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This qualitative study aimed to investigate psychotherapists’ experience of dishonesty in the therapy setting. Therapist dishonesty is broadly defined as “behaviors or words, spoken or withheld, that are meant to deceive or mislead” (Jackson & Farber, 2021, p. 1). Though it is anecdotally acknowledged in the clinical literature, the phenomenon of therapist dishonesty has been empirically under-researched and unexplored, in favor of topics such as client dishonesty and client and therapist self-disclosure. Designed as a follow-up to a quantitative study of 401 participants (Jackson & Farber, 2021), the present study aimed to capture a comprehensive phenomenological understanding of the circumstances, motives, feelings, perceived consequences, guidelines, and attitudes therapists carry about dishonesty in therapy. Further, this study aims to understand the extent to which therapists, in practice, are dishonest, and whether this occurrence is consistent with professional ethics and guidelines regarding dishonesty. Additionally, this study intends to review and synthesize the advice practicing therapists would provide to beginning therapists on handling situations in which they are tempted to refrain from telling the entire truth to patients. Following the methodology of Consensual Qualitative Research (CQR), 20 psychotherapists participated in semi-structured interviews prompting the factors that contribute to honesty and dishonesty in psychotherapy and its perceived impacts and clinical implications. Nine domains and various salient findings emerged from the analysis. Findings revealed that most commonly, dishonesty occurs around personal disclosures to patients, reasons for dishonesty are typically associated with boundary setting to protect therapists’ needs or patients’ feelings, while nearly all therapists would not have handled their dishonest moment differently, many regret this moment, and typically, therapists contend that their honest disclosure have increased, rather than decreased, over the course of their careers. Therapist dishonesty and its association with clinical tact, therapist disclosure, and therapist matching are discussed. Limitations, clinical implications for novice therapists, and future directions are noted. Keywords: Therapist dishonesty, therapist honesty, therapist disclosure, clinical tact, therapist effects

Endocrine disrupting chemicals (EDCs) of exogenous origin refer to compounds that disrupt the regular functioning of the endocrine system responsible for maintaining hormonal balance in the body. These disruptors are prevalent in our surroundings and are present in various consumer products, including cosmetics, plastics, and pesticides. The means of action vary depending on the specific chemical and target hormone receptor. EDCs can mimic, obstruct, alter hormone production, transport, and metabolize, leading to a range of health risks such as metabolic disorders, immune system dysfunction, and endocrine-related cancers, as well as reproductive abnormalities. Interference with the production, transport, and function of hormones responsible for the menstrual cycle and pregnancy, including estrogen, progesterone, and luteinizing hormone, leads to reproductive problems. EDCs also cause permanent alterations in the development of the female reproductive system during fetal and early childhood stages. Some of the most widely known EDCs include bisphenol-A (BPA), phthalates, and polychlorinated biphenyls (PCBs), which have been found in human tissue and fluids, such as urine and breast milk. Researchers continue to discover and analyze EDC prevalence and the effects on human health. While efforts have been made to reduce exposure to these compounds, they remain prevalent in the environment. There are lifestyle interventions that can help with the prevention and exposure to EDCs. Such interventions include healthier eating habits, avoiding the use of plastic containers containing EDCs, choosing safer personal care products, filtering drinking water, reducing exposure to air pollution, and supporting policies and regulations that promote the use of safer chemicals.

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Importance – The homeless face higher rates of morbidity and mortality than the general population, and have lower rates of end-of-life care planning. An effective and sustainable intervention, to provide living wills and durable power of attorney, is required to protect the autonomy of a vulnerable population. Objective – To determine if medical student-led 1:1 counseling is as effective as social worker-led counseling as reported in the literature, determined by rate of advanced directive completion. Design – A focus groups and educational sessions on EOL care and ADs were conducted at 2 shelters, after which participants were offered the opportunity to sign up for a 1:1 counseling session with a medical student volunteer. Rates of sign-ups and completion were recorded. Setting – 2 North Philadelphia homeless shelters, requiring either an Axis I or current substance abuse diagnosis for residence. Participants – A convenience sample of 20 homeless men were approached; 10 enrolled in the study. Interventions – Educational sessions, focus groups, and 1:1 AD completion counseling sessions Main Outcomes – Interest in and completion of an advanced directive. Results – 9 participants signed up to complete ADs after an informational session. At the conclusion of the study, 8 of them (88.8%) completed ADs. 40% of the total participants completed an AD. Conclusions – Similar rates of advanced directive completion were achieved with the student-led intervention compared to a previous intervention in the literature. Further study with a larger sample including homeless women should be conducted to provide a generalized conclusion. / Urban Bioethics

