Member, Stanford Cancer Institute
1. To explore specific aspects of social adaptation such as social connectedness, occupational outcomes and family relationships in lymphoma patients after autologous blood or marrow transplantation (BMT). 2. To investigate how social adaptation varies with time lapsed since BMT and with the life stage as determined by patient?s age. Understanding both the positive and negative aspects of cancer and cancer therapy leads to opportunities to promote adaptive strategies.
Stanford is currently not accepting patients for this trial. For more information, please contact Kate Tierney, (650) 725 - 7063.
View details for PubMedID 29449349
This study examines caregiver quality of life (CQOL) 3-26 years after autologous hematopoietic cell transplantation (HCT) for patients with lymphoma. Using a framework that views the patient-caregiver dyad as a system of mutual influence, we argue that CQOL is associated with survivor functional health status and sense of personal control.Ninety-nine autologous HCT survivor-caregiver dyads participated. CQOL was measured using the Caregiver Quality of Life Scale-Cancer. Survivor functional health status was assessed using the Functional Assessment of Cancer Therapy-General. Sense of control was examined using an instrument from the MIDUS II study. Clinical measures were collected from medical records.After controlling for sociodemographic and clinical covariates, caregivers with higher sense of control had higher CQOL. Poorer survivor functional health was associated with lower CQOL but only when the survivor reported low personal control. When the survivor reported high personal control, functional health was not a factor. Lower CQOL was observed for younger and more educated caregivers. In contrast, more education among survivors was linked to higher CQOL.These results (1) support using a mutuality framework for the study of long-term outcomes of caregivers, (2) suggest the importance of ongoing support for caregivers, and (3) help identify caregivers at risk for poorer adaptation. Poorer survivor functional health is a risk factor, but its adverse implications can be offset by higher caregiver and survivor sense of control, a psychological resource aiding caregiver adaptation. These findings can inform the development of support programs for long-term caregivers.
View details for PubMedID 29926161
View details for Web of Science ID 000461244200006
Little is known about how long-term cancer survivors adapt in the realm of work and finances, and whether there are differences in these adaptations based on overall health status. We hypothesize that survivors with better health-related quality of life (HQL) have better work and financial outcomes.Cross-sectional study with 200 adult recipients of autologous hematopoietic cell transplantation (HCT) 3-26 years after transplant using self-administered questionnaires and medical records extraction.Questionnaires assessed work status, financial satisfaction, and perceived improvements in financial status since transplant.Nearly half the survivors were employed (37.2% full-time, 8.7% part-time); 37.2% had retired. Higher scores on the functional HQL were linked to a lower relative risk of having retired (RRR 0.85, CI 0.75-0.98) and of being neither in the workforce nor retired (RRR 0.84, CI 0.72-0.99) compared with working full-time. Higher functional HQL also related to higher financial satisfaction (b 0.06, CI 0.01-0.10) and increased odds of perceived improvements in one's financial situation since transplant (OR 1.15, CI 1.04-1.17). Patients receiving HCT at age ≥60 were more likely than counterparts receiving HCT at age 18-39 to work part-time (RRR 18.24, 95% CI 1.19-280.24) and to have retired (Model 1 RRR 579.14, 95% CI 49.53-6771.54) than to be working full-time.Survivors with poorer HQL may be at risk for overall poorer work and financial adaptation. Interventions targeting this group and specifically focusing on re-integration into the world of paid work should be considered.
View details for PubMedID 28780252
Why do people distrust others in social exchange? To what degree, if at all, is distrust subject to genetic influences, and thus possibly heritable, and to what degree is it nurtured by families and immediate peers who encourage young people to be vigilant and suspicious of others? Answering these questions could provide fundamental clues about the sources of individual differences in the disposition to distrust, including how they may differ from the sources of individual differences in the disposition to trust. In this article, we report the results of a study of monozygotic and dizygotic female twins who were asked to decide either how much of a counterpart player's monetary endowment they wanted to take from their counterpart (i.e., distrust) or how much of their own monetary endowment they wanted to send to their counterpart (i.e., trust). Our results demonstrate that although the disposition to trust is explained to some extent by heritability but not by shared socialization, the disposition to distrust is explained by shared socialization but not by heritability. The sources of distrust are therefore distinct from the sources of trust in many ways.
