Abstract
Studies were carried out with Doctors, Nurses, members of the public and cancer patients. In the first set of studies it was discovered that there is very little difference between doctors and nurses in the way they conceptualize disease, and in their classification "schema" of illnesses. Using an open-ended multiple sorting procedure with two groups of doctors and three groups of nurses it was found that categorizations were mostly based on the criterion of prognosis and expected outcome for the different illnesses. Results showed a common pattern, revealing a general order across professionals' conceptions of different diseases, from the least serious to the most serious. All five groups of professionals were found to differentiate cancerous diseases from other illnesses. Also nurses and doctors perceive every single cancer as being very serious with very bad prognosis and with an expected outcome of death. The results from this investigation support the idea that cancerous disease has maintained some unique associations which differentiate it from other diseases of equal seriousness and uncertainty (e.g. - multiple sclerosis which is untreatable and lethal, and myocardial infraction which is quite uncertain in terms of prognosis). Thus cancer as a concept per se is treated by the experts in a totally different way from other illnesses and the existing attitudes towards this "concept" are thought to be almost the same as those that would be towards a "doomed", and "cursed" case. Based on the fact that the information passed on to the lay population relies mostly on the professionals who establish a general framework on which the non-experts organise their general conceptual schema, it was hypothesised that lay perceptions would probably emerge as being in line with the experts attitudes and beliefs. Also the relative weights of the criteria used by the medical staff for differentiating diseases into groups could have a strong relationship to the way people think and classify different illnesses within their own "conceptual schemata". The objective of the second phase of research was to identify the role and the power assigned to different aspects of disease by laymen. The construction of the scenaria which then served as the main tool for this investigation was based on the idea of facet approach. Five facets were chosen from the ones used by the experts to classify diseases (criteria) considered as the most representative and complete set to describe the universe of content being described. The structuples of these five facets were used to construct a questionnaire which was then administered to a random sample of the lay population of Athens. The facets were (A) Disease specification which had the elements of being or not a cancerous disease (B) Seriousness, the elements of which were, "being" or "not" serious. The same elements were used for facet (C) Treatability and (E) Pain. There was also facet (D) "Quality of life" which had an element of good quality and an element of bad quality. The structuples were in the form of short "cases" of different patients and the respondents had to rate each of these "cases" on five different scales. The results of this study shed light on the research question as to whether different aspects of the concept of disease have different "weight" and value in the minds of the nonexperts and consequently to the formation of their attitudes and beliefs towards the different illnesses. The results revealed that facet (A) which was the specification of disease as being cancer or not cancer had the greatest power of all, followed by facet (C) treatability, which proved to be the second most important aspect of the illness in the minds of the people. A subsequent study explored the concept of disease and medicine in general from another point of view, the focus being on words and the associations that different words, like names of diseases have for people. The respondents were asked to write next to each word appearing in the questionnaire administered to them anything that came into their minds when they saw or heard that word. Surprisingly enough the results revealed that the word "cancer" and the words "cancer patient" had similar associations. On the other hand the words that laymen associated with other illnesses and patients included in the questionnaire were distinct. This confirmed again the general hypothesis that cancer is a concept that elicits an immediate emotional response which differentiates it from all other diseases, extending this perception to the patients who suffer from it. (Abstract shortened by ProQuest.).