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Breau G, Thorne S, Baumbusch J, Hislop TG, Kazanjian A. Family physicians' and trainees' experiences regarding cancer screening with patients with intellectual disability: An interpretive description study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:250-265. [PMID: 35189749 PMCID: PMC9941798 DOI: 10.1177/17446295211044041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 06/14/2023]
Abstract
People with intellectual disability receive breast, cervical, and colorectal cancer screening at lower rates relative to the general population, although the reasons for this disparity are largely unknown. Research, both with the general population and specific to people with intellectual disability, has revealed that a family physician's recommendation for cancer screening or continuity of primary care may increase screening rates. We interviewed family physicians and family medicine trainees regarding their experiences recommending cancer screening to patients with intellectual disability. We concluded that the decision to recommend cancer screening is complex, and includes physicians weighing their clinical judgement as to the best provision of care for patients with a patient's eligibility for screening, while continuing to respect patients' autonomy. This patient-physician interaction occurs within the larger medical environment. Further research with experienced family physicians is warranted to better understand this complex phenomenon.
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Affiliation(s)
- Genevieve Breau
- Genevieve Breau, School of Human Sciences,
Faculty of Education, Health & Human Sciences, University of Greenwich,
Dreadnought Building, Room D113, Greenwich Campus, Old Royal Naval College, Park
Row, London SE10 9LS, UK. Emails:
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Shady K, Phillips S, Newman S. Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-13. [PMID: 35669718 PMCID: PMC9148936 DOI: 10.1007/s40489-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00324-8.
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Affiliation(s)
- Kathryn Shady
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Shannon Phillips
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Susan Newman
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
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Walsh S, Hegarty J, Lehane E, Farrell D, Taggart L, Kelly L, Sahm L, Corrigan M, Caples M, Martin AM, Tabirca S, Corrigan MA, O'Mahony M. Determining the need for a breast cancer awareness educational intervention for women with mild/moderate levels of intellectual disability: A qualitative descriptive study. Eur J Cancer Care (Engl) 2022; 31:e13590. [PMID: 35393746 PMCID: PMC9539590 DOI: 10.1111/ecc.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Following a review of the existing body of literature, this study aimed to explore the need for a breast cancer awareness intervention specifically targeted at women with mild/moderate levels of intellectual disability (ID) and provide perspectives on the preferred processes and content underpinning an intervention. METHODS A qualitative, descriptive design using semi-structured, individual (n = 5) and focus group (n = 5) interviews were used to engage with a non-probability, purposive sample of key stakeholders (n = 25) including women with mild/moderate levels of ID, caregivers and healthcare professionals. Data were analysed using qualitative content analysis. RESULTS Findings highlighted that an educational intervention should focus on breast awareness as opposed to breast cancer awareness. Additionally, findings identified that a combined breast awareness and healthy living intervention could be effective. However, the intervention needs to have a multimodal, hands-on, person-centred approach to learning which is underpinned by theory. Furthermore, integrating the caregivers and healthcare professionals into the intervention is recommended. CONCLUSION Findings from this study provide a foundation for developing and implementing a theoretically underpinned, multimodal, breast awareness and healthy living educational intervention for women with mild/moderate levels of ID.
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Affiliation(s)
- Susan Walsh
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Josephine Hegarty
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Elaine Lehane
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Dawn Farrell
- Department of Nursing and Healthcare Sciences, Institute of Technology Tralee, Tralee, Ireland
| | - Laurence Taggart
- Institute of Nursing and Health, Ulster University, Jordanstown, UK
| | - Louise Kelly
- Department of Academic Surgery, Cork Breast Research Centre-Cork University Hospital, Cork, Ireland
| | - Laura Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Maria Caples
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Anne Marie Martin
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
| | - Sabin Tabirca
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Mark A Corrigan
- Department of Academic Surgery, Cork Breast Research Centre-Cork University Hospital, Cork, Ireland
| | - Mairin O'Mahony
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork
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Chan DNS, Law BMH, Au DWH, So WKW, Fan N. A systematic review of the barriers and facilitators influencing the cancer screening behaviour among people with intellectual disabilities. Cancer Epidemiol 2021; 76:102084. [PMID: 34920342 DOI: 10.1016/j.canep.2021.102084] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022]
Abstract
Individuals with intellectual disabilities (ID) may require assistance in accessing healthcare services, including cancer screening. A better understanding of the factors affecting cancer screening utilisation among these individuals is needed for the development of strategies to promote screening uptake in them. This review aimed to explore the facilitators of and barriers to cancer screening utilisation among people with ID. A literature search was conducted using five databases, and an additional snowball search yielded 16 studies for inclusion in the review. Overall, the methodological quality of these studies was good (43-100%). In this review, we noted barriers to screening among individuals with ID, including perceptions of fear, distress, and embarrassment; unpreparedness for screening; negative interactions with healthcare professionals; a lack of knowledge about cancer screening; mobility issues; a high severity of ID; and a lack of ability to provide consent and communicate verbally. Facilitators to screening among these individuals were also identified, including living in a supervised setting, prior use of other healthcare services, being educated about screening via social media, having carers accompany them to screening appointments, and having dual insurance coverage or a higher income. Our review highlights the current needs of individuals with ID undergoing cancer screening. Strategies should be developed to address these needs, such as the provision of training to healthcare professionals on how to conduct screening for people with ID.
