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Is it disgusting? (May-08)

People vary in their attitudes toward physical disabilities. Give us your reactions, and we'll tell you the results of surveys of the general public--and of actual patients.

 

Strongly

disagree

Mildly

disagree

Mildly

agree

Strongly

agree

I try to avoid letting any part of my body touch the toilet seat in a public restroom, even when it appears clean.

1

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4

It would make me uncomfortable to hear a couple making love in the next room of a hotel.

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It would bother me tremendously to touch a dead body.

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4

Even if I were hungry, I would not eat a bowl of my favorite soup if it had been stirred by a used-but thoroughly washed- fly-swatter

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4

I am bothered by the odor caused by passing gas.

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The smell of other persons' bowel movements disgusts me.

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4

Consider the following

Now we'd like you to think about a specific health condition. Please read this scenario carefully so that you can answer some questions. Imagine you have a colostomy. A colostomy is an operation involving the surgical redirection of your bowels through a hole created in your gut. This hole is called a stoma. Waste passes through your intestines and out the stoma into a bag, which you must empty several times a day. If you wear relatively loose clothing, this bag won't be visible underneath your garments. Occasionally, you'll experience odors and noises caused by gas and waste passing through the stoma into the bag. There's also the chance that the colostomy bag may leak if it's allowed to fill past capacity. Although you'll be restricted from lifting very heavy objects, your daily activities won't otherwise be greatly affected by the colostomy.

To what extent does your colostomy make you feel embarrassed or socially uncomfortable?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 
To what extent does your colostomy make you feel stigmatized?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 

How do your answers compare?

Do your responses to the six questions on the disgust scale correlate with the stigmatization you expressed related to your imaginary colostomy?

In their national survey of the general public (people without colostomies), CBDSM researchers found that people who reported a higher level of disgust sensitivity responded more negatively to colostomy.

Current and former colostomy patients were also surveyed. In these groups, patients with higher disgust sensitivity had more difficulty adjusting to life with a colostomy. Specifically,colostomy patients with higher disgust sensitivity felt more stigmatized in society by their colostomy and felt more bothered by colostomy symptoms, such as leakage. Dr. Dylan Smith and his colleagues postulate that people who have a pre-existing high sensitivity to disgusting stimuli will be less likely to adjust well to life with a colostomy. Alternatively, it could be that people who adjust successfully to a colostomy do so in part by reducing their sensitivity to certain kinds of disgusting stimuli.

If future studies show that we can predict that patients with high disgust sensitivity are likely to have more difficulty adjusting to a colostomy, health-care teams can then seek ways to de-sensitize responses to bowel functioning, in order to aid patients in their adaptation to life with a colostomy. Further, many people with inflammatory bowel syndrome can choose whether or not to have a colostomy for relief of their symptoms. For these patients, a clear understanding of disgust sensitivity could be a factor in helping to make an informed choice about elective colostomy.

Certainly this research suggests that disgust plays a role in perceived and actual stigmatization of disabled patients. Previous studies of patients' adjustment to disability have focused on general responses to adversity, taking into account their social support, their coping style, or their optimism, for example. The uniqueness of this recent CBDSM study is that it considers how the specific challenges of a disability interact with a personality trait relevant to that disability: disgust sensitivity. This personality trait might also be linked to other health conditions, such as amputation or incontinence. In addition, personality traits other than disgust might affect patients' adaptation to other disabilities.

Read the article:

Sensitivity to disgust, stigma, and adjustment to life with a colostomy
Smith DM, Loewenstein G, Rozin P, Sherriff RL, Ubel PA. Journal of Research in Personality 2007;41(4):787–803.

The Disgust Scale used here is adapted from the work of Haidt J, McCauley C, Rozin P. Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences. 1994; 16(5): 701-713.

 

Reshma Jagsi, MD, DPhil, has found that 29% of cancer research published in high-impact journals disclosed a conflict of interest, including industry funding of the study or a study author who was an industry employee. "Given the frequency we observed for conflicts of interest and the fact that conflicts were associated with study outcomes, I would suggest that merely disclosing conflicts is probably not enough. It's becoming increasingly clear that we need to look more at how we can disentangle cancer research from industry ties," comments Jagsi. The study, which has received wide media attention, was published in the journal Cancer, online at  http://www3.interscience.wiley.com/journal/122381054/abstract?CRETRY=1&SRETRY=0

Additional authors are Nathan Sheets, Aleksandra Jankovic, Amy R. Motomura, Sudha Amarnath, and Peter A. Ubel.

