Examining an Intervention to Reduce Under-diagnosis of Cad for Older Women

Open Access
Author:
Zawadzki, Matthew Jason
Graduate Program:
Psychology
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
May 15, 2012
Committee Members:
  • Stephanie A Shields, Dissertation Advisor
  • Karen Gasper, Committee Member
  • William Gerin, Committee Member
  • Nancy Anne Coulter Dennis, Committee Member
  • Susan Merrill Squier, Committee Member
Keywords:
  • Coronary Artery Disease
  • Emotion
  • Stereotypes
  • Under-diagnosis
Abstract:
Women are under-diagnosed for coronary artery disease (CAD) compared to men; the reasons for under-diagnosis are unclear. Diagnosing CAD may foster stereotype usage because presenting symptoms of CAD can be ambiguous and physicians are under time constraints to make diagnoses. I propose that stereotypes about women being portrayed as more emotional than men, and that women’s emotions reflects a dispositional attribute rather than a contextual factor, influence how a physician perceives and diagnoses a female patient. Furthermore, I propose that acknowledging and contextualizing one’s emotions, through a process called skilled self-labeling (SSL), can disrupt this bias. To test these predictions, I showed medical students and residents a video vignette of a standardized patient presenting with CAD and asked participants to diagnose the patient. The patient was either female or male, and presented CAD with either no emotion, with anxiety that was ignored, or with anxiety and SSL. Confirming predictions, only women were affected by the anxious display; specifically, while women in the no emotion condition were diagnosed similarly to men, women who ignored their anxiety were under-diagnosed. Using SSL eliminated this under-diagnosis effect. Results suggest emotion stereotypes as a mechanism for why under-diagnosis of CAD occurs for women, and offers patients SSL as a means of empowerment so as to interrupt these stereotypes and help physicians provide more accurate diagnoses. Furthermore, these results inform future research concerning the development of interventions, translating feminist social psychological work to the health domain, and improving health care for older adults.