Implicit bias toward cervical cancer: Provider and training differences

Abstract

14Objective 15 Implicit prejudice and stereotyping may exist in health care providers automatically without their 16 awareness. These biases can correlate with outcomes that are consequential for the patient. This 17 study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward 18 cervical cancer. 19Methods 20Members of professional gynecologic oncology organizations were asked to complete two 21 Implicit Association Tests to determine if they implicitly associate cervical cancer with feelings 22 of anger (prejudice) and beliefs about culpability for the disease (stereotypes), compared to 23 ovarian cancer. Linear models and student t-tests examined average levels of implicit bias and 24 moderators of the implicit bias effects. 25 Results 26One-hundred seventy-six (132 female, 43 male, 1 nonresponse; � age = 39.18 years, SDage = 10.58 27 years) providers were recruited and the final sample included 151 participants (93 physicians and 28 58 nurses, � age = 38.93, SDage= 10.59). Gynecologic oncology providers showed significant 29 levels of implicit prejudice, � = 0.17, SD = 0.47, 95% CI: (0.10, 0.25), towards cervical cancer 30 patients. They also showed significant levels of implicit stereotyping of cervical cancer patients, 31 � = 0.15, SD = 0.42, 95% CI: (0.08, 0.21). Whereas physicians did not demonstrate significant 32 levels of implicit bias, nurses demonstrated greater levels of implicit prejudice and implicit 33 stereotyping. Providers without cultural competency/implicit bias training demonstrated greater 34 bias than those who had completed such training (p < 0.05). 35Conclusions 36 3This study provides the first evidence that gynecologic oncology providers hold implicit biases 37 related to cervical cancer. Interventions may be designed to target specific groups in gynecologic 38 oncology to improve interactions with patients. 39 4

What is the Image of the “Typical Cancer Patient”? The View of Physicians

“…Research on physicians' perceptions and implicit bias related to cancer patients is scarce (Liang et al, 2019;Sriram et al, 2015). Our results suggest that attributes describing the "typical cancer patient" have primarily unfavorable connotations.…”

The Explicit Attitude of Adolescents Towards Peers with Cancer

“…Accordingly, cancer triggers a series of conscious (controlled) vs. unconscious (automatic) cognitive, affective, and behavioral reactions (Fujisawa & Hagiwara, 2015;Sriram et al, 2015;Paradies et al, 2016;Liang et al, 2019). These reactions, as social psychologists (Ajzen & Fishbein, 1980;Dovidio et al, 2000;Aronson, 2009;Whitley & Kite, 2010;Barlow & Sibley, 2018) stress, define the attitudes of interaction partners and their individual and group identities.…”

“…Moreover, ambivalence may result from a conviction regarding the fundamentally different experiences of the observer and patient, in light of which every question seems unsuitable. Therefore, spontaneous behavior in contact with the patient, which arouses disgust/anxiety or compassion, may be avoidance (Sriram et al, 2015;Liang et al, 2019).…”

“…Information about cancer induces cognitive-affective schemas regulating attitudes towards patients (Stern & Arenson, 1989;Wiens & Gilbert, 2000;Fujisawa & Hagiwara, 2015;Liang et al, 2019;). Connectionist models of social reasoning and social behavior concern knowledge about the self and others as a semantic-affective network (Read & Miller, 1998;Fiske & Taylor, 2013).…”

“…Accordingly, the "cancer" label automatically triggers schematic associations focusing on the most visible disease indicators (hair and weight loss, pale skin, etc.). Stereotypical image and linked affective reactions may be altered and corrected when the observer is motivated and has the appropriate cognitive tools, i.e., he/she is asked to do it and knows various aspects of cancer (Drury et al, 2005;Dunn, 2015;Fujisawa & Hagiwara, 2015;Liang et al, 2019).…”