How We Can Help

CBSSM offers a variety of resources and tools that have broad applicability.

Please consider attending one of our working group meetings. These meetings provide a forum for project focused discussions and interdisciplinary collaborations. Presenters can receive feedback on a range of issues, from project inception and grant applications to manuscript drafts.

As part of our ongoing research efforts, CBSSM investigators often create methodological tools that have broad applicability beyond the specific research projects for which they were developed. We are pleased to make these tools available to all researchers and non-profit organizations, subject only to appropriate attribution in work products (materials and/or manuscripts).Please explore the following tools:

Erica Sutton, PhD

Alumni

Dr. Erica Sutton was a CBSSM Postdoctoral Research Fellow, 2013-2015. She is an interdisciplinary social scientist engaged in social and behavioral science research that explores the health care experiences of individuals living with rare genetic conditions; the manner in which biotechnologies shape personal experience and social life; and the ethical implications of these technologies for individuals, public health, social policy, health care institutions, and communities.

Last Name: 
Sutton

Susan Goold, MD, MHSA, MA

Faculty

Susan Dorr Goold, M.D., M.H.S.A., M.A., studies the allocation of scarce healthcare resources, especially the perspectives of patients and the public. Results from projects using the CHAT (Choosing Healthplans All Together) allocation game have been published and presented in national and international venues. CHAT won the 2003 Paul Ellwood Award and Dr. Goold is listed in the Foundation for Accountability's database of Innovators and Visionaries. Dr.

Last Name: 
Goold

We are pleased to announce that Reshma Jagsi, M.D., D.Phil., has been appointed director of the Center for Bioethics and Social Sciences in Medicine.

CBSSM is one of the premier intellectual gathering place of clinicians, social scientists, bioethicists and all others interested in improving individual and societal health through application of social science and bioethics methods to health research, education and public outreach. The center also serves as the home of the Program in Clinical Ethics.

Click here for more details.

CBSSM co-director Raymond De Vries was the keynote speaker at The Sixth Annual Terri Murtland Lecture and Scholarship in Midwifery. His talk was entitled, “What is a good birth? How do we know?”. You can read more at the UM School of Nursing website.

Health Communication and Decision Making

A major theme of CBSSM involves using techniques from basic and applied research to determine the best practices for communicating health information to patients and the public more generally. This special interest group explores topics related to understanding and improving patient and public decision making about medical issues.

Research that falls within this programmatic area includes topics such as:

  • Risk communication and perception
  • Health communication and education
  • Development and testing of decision aids/patient education materials
  • Visualization and contextualization of health data
  • Communication of genomic information to patients and providers
  • Numeracy and literacy
  • Utility and survey methods
  • Patient decision making
  • Patient-physician communication

A number of CBSSM faculty spoke at the recent Michigan State Medical Society Conference on Neonatal and Pediatric Ethics on November 13-14 in Ann Arbor

  • Welcome and Opening & Closing Remarks:  Lauren B. Smith, MD, Chair, MSMS Committee on Bioethics
  • “What’s New at the Margin of Viability?”  Naomi Laventhal, MD, MA, FAAP, Assistant Professor, Pediatrics; Brandon Neonatal Intensive Care, C. S. Mott Children’s Hospital
  • “Elective Operations in Children” Christian J. Vercler, MD, MA, Clinical Assistant Professor, Plastic Surgery; Co-Chair, Pediatric & Adult Ethics Committees; and Co-Director, Clinical Ethics Program, CBSSM
  • “Harms of Newborn Screening: Fact or Fiction?” Beth A. Tarini, MD, Assistant Professor, Department of Pediatrics and Communicable Diseases

Visit this link for more information on the conference.

Michael D. Fetters, MD, MPH, MA, Associate Professor, was co-presenter at the 38th annual North American Primary Care Research Group (NAPCRG) meeting, November 13-17, 2010, in Seattle, WA.

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