Background: The childbearing years place socioeconomically disadvantaged African American women at increased risk for poor diet quality, excess weight gain, and cardiometabolic complications. Little is known about the attitudes, beliefs, values, and contextual constraints that shape these high risk mothers’ dietary and physical activity behaviors. Objective: The purpose of this study was to examine health perceptions of diet quality and physical activity among low-income African American women in the early postpartum period, and how these perceptions manifest as barriers or facilitators to health. Additionally, we examined how they may differ by known predictors of health, such as education, age, parity, and BMI. Methods: We conducted semi-structured, individual interviews with 20 women who were between 3-6 months postpartum. Mothers were approached and recruited in the waiting room of a university-affiliated, outpatient prenatal care clinic in Philadelphia, PA. Enrollment in the study was restricted to women who self-identified as African American, were at least 18 years old, and met the federal income guidelines to qualify for assistance (Medicaid, WIC). Individual interviews were audio recorded and transcribed verbatim, with transcripts verified by research staff. Thematic coding and content analysis were performed by 3 researchers using NVivo 10 software to assist with data management. Results: Barriers and facilitators of healthy eating and physical activity after childbirth fell into 4 major themes of mothers’ lives: 1) new structural reality in the postpartum period; 2) physiologic changes after delivery; 3) correct/incorrect perceptions of healthy eating and activity; and 4) social determinants influencing behaviors. Mothers described the transition from pregnancy to the early postpartum period as having a significant negative impact on their eating and activity behaviors due to heightened fatigue, time constraints, and the monotony of daily life with a newborn. We found more than double the number of perceived barriers to engaging in healthy eating than facilitators with regard to fluctuations in food supply, cost of food, and the built environment. Mothers with obesity and less education were more likely to have misperceptions; these misperceptions additionally served as strong barriers to making healthy lifestyle choices. Changes in mothers’ physical symptoms and health status (e.g., developing diabetes, hypertension), on the other hand, facilitated healthy behaviors. Conclusion: This research deepens our understanding of the primary drivers of health behaviors among low-income African American women in the postpartum period. We identified barriers which limit and facilitators which support these mothers’ ability to engage in healthy behaviors, though there were far fewer facilitators of healthy eating and physical activity. Interventions designed to overcome these barriers and capitalize on these facilitators have the potential to improve health outcomes for this population. / Urban Bioethics

The current fragmented delivery of health care has contributed to unplanned hospital readmissions as a leading problem in the United States. Reducing readmissions to urban teaching hospitals is difficult. Many patients living in urban communities face social, economic, language, and transportation barriers to maintaining their health. Both the patient and the medical center experience the burden of readmission and are challenged with addressing SDoH and social injustices at several levels. Medicare views hospital readmissions as a marker representing lower quality of health care delivery to penalize hospitals providing care to the poor. This thesis addresses multiple social and economic factors associated with hospital readmissions, explores the interrelated components of readmissions at the personal and hospital system level, and delves into the interactions of bioethical principles associated with urban living. Hospital readmissions remain a serious issue nationwide and in order to reduce the rates of re-hospitalization the social and economic inequalities contributing to hospital readmissions are significant and must be addressed. / Urban Bioethics

Low health literacy in the United States has numerous negative impacts on health outcomes. Efforts to equip physicians with the ability to better identify patients with low health literacy have consistently shown lackluster and transient results. The transient nature of these results closely mirror those seen in the implicit bias literature, implying that health literacy may be better addressed if considered a type of coded bias among clinicians. In this paper, a review of the literature is presented which includes the impact of health literacy on patient outcomes, physician understanding and ability to screen for low health literacy, past interventions aimed at improving physician ability to identify and assist low health literacy patients, and the existing literature involving implicit bias among physicians. This review allows for the argument that interventions aimed at helping physicians better identify low health literacy patients would be more effective if designed to address unconscious biases rather than a knowledge deficit. Finally, the ethical imperative to address these biases in the healthcare setting is described. / Urban Bioethics

Those who have known an individual with a chronic medical condition or someone that has been diagnosed with a terminal illness have experienced the physical and emotional toll these diagnoses have on both patients and their loved ones. Medical providers encounter these situations daily and are often responsible for assisting the patient and their family in the decision-making process. The specialty of Hospice and Palliative Medicine was created specifically with these difficult, but very common, situations in mind. Even though the concept of palliative care has become mainstream and its practice is considered standard of care in many situations, it continues to be misunderstood, misrepresented, and underutilized, despite providing measurable benefits to patients, families and the healthcare system. This paper explores two systemic barriers to palliative care that contribute to this problem and highlights how race, cultural mistrust, and a long history of racial disparities in health care work together to undermine the effective delivery of palliative care. / Urban Bioethics