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Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Bernard M H Law
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Doreen W H Au
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Ning Fan
- Yan Chai Hospital, Hospital Authority, Hong Kong SAR, China.
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Stirling M, Anderson A, Ouellette-Kuntz H, Hallet J, Shooshtari S, Kelly C, Dawe DE, Kristjanson M, Decker K, Mahar AL. A scoping review documenting cancer outcomes and inequities for adults living with intellectual and/or developmental disabilities. Eur J Oncol Nurs 2021; 54:102011. [PMID: 34517198 DOI: 10.1016/j.ejon.2021.102011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emerging evidence suggests adults with intellectual and/or developmental disabilities (IDD) may be at risk of inequities in cancer experiences and outcomes. Individuals with IDD may experience multiple barriers that could worsen outcomes and experience. These barriers may be connected to features of IDD or the healthcare system overall. Future research and program planning to support adults with IDD and cancer must be informed by evidence that acknowledges potential disparities, underlying determinants, and knowledge deficits. OBJECTIVE We conducted a scoping review to systematically map the evidence describing and comparing cancer-related outcomes along the cancer continuum from risk to mortality for adults with IDD. We identified specific factors observed to influence those outcomes. METHODS We followed the expanded Arksey & O'Malley framework for conducting the scoping review. We searched for literature in PubMed and Embase databases. We abstracted cancer-related data, IDD-related data, and data related to physical and social determinants of health. RESULTS Of the 2796 studies retrieved, 38 were included for review. Most studies focused on screening outcomes and experiences. Studies reported that adults with IDD experienced inequities at various points along the cancer continuum. Numerous social and physical determinants of health influenced the experiences and outcomes of adults with IDD. CONCLUSION This scoping review identified significant gaps in the literature. Of note was the focus on cancer screening and lack of attention to larger systems of oppression that may influence poor cancer experiences and outcomes for adults with IDD. There is strong need to improve both quality and quantity of research in this area.
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Affiliation(s)
- Morgan Stirling
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba, Winnipeg, Canada
| | - Alexandrea Anderson
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - David E Dawe
- CancerCare Manitoba, Winnipeg, Canada; CancerCare Manitoba Research Institute, Winnipeg, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Mark Kristjanson
- CancerCare Manitoba, Winnipeg, Canada; Department of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Kathleen Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba Research Institute, Winnipeg, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba Research Institute, Winnipeg, Canada.
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Walsh S, O'Mahony M, Hegarty J, Farrell D, Taggart L, Kelly L, Sahm L, Corrigan M, Caples M, Martin AM, Tabirca S, Corrigan MA, Lehane E. Defining breast cancer awareness and identifying barriers to breast cancer awareness for women with an intellectual disability: A review of the literature. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 26:1744629521999548. [PMID: 33769130 DOI: 10.1177/1744629521999548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Incidence rates for developing breast cancer are similar for women regardless of intellectual ability. However, women with an intellectual disability present with advanced breast cancers, which often have a poor prognosis. METHOD A structured narrative review of the literature was performed to explore the concepts of breast awareness and breast cancer awareness and subsequently, identify barriers to breast cancer awareness encountered by women with an intellectual disability. RESULTS A total of 22 studies involving people with varying levels of intellectual disability informed this review. The barriers to breast cancer awareness encountered by women with an intellectual disability include: lack of their understanding, the role of the carer and literacy issues. CONCLUSION Identifying the barriers to breast cancer awareness for women with an intellectual disability will help to facilitate breast cancer awareness which has the potential to result in better long-term outcomes through an early diagnosis of breast cancer.
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Affiliation(s)
| | | | | | | | | | - Louise Kelly
- Cork Breast Research Centre-Cork University Hospital, Ireland
| | | | | | | | | | | | - Mark A Corrigan
- Cork Breast Research Centre-Cork University Hospital, Ireland
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Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review. BJGP Open 2020; 4:bjgpopen20X101030. [PMID: 32605913 PMCID: PMC7465578 DOI: 10.3399/bjgpopen20x101030] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 01/14/2023] Open
Abstract
Background Globally, people with intellectual disabilities and/or autism experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower than the general population, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy, and practice. Aim To investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism, or both, and/or their carers, to accessing and utilising primary health care for their physical and mental health needs. Design & setting An integrative review was undertaken, which used systematic review methodology. Method Electronic databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of the studies. Results Sixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The main themes were: training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships, and reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes. Conclusion Adolescents and adults with intellectual disabilities and/or autism experience several barriers to accessing and utilising primary health care. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary health care.
