Development of a decision aid to inform patients' and families' renal replacement therapy selection decisions.

BACKGROUND: Few educational resources have been developed to inform patients' renal replacement therapy (RRT) selection decisions. Patients progressing toward end stage renal disease (ESRD) must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients' treatment and support patients' decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function. METHODS: We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in "stages." For the video, stages included (1) directed interviews with culturally appropriate patients and families and preliminary script development, (2) video production, and (3) screening the video with patients and their families. For the handbook, stages comprised (1) preliminary content design, (2) a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3) screening the handbook with patients and their families. RESULTS: The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals' testimonials regarding various considerations that might influence patients' and families' treatment selections. The handbook was comprised of written words, pictures of patients and health care providers, and diagrams describing the findings and quality of scientific studies comparing treatments. The handbook text was written at a 4th to 6th grade reading level. Pilot study results demonstrated that a majority of patients could understand information presented in the handbook. Patient and families screening the nearly completed video and handbook reviewed the materials favorably. CONCLUSIONS: This rigorously designed decision aid may help patients and families make informed decisions about their treatment options for RRT that are well aligned with their values.

Knowing The Way: Scriptural Imagination and the Acts of the Apostles

In this dissertation, I offer a pedagogical proposal for learning the Christian Scriptures guided by respect for the nature of the reader and the integrity of the biblical text. Christian educators have profitably developed recent theoretical interest in the body’s role in human meaning with regard to worship and praxis methodologies, but the implications of this research for communal study of the biblical text merit further development. I make the case for adopting scriptural imagination as the goal of pedagogically constructed encounters with the Christian Scriptures. The argument proceeds through a series of questions addressing both sides of the text/reader encounter.

Chapter one considers the question “what is the nature of the reader and, subsequently, the shape of the reader’s ways of knowing?” This investigation into recent literature on the body’s involvement in human knowing includes related epistemological shifts with Christian education. On the basis of this survey, imagination emerges as a compelling designator of an incorporative, constructive creaturely capacity that gives rise to a way of being in the world. Teachers of Scripture who intend to participate in Christian formation should account for the imagination’s centrality for all knowing. After briefly situating this proposal within a theological account of creatureliness, I make the initial case for Scriptural imagination as a pedagogical aim.

Imagination as creaturely capacity addresses the first guiding value, but does this proposal also respect the integrity and nature of the biblical text, and specifically of biblical narratives? In response, in chapter two I take up the Acts of the Apostles as a potential test case and exemplar for the dynamics pertinent to the formation of imagination. Drawing on secondary literature on the genre and literary features of Acts, I conclude that Acts coheres with this project’s explicit interest in imagination as a central component of the process of Christian formation in relationship to the Scriptures.

Chapters three and four each take up a pericope from Acts to assess whether the theoretical perspectives developed in prior chapters generate any interpretive payoff. In each of these chapters, a particular story within Acts functions as a test case for readings of biblical narratives guided by a concern for scriptural imagination. Each of these chapters begins with further theoretical development of some element of imaginal formation. Chapter three provides a theoretical account of practices as they relate to imagination, bringing that theory into conversation with Peter’s engagement in hospitality practices with Cornelius in Acts 10:1-11:18. Chapter four discusses the formative power of narratives, with implications for the analysis of Paul’s shipwreck in Acts 27:1-28:16.

In the final chapter, I offer a two-part constructive pedagogical proposal for reading scriptural narratives in Christian communities. First, I suggest adopting resonance above relevance as the goal of pedagogically constructed encounters with the Scriptures. Second, I offer three ways of reading with the body, including the physical, ecclesial, and social bodies that shape all learning. I conclude by identifying the importance of scriptural imagination for Christian formation and witness in the twenty-first century.

War Worlds: Violence, Sociality, and the Forms of Twentieth-Century Transatlantic Literature

“War Worlds” reads twentieth-century British and Anglophone literature to examine the social practices of marginal groups (pacifists, strangers, traitors, anticolonial rebels, queer soldiers) during the world wars. This dissertation shows that these diverse “enemies within” England and its colonies—those often deemed expendable for, but nonetheless threatening to, British state and imperial projects—provided writers with alternative visions of collective life in periods of escalated violence and social control. By focusing on the social and political activities of those who were not loyal citizens or productive laborers within the British Empire, “War Worlds” foregrounds the small group, a form of collectivity frequently portrayed in the literature of the war years but typically overlooked in literary critical studies. I argue that this shift of focus from grand politics to small groups not only illuminates surprising social fissures within England and its colonies but provides a new vantage from which to view twentieth-century experiments in literary form.

Akrasia and the Aesthetic: Human Agency and the Site of Literature, 1760-1820

This study focuses on a series of foundational stylistic and formal innovations in eighteenth-century and Romantic literature, and argues that they can be cumulatively attributed to the distinct challenges authors faced in representing human action and the will. The study focuses in particular on cases of “acting against better judgment” or “failing to do what one knows one ought to do” – concepts originally theorized as “akrasia” and “weakness of the will” in ancient Greek and Scholastic thought. During the Enlightenment, philosophy increasingly conceives of human minds and bodies like systems and machines, and consequently fails to address such cases except as intractable or incoherent. Yet eighteenth-century and Romantic narratives and poetry consistently engage the paradoxes and ambiguities of action and volition in representations of akrasia. As a result, literature develops representational strategies that distinguish the epistemic capacities of literature as privileged over those of philosophy.

The study begins by centering on narratives of distempered selves from the 1760s. Jean-Jacques Rousseau’s Confessions and Laurence Sterne’s A Sentimental Journey narrate cases of knowingly and weakly acting against better judgment, and in so doing, reveal the limitations of the “philosophy of the passions” that famously informed sentimental literature at the time. These texts find that the interpretive difficulties of action demand a non-systematic and hermeneutic approach to interpreting a self through the genre of narrative. Rousseau’s narrative in particular informs William Godwin’s realist novels of distempered subjects. Departing from his mechanistic philosophy of mind and action, Godwin develops the technique of free indirect discourse in his third novel Fleetwood (1805) as a means of evoking the ironies and self-deceptions in how we talk about willing.

Romantic poetry employs the literary trope of weakness of will primarily through the problem of regretted inaction – a problem which I argue motivates the major poetic innovations of William Wordsworth and John Keats. While Samuel Taylor Coleridge sought to characterize his weakness of will in philosophical writing, Wordsworth turns to poetry with The Prelude (1805), revealing poetry itself to be a self-deceiving and disappointing form of procrastination. More explicitly than Wordsworth, John Keats identifies indolence as the prime symbol and basis of what he calls “negative capability.” In his letters and poems such as “On Seeing the Elgin Marbles” (1817) and “Ode on Indolence” (1819), Keats reveals how the irreducibly contradictory qualities of human agency speak to the particular privilege of “disinterested aesthetics” – a genre fitted for the modern era for its ability to disclose contradictions without seeking to resolve or explain them in terms of component parts.