paths of politicians. (shrink)

Theories of citizenship have largely focused on the provision of rights by law and policy measures, as if rights are universally beneficial and cost-free and the invitations of rights will be accepted once offered. I challenge this assumption and highlight the need to empirically address how people negotiate with the benefit and cost of claiming rights. Based on ethnographic research in South Korea, this article delves into the everyday lives of migrant women in two feminized sectors of migration—cross-border marriage and (...) sexual commerce—to situate the act of claiming rights in relation to the gendered pursuit of moral respect. I show that feminist groups in South Korea relied on the discourse of victimization and trafficking in pressuring the South Korean state to account for the human rights of migrant wives and migrant hostesses, while reinforcing the moral hierarchy that renders problematic migrant women’s work and intimate relationships. I argue that the distinctive material and moral costs that accompanied human rights–based provisions compelled migrant wives and hostesses to pursue divergent paths in seeking alternate bases to citizenship that would support their inclusion as moral equals. (shrink)

While understanding and expressing causal relations are universal aspects of human cognition, language users may differ in their capacity to perceive, interpret, and express events. One source of variation in descriptions of caused motion events is agentivity, which refers to the attribution of a result to the agent's action. Depending on the perspective taken, the same event may be described with agentive or non-agentive interpretations. Does language play a role in how people construe and express caused motion events? The present (...) study investigated the use of agentive vs. non-agentive language by speakers of different languages (i.e., monolingual speakers of English and Korean, and Korean learners of English). All three groups described prototypical causal events similarly, using agentive language (active transitive sentences). However, when it came to non-prototypical causal events (where the agent was not shown in the scene), they diverged in their choice of language: English speakers favored agentive language (passive transitive sentences), whereas Korean speakers preferred non-agentive language (intransitive sentences). Korean learners of English patterned with Korean speakers, demonstrating L1 influence on their use of English. These findings highlight the effects of language on motion event construal. (shrink)

BackgroundResearchers worry that patients in early-phase research experience unrealistic optimism about benefits and risks of participation. The standard measure of unrealistic optimism is the Comparative Risk/Benefit Assessment questionnaire, which asks people to estimate their chances of an outcome relative to others in similar situations. Such a comparative framework may not be a natural way for research participants to think about their chances.ObjectiveTo examine how people interpret questions measuring unrealistic optimism and how their interpretations are associated with their responses.MethodsUsing an early-phase (...) cancer trial vignette, we administered the CRBA to 297 adults from the general public. They estimated their comparative chances of risk and benefit, then provided rationales for their estimates.ResultsFor both CRBA benefit and risk questions, about 50% of respondents chose 0, and 50% chose a non-0 response. Respondents’ rationales for their estimates showed that overall only about 40%–44% gave comparative rationales, indicating that they interpreted the CRBA as intended. 68.7% of respondents who gave the ‘correct’ 0 rating gave comparative rationales, whereas only 11.6% of respondents who gave non-0 ratings did so. A similar trend was seen for chances of risk.ConclusionResearch participants may not understand comparative benefit and risk questions as intended; attributions of unrealistic optimism may require additional evidence that the respondents’ estimates are intended to be comparative. (shrink)