View details for PubMedID 28630324
View details for PubMedCentralID PMC5502587
To provide social exchange on a global level, sharing-economy companies leverage interpersonal trust between their members on a scale unimaginable even a few years ago. A challenge to this mission is the presence of social biases among a large heterogeneous and independent population of users, a factor that hinders the growth of these services. We investigate whether and to what extent a sharing-economy platform can design artificially engineered features, such as reputation systems, to override people's natural tendency to base judgments of trustworthiness on social biases. We focus on the common tendency to trust others who are similar (i.e., homophily) as a source of bias. We test this argument through an online experiment with 8,906 users of Airbnb, a leading hospitality company in the sharing economy. The experiment is based on an interpersonal investment game, in which we vary the characteristics of recipients to study trust through the interplay between homophily and reputation. Our findings show that reputation systems can significantly increase the trust between dissimilar users and that risk aversion has an inverse relationship with trust given high reputation. We also present evidence that our experimental findings are confirmed by analyses of 1 million actual hospitality interactions among users of Airbnb.
View details for PubMedID 28847948
Despite the popularity of the notion that social cohesion in the form of dense social networks promotes cooperation in Prisoner's Dilemmas through reputation, very little experimental evidence for this claim exists. We address this issue by testing hypotheses from one of the few rigorous game-theoretic models on this topic, the Raub & Weesie model, in two incentivized lab experiments. In the experiments, 156 subjects played repeated two-person PDs in groups of six. In the "atomized interactions" condition, subjects were only informed about the outcomes of their own interactions, while in the "embedded" condition, subjects were informed about the outcomes of all interactions in their group, allowing for reputation effects. The design of the experiments followed the specification of the RW model as closely as possible. For those aspects of the model that had to be modified to allow practical implementation in an experiment, we present additional analyses that show that these modifications do not affect the predictions. Contrary to expectations, we do not find that cooperation is higher in the embedded condition than in the atomized interaction. Instead, our results are consistent with an interpretation of the RW model that includes random noise, or with learning models of cooperation in networks.
View details for DOI 10.1371/journal.pone.0155703
View details for Web of Science ID 000378914900003
View details for PubMedID 27366907
View details for PubMedCentralID PMC4930174
Using semi-structured interviews with 50 hematopoietic stem cell transplantation (HSCT) recipients who were 2 to 22 years post-transplant, this study investigates cancer survivors' interpretations of their economic and work-related experiences during and after treatment. Survivors described a variety of challenges in these areas, including job insecurity, discrimination, career derailment, the lack of career direction, delayed goals, financial losses, insurance difficulties, constraints on job mobility, and physical/mental limitations. Survivors described the ways these challenges were offset by external factors that helped them to navigate these difficulties and buffered the negative financial and career-related impacts. Good health insurance, favorable job characteristics, job accommodations, and financial buffers were prominent offsetting factors. Most survivors, however, were also forced to rely on individual behavioral and interpretative strategies to cope with challenges. Behavioral strategies included purposeful job moves, retraining, striving harder, and retiring. Some strategies were potentially problematic, such as acquiring large debt. Interpretive strategies included reprioritizing and value shifts, downplaying the magnitude of cancer impact on one's life, denying the causal role of cancer in negative events, making favorable social comparisons, and benefit finding. Post-treatment counseling and support services may assist survivors in identifying available resources and useful strategies to improve long-term adaptation in the career and financial realms.
