A cross-sectional study of the first two years of mandatory training for doctors participating in voluntary assisted dying.

OBJECTIVES: Voluntary assisted dying (VAD) was legalized in Victoria, Australia, in June 2019. Victoria was the first jurisdiction in the world to require doctors to undertake training before providing VAD. This study examines data from doctors who completed the mandatory training in the first 2 years of the VAD system's operation (up to 30 June 2021). It describes the doctors who are undertaking VAD training, their post-training attitudes toward VAD participation, and their experiences of the mandatory training. METHODS: Through the online training, doctors completed a short demographic survey and undertook formal assessment of knowledge (90% pass mark). They also were invited to complete an optional survey evaluating the training. RESULTS: In total, 289 doctors passed the training, most commonly males (56%) aged 36-65 years (82%) from an urban location (72%). Most were more than 10 years post fellowship (68%) and practising as general practitioners (51%) or medical oncologists (16%). The training most commonly took 6 h (range 2 h to over 9 h). Most doctors passed the assessment at the first (65%) or second (19%) attempt. Almost all participants (97%) found the training helpful or very helpful and most reported being confident or very confident in their knowledge (93%) and application (88%) of the VAD legislation. SIGNIFICANCE OF RESULTS: Doctors reported the training was helpful and improved their confidence in knowing the law and applying it in clinical practice. The profile of trained doctors (particularly their location and specialty) suggests continued growth of participating doctors is needed to facilitate patient access to VAD. It is important that this safeguard does not discourage doctors' participation.

Stakeholder perspectives: Communication, care coordination, and transitions in care for children with medical complexity.

PURPOSE: The purpose of this study was to obtain feedback on communication, care coordination, and transitions in care for hospitalized children with medical complexity (CMC). DESIGN AND METHODS: This descriptive, mixed-methods study used online surveys with forced-choice and open-ended questions to obtain stakeholder feedback. Stakeholders included parents, healthcare providers, and nurses. Participants over 18 years of age were recruited from a Midwest children's hospital inpatient unit dedicated to care of CMC. Quantitative data were analyzed using t-tests and one-way analysis of variance. Qualitative description was used to analyze responses to open-ended questions. RESULTS: Parents' ratings of communication, care coordination, and transitions in care were generally high. Transitions from other facilities to the emergency department and unit received lower ratings. Providers and nurses gave high ratings to overall care, communication among providers and nurses on the patient unit, and experiences with discharge; however, between unit communication and unit-based coordination received lower ratings. Providers and nurses had higher ratings for discharge preparation than parents (p ≤ .001). Three themes were identified in responses to the open-ended questions: establishing balanced and collaborative relationships between the care team and families, taking a proactive approach to care coordination, and the importance of an inclusive, interdisciplinary, and centralized approach to care coordination and communication. PRACTICE IMPLICATIONS: Collaboration among all stakeholders is needed to achieve coordinated care, inclusive communication, and transitions with positive outcomes during hospitalization. Parents identified a need for consistent communication from care teams, with the primary inpatient team taking a lead role. Including parents in care coordination and transitions in care is key, as they are the experts in their children's health and well-being.

Trait self-esteem moderates the effect of initiator status on emotional and cognitive responses to romantic relationship dissolution.

We hypothesized that the effect of initiator status on post breakup distress would vary as a function of trait self-esteem, such that individuals with low self-esteem would experience more distress after being rejected by their partners, whereas, among individuals with high self-esteem, initiator status would not predict distress. We used a prospective design in which university students (N=66) were assessed for emotional responses following the dissolution of their real-life romantic relationships, as well as a laboratory design in which students (N=190) imagined breaking up with their partners. As predicted, participants with lower trait self-esteem exhibited greater distress after experiencing or imagining a romantic rejection than after ending or imagining themselves ending their relationships. Conversely, distress experienced by those with high trait self-esteem did not differ as a function of who ended the relationship. Implications for understanding self-esteem processes and the effects of romantic rejection are discussed.

The effect of infant fetal alcohol syndrome facial features on adoption preference.

Infant facial characteristics may affect discriminative parental solicitude because they convey information about the health of the offspring. We examined the effect of Fetal Alcohol Syndrome (FAS) infant facial characteristics on hypothetical adoption preferences, ratings of attractiveness, and ratings of health. As expected, potential parents were more likely to adopt "normal" infants, and they rated the FAS infants as less attractive and less healthy. Cuteness/attractiveness was the best predictor of adoption likelihood.