Joan H. Schiller, MD; Alice Goodman, MA


July 18, 2013

In This Article

How Negative Are Public Attitudes?

Medscape: Tell me about the study details.

Dr. Schiller: This was an online study that involved over 1700 respondents from different sectors, including healthcare providers, public caregivers, and patients.

We wanted to study explicit or conscious attitudes and implicit or unconscious attitudes toward lung cancer. Explicit attitudes were captured by answers to specific questions, and implicit attitudes were captured by responses to a rapid series of photographs and words.

We needed a comparator so we could show that attitudes toward lung cancer were more negative than attitudes toward another type of cancer. We selected breast cancer as a comparator because we felt it was associated with little guilt and stigma and is not perceived as a self-induced disease. Also, breast cancer has a strong patient advocacy movement supporting public awareness, and to a great extent, this has overcome any stigma that may have been attached to it many years ago.

Medscape: How did you test for explicit attitudes?

Dr. Schiller: Participants were asked to agree/disagree with statements on a scale from 1-6. Statements could be: "Patients with lung cancer ought to be ashamed of their disease" and "Patients with breast cancer ought to be ashamed of their disease."

Medscape: And implicit attitudes?

Dr. Schiller: We used the Implicit Association Test, which has been used in the social sciences. Words are flashed on a computer monitor screen, and the participant is asked to associate them as positive or negative by pressing 1 of 2 keys on the keyboard. For example, the participant may be asked to press the letter "E" for a positive word, such as "hope," and the "I" key for a negative word, such as "shame." This all happens rapidly, and the reaction time is measured.

Participants were also shown a series of pictures or drawings about lung cancer or breast cancer, and then were asked to press "E" or "I" depending on whether the words "lung cancer" or "breast cancer" were on the right or left sides of the screen.

Medscape: What did you find?

Dr. Schiller: Participants were very accurate in making classifications, and the reaction times were typically under 1 second per item. However, they found the task easier and had faster reaction times when lung cancer and negative words were mapped to the same "E" key and breast cancer and positive words were mapped to the same "I" key. In contrast, they found the task more difficult and were slower to respond when lung cancer and positive words were mapped to the same key. The differences in reaction times across these conditions were significant, suggesting the presence of unconscious attitudes that associate lung cancer with negative attitudes relative to breast cancer.

The bottom line is that both the explicit and implicit tests revealed much more negative attitudes toward lung cancer than toward breast cancer. For explicit attitudes, about 70% of all participants had a negative attitude about lung cancer, compared with 8% about breast cancer; 22% of participants had neutral attitudes about both cancers.

For implicit attitudes, about 74% had negative attitudes toward lung cancer, 20% against breast cancer, and 16% were neutral. Surprisingly, negative attitudes did not differ among groups.


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