View details for DOI 10.1080/07347332.2015.1101040
View details for Web of Science ID 000372131100002
View details for PubMedID 26492184
View details for PubMedID 24626914
A violation of trust can have quite different consequences, depending on the nature of the relationship in which the trust breach occurs. In this article, we identify a key relationship characteristic that affects trust recovery: the extent of relationship experience before the trust breach. Across two experiments, this investigation establishes the behavioral effect that greater relationship experience before a trust breach fosters trust recovery. A neuroimaging experiment provides initial evidence that this behavioral effect is possible because of differential activation of two brain systems: while decision making after early trust breaches engages structures of a controlled social cognition system (C-system), specifically the anterior cingulate cortex and lateral frontal cortex, decision making after later trust breaches engages structures of an automatic social cognition system (X-system), specifically the lateral temporal cortex. The present findings make contributions to both social psychological theory and the neurophysiology of trust.
View details for DOI 10.1073/pnas.1314857110
View details for Web of Science ID 000324495300034
View details for PubMedID 24003151
In this paper we explore two contrasting perspectives on individuals' participation in associations. On the one hand, some have considered participation the byproduct of pre-existing friendship ties - the more friends one already has in the association, the more likely he or she is to participate. On the other hand, some have considered participation to be driven by the association's capacity to form new identities - the more new friends one meets in the association, the more likely he or she is to participate. We use detailed temporal data from an online association to adjudicate between these two mechanisms and explore their interplay. Our results show a significant impact of new friendship ties on participation, compared to a negligible impact of pre-existing friends, defined here as ties to other members formed outside of the organization's context. We relate this finding to the sociological literature on participation and we explore its implications in the discussion.
View details for DOI 10.1371/journal.pone.0067388
View details for PubMedID 23861761
View details for PubMedCentralID PMC3701679
View details for Web of Science ID 000283803500011
View details for Web of Science ID 000283803500013
In a series of experiments, we demonstrate that certain players of an economic game reject unfair offers even when this behavior increases rather than decreases inequity. A substantial proportion (30-40%, compared with 60-70% in the standard ultimatum game) of those who responded rejected unfair offers even when rejection reduced only their own earnings to 0, while not affecting the earnings of the person who proposed the unfair split (in an impunity game). Furthermore, even when the responders were not able to communicate their anger to the proposers by rejecting unfair offers in a private impunity game, a similar rate of rejection was observed. The rejection of unfair offers that increases inequity cannot be explained by the social preference for inequity aversion or reciprocity; however, it does provide support for the model of emotion as a commitment device. In this view, emotions such as anger or moral disgust lead people to disregard the immediate consequences of their behavior, committing them to behave consistently to preserve integrity and maintain a reputation over time as someone who is reliably committed to this behavior.
View details for DOI 10.1073/pnas.0900636106
View details for Web of Science ID 000267972700019
View details for PubMedID 19564602
View details for Web of Science ID 000259753200003
To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care.2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556).We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups.Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician-patient communication is negatively associated with perceived racial and ethnic bias.Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups.
View details for DOI 10.1111/j.1475-6773.2007.00816.x
View details for Web of Science ID 000255481200008
View details for PubMedID 18546546
We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of trust asking about expectations for specific physician behaviors, including referring to a specialist, being influenced by insurance rules, and performing unnecessary tests. Using a national survey, we find lower scores on indirect measures of trust in a physician among minority users of health care services than among non-Hispanic white users. In contrast, the direct measure of trust does not differ among non-Hispanic whites and nonwhites once we control for potential confounding factors. The results indicate that racial/ethnic/language-based differences exist primarily in those aspects of patients' trust in a physician that reflect specific physician behaviors.
View details for Web of Science ID 000242750800006
View details for PubMedID 17240927
View details for Web of Science ID 000241211700004
To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.The 1998-1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care (n = 29,994).We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.
