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

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          Abstract

          Former research has identified stigmatizing attitudes toward cancer patients in the general population. Little is known about (implicit) attitudes of physicians toward cancer patients. By using the prototype approach, the study investigated German physicians’ prototypical perceptions of cancer patients. Five hundred nineteen physicians (mean age: 46 years, 47% female) who regularly treat cancer patients participated in the questionnaire study. Participants were asked to state three prototype attributes that describe the “typical cancer patient.” Open format answers were coded on the dimensions favorability (coded with unfavorable, favorable, or neutral) and gender-stereotypicality (coded with masculine stereotypical, feminine stereotypical, or gender-neutral). Of all prototype attributes ( N = 1,589), 69.9% were coded as unfavorable and 14.3% as favorable, the remaining attributes were neutral (15.9%). Analysis of gender-stereotypicality revealed that nearly half of the attributes (49.5%) were compatible with the feminine, whereas only 6.5% were compatible with the masculine stereotype. The remaining attributes (44.0%) were gender-neutral. There were no significant associations between prototype favorability or gender-stereotypicality and demographic/professional characteristics of physicians. The prototype approach was successful to identify (implicit) attitudes toward cancer patients and might be more sensitive than social distance scales when investigating stigmatizing attitudes. Physicians described the “typical cancer patient” with predominantly unfavorable and feminine attributes, while favorable attributes were underrepresented and positive masculine attributes were barely mentioned. The finding that the “typical cancer patient” lacks (positive) masculine attributes should be followed up in further research.

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          Implicit bias in healthcare professionals: a systematic review

          Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
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            Constructions of masculinity and their influence on men's well-being: a theory of gender and health.

            Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.
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              The measurement of psychological androgyny.

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                Author and article information

                Journal
                Am J Mens Health
                Am J Mens Health
                JMH
                spjmh
                American Journal of Men's Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1557-9883
                1557-9891
                5 March 2021
                Mar-Apr 2021
                : 15
                : 2
                : 1557988320988480
                Affiliations
                [1 ]Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
                [2 ]Institute of Sport and Sport Science, Heidelberg University, Heidelberg, Germany
                [3 ]Gender Studies and Health Psychology, Institute of Psychology, Heidelberg University, Heidelberg, Germany
                [4 ]Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
                Author notes
                [*]Prof. Dr. Monika Sieverding, Institute of Psychology, Heidelberg University, Hauptstraße 47-51, Heidelberg 69117, Germany. Email: monika.sieverding@ 123456psychologie.uni-heidelberg.de
                Author information
                https://orcid.org/0000-0002-9865-4525
                Article
                10.1177_1557988320988480
                10.1177/1557988320988480
                7940746
                33666112
                7b30e6dd-d46a-4389-9668-196cc468a00f
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 June 2020
                : 15 December 2020
                : 28 December 2020
                Funding
                Funded by: Deutsche Krebshilfe, FundRef https://doi.org/10.13039/501100005972;
                Award ID: 110512, 110551 and 111223
                Categories
                Original Article
                Custom metadata
                March-April 2021
                ts1

                cancer patient prototypes,physicians’ attitudes,cancer patients,gender stereotypes,favorability

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