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Byrnes K, Hamilton S, McGeechan GJ, O'Malley C, Mankelow J, Giles EL. Attitudes and perceptions of people with a learning disability, family carers, and paid care workers towards cancer screening programmes in the United Kingdom: A qualitative systematic review and meta-aggregation. Psychooncology 2019; 29:475-484. [PMID: 31834649 DOI: 10.1002/pon.5311] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/11/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Evidence suggests that people with a learning disability (PwLD) are less likely to attend cancer screening than the general population in the United Kingdom. The aim of this systematic review was to identify and synthesise qualitative studies reporting the attitudes and opinions of PwLD, family carers, and paid care workers towards national cancer screening programmes. METHODS Five electronic and two grey literature databases were searched. Fourteen thousand eight hundred forty-six papers were reviewed against predetermined inclusion criteria. Included papers were critically appraised. Findings were synthesised using meta-aggregation. RESULTS Eleven papers met the inclusion criteria, all related to cervical and breast screening. No papers were related to colorectal cancer screening. Findings were clustered into four synthesised findings: (1) supporting women with a learning disability (WwLD) to attend screening, (2) WwLD's awareness of screening and their psychophysical experiences, 3) professional practice barriers including the need for multidisciplinary working and an understanding of the needs of WwLD, and (4) approaches to improve the uptake of cervical and breast cancer screening. The synthesis highlights the significance of WwLD having support to understand the importance of screening to be able to make an informed choice about attending. CONCLUSIONS WwLD may not attend cancer screening due to fear, concerns over pain, and the potential influence of family carers and paid care workers. The review identified practical mechanisms which could help WwLD attend screening. Future research should focus on identifying potential barriers and facilitators as a proactive measure to promote colorectal cancer screening.
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Affiliation(s)
- Kate Byrnes
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health & Life Science, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Jagjit Mankelow
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Emma L Giles
- School of Health & Life Science, Teesside University, Middlesbrough, UK
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Arana-Chicas E, Kioumarsi A, Carroll-Scott A, Massey PM, Klassen AC, Yudell M. Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach. DISABILITY & SOCIETY 2019; 35:1290-1314. [PMID: 34408338 PMCID: PMC8370097 DOI: 10.1080/09687599.2019.1680348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 06/13/2023]
Abstract
Although women with intellectual disabilities have the same breast cancer incidence rate as women without intellectual disabilities, they have fewer mammograms and higher mortality rates. Qualitative inquiry was employed to explore barriers and facilitators to mammography among this population. In-depth qualitative interviews were conducted with 30 women with intellectual disabilities and their caregivers in Philadelphia during 2015-2016. Thematic analysis was conducted using inductive and deductive coding. While results provide further evidence for prior research on barriers to mammography among women with intellectual disabilities (e.g. being unprepared, fear of the exam), this study generated novel barriers such as lack of breast ultrasound awareness, sedation failing to work, and lack of mammogram education in adult day programs, and novel facilitators such as extended family support and positive attitudes. Results support the need to address barriers and promote facilitators to improve the breast cancer screening experience among women with intellectual disabilities.
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Affiliation(s)
- Evelyn Arana-Chicas
- Cancer Disparities Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Avat Kioumarsi
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Amy Carroll-Scott
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Philip M. Massey
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Ann C. Klassen
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Michael Yudell
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
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Bates C, Triantafyllopoulou P. Exploring the impact of mental capacity on breast screening for women with intellectual disabilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:880-888. [PMID: 30565767 DOI: 10.1111/hsc.12704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
This study explores the impact of mental capacity in relation to breast screening for women with intellectual disabilities in the UK. Participation in breast screening is considerably lower for women with intellectual disabilities compared to the general population. Barriers to screening include poor mobility and behavioural difficulties. There is currently no research which primarily explores the relationship between mental capacity and breast screening for this group of individuals. This paper presents the results of a cross-sectional survey of 131 women with intellectual disabilities supported by eight Social Care Providers within England and Wales. The data were collected between January 2017 and July 2017. The current research explores the decision-making process surrounding breast screening, considering the impact of associated risk factors during this process. Participants completed a specifically created survey addressing the aforementioned issues. The results indicated that women who lacked capacity, were less likely to engage in breast screening. It was also demonstrated that the process outlined in the Mental Capacity Act (MCA; 2005) was not always followed; women were not routinely assessed if there were doubts regarding their decision-making ability around breast screening and best interest meetings (BIM) were not always held if the person lacked capacity. In order to be able to generalise the current findings, further research is needed to gain a broader understanding of how professionals make decisions around breast screening for women with intellectual disabilities in case the individuals are unable to decide this independently.
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Williamson HJ, Contreras GM, Rodriguez ES, Smith JM, Perkins EA. Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:227-236. [PMID: 28703641 DOI: 10.1177/1539449217714148] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
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Xu X, McDermott SW, Mann JR, Hardin JW, Deroche CB, Carroll DD, Courtney-Long