View details for DOI 10.1111/j.1475-6773.2005.00457.x
View details for Web of Science ID 000233170100012
View details for PubMedID 16336555
View details for Web of Science ID 000229843100002
View details for Web of Science ID 000229515200002
Little is known about whether some features of managed care widen disparities in patients' evaluations of primary care.We investigated whether the magnitudes of racial and ethnic/language-based differences in patients' evaluations of the quality of primary care vary by capitation and gatekeeping.We used a telephone survey of a representative sample of the US noninstitutionalized population, Community Tracking Study Household Survey 1998-1999, and Followback Survey of respondents' insurance administrators.Our sample was privately insured adults who saw a physician at least once during the year preceding the interview and whose last visit was to a primary care physician.We measured patients' evaluations of (1) how well the physician listened, (2) how well the physician explained, and (3) how thorough and careful the physician was during the last visit.Significant white-minority differences emerge more often in plans using capitation or gatekeeping than in other plans. The gaps in patients' evaluations of their primary care providers' (PCP) explanations and thoroughness between whites and Hispanics interviewed in English are larger when the PCP is capitated than when the PCP is not capitated. The gap in the evaluations of their PCP's explanations by whites and Hispanics interviewed in English is larger in plans that require referrals for specialist visits than in other plans. The magnitude of racial and ethnic/language-based gaps for Hispanics interviewed in Spanish, blacks, and Native American/Asian/Pacific Islanders do not differ by capitation and gatekeeping.English-speaking Hispanics' perceptions of the quality of primary care may be more dissimilar from whites' when capitation or gatekeeping are used than when these policies are not used.
View details for Web of Science ID 000224196900005
View details for PubMedID 15377929
View details for Web of Science ID 000223221000008
Many countries are importing managed care and price competition from the US to improve the performance of their health care systems. However, relatively little is known about how power is organized and exercised in the US health care system to control costs, improve quality and achieve other objectives. To close this knowledge gap, we applied social exchange theory to examine the power relations between purchasers, managed care organizations, providers and patients in the US health care system at three interrelated levels: (1) exchanges between purchasers and managed care organizations (MCOs); (2) exchanges between MCOs and physicians; and (3) exchanges between physicians and patients. The theory and evidence indicated that imbalanced exchange, or dependence, at all levels prompts behavior to move the exchange toward power balance. Collective action is a common strategy at all levels for reducing dependence and therefore, increasing power in exchange relations. The theoretical and research implications of exchange theory for the comparative study of health care systems are discussed.
View details for Web of Science ID 000174926000002
View details for PubMedID 11989955
View details for Web of Science ID 000170748100016
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Smith and Mick identify four basic problems with the theory the present writers developed to explain organizational responses (in this case the behavior of hospitals) to regulation. They challenge the basic assumption regarding autonomy, disagree with the implied cause and effect relations between organizational response and regulation, criticize the omission of goals, and claim that the theory has only limited generality. In so doing they state that their primary concern is with "improving our understanding of the limitations and benefits of the theory." Each of the four topics they raise for consideration will receive comment.
View details for Web of Science ID A1985AGL4800015
View details for PubMedID 10271250
View details for Web of Science ID A1985ADC4900117
This paper presents a theory of the effects of rate review on hospital operations and organization. Its purpose is to explain the way in which hospitals have responded to regulation. In the development of this theory, the hospital product was viewed as a bundle of services, rate review was looked upon as a ceiling on the value of the bundle. The ceiling creates an incentive to remove elements from the bundle, i.e., to reduce 'quality'. When quality is variable, the effect on utilization becomes indeterminate. The model argues, among other things, that the hospital will change its service complement and its contractural arrangements with physicians and other hospitals. An extension of the organizational theory literature leads to implications concerning the ordering of hospital responses to regulation. The growing body of empirical literature on the effects of hospital rate review is used as an initial test of the major thrusts of the theory. A suggested agenda for further empirical work also is presented.
View details for Web of Science ID A1984SW29700002
View details for PubMedID 10299548
View details for Web of Science ID A1983QQ78000015
This paper presents a general theory of organizational response to regulation, a theory that integrates adaptation and mutual selection perspectives. Two major forms of regulation in the hospital industry, certificate of need and rate review, are examined. Hypotheses are derived concerning the nature and timing of the various adjustments hospitals make both in internal organizational arrangements and in patterns of interorganizational activity in the face of regulatory constraints. Suggestions and data sources for testing the theory are presented.
View details for Web of Science ID A1983QQ09400001
View details for PubMedID 10263058
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