Implicit bias toward cervical cancer: Provider and training differences

Published:February 08, 2019DOI:


      • Gynecologic oncology providers associate cervical cancer with feelings of anger and beliefs related to risk.
      • Nurses demonstrate stronger implicit biases than gynecologic oncologists.
      • Older providers demonstrate greater implicit bias than younger providers.
      • Providers who have completed cultural competency training or implicit bias training demonstrate lower implicit bias.



      Implicit prejudice and stereotyping may exist in health care providers automatically without their awareness. These biases can correlate with outcomes that are consequential for the patient. This study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward cervical cancer.


      Members of professional gynecologic oncology organizations were asked to complete two Implicit Association Tests to determine if they implicitly associate cervical cancer with feelings of anger (prejudice) and beliefs about culpability for the disease (stereotypes), compared to ovarian cancer. Linear models and Student t-tests examined average levels of implicit bias and moderators of the implicit bias effects.


      One-hundred seventy-six (132 female, 43 male, 1 nonresponse; X ¯ age = 39.18 years, SDage = 10.58 years) providers were recruited and the final sample included 151 participants (93 physicians and 58 nurses, X ¯ age = 38.93, SDage = 10.59). Gynecologic oncology providers showed significant levels of implicit prejudice, X ¯  = 0.17, SD = 0.47, 95% CI: (0.10, 0.25), toward cervical cancer patients. They also showed significant levels of implicit stereotyping of cervical cancer patients, X ¯  = 0.15, SD = 0.42, 95% CI: (0.08, 0.21). Whereas physicians did not demonstrate significant levels of implicit bias, nurses demonstrated greater levels of implicit prejudice and implicit stereotyping. Providers without cultural competency/implicit bias training demonstrated greater bias than those who had completed such training (p < .05).


      This study provides the first evidence that gynecologic oncology providers hold implicit biases related to cervical cancer. Interventions may be designed to target specific groups in gynecologic oncology to improve interactions with patients.


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