PubMed · 7413739
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J Mathews-Gentry. 1980. Bridging the reality gap.. https://doi.org/10.1093/ptj%2F60.7.912
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PURPOSE: To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. PATIENTS AND METHODS: We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients' and physicians' satisfaction with the consultation. RESULTS: Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. CONCLUSION: Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient's agenda, were more satisfying to patients and physicians than the Productive Listening sessions.
The Nash equilibrium, the main solution concept in analytical game theory, cannot make precise predictions about the outcome of repeated mixed-motive games. Nor can it tell us much about the dynamics by which a population of players moves from one equilibrium to another. These limitations, along with concerns about the cognitive demands of forward-looking rationality, have motivated efforts to explore backward-looking alternatives to analytical game theory. Most of the effort has been invested in evolutionary models of population dynamics. We shift attention to a learning-theoretic alternative. Computational experiments with adaptive agents identify a fundamental solution concept for social dilemmas--stochastic collusion--based on a random walk from a self-limiting noncooperative equilibrium into a self-reinforcing cooperative equilibrium. However, we show that this solution is viable only within a narrow range of aspiration levels. Below the lower threshold, agents are pulled into a deficient equilibrium that is a stronger attractor than mutual cooperation. Above the upper threshold, agents are dissatisfied with mutual cooperation. Aspirations that adapt with experience (producing habituation to stimuli) do not gravitate into the window of viability; rather, they are the worst of both worlds. Habituation destabilizes cooperation and stabilizes defection. Results from the two-person problem suggest that applications to multiplex and embedded relationships will yield unexpected insights into the global dynamics of cooperation in social dilemmas.
INTRODUCTION: Vision and hearing loss are prevalent disorders in older adults although their effects on communication are not well documented. METHOD: The purpose of this study was to investigate the perceptions of older adults with sensory loss and their communication partners with regard to their communication, situational difficulties and conversational needs. RESULTS: Questionnaire results revealed that the sensory loss group experienced a range of functional vision and hearing difficulties. Over two-thirds of subjects reported frequent conversational difficulty, particularly in background noise and group conversations. Most subjects used clarification requests (mainly non-specific clarification and repetition requests) to overcome misunderstandings. By contrast, the communication partners reported few communication difficulties and claimed that they proactively eliminated or controlled environmental, speaker and listener variables to optimize conversation. The most frequently reported strategy was repetition. CONCLUSION: The findings suggest that older adults with sensory loss experience communication disruptions, which in many instances are not resolved. To optimize communication efficacy in this population, a communication training programme for people with sensory loss and their communication partners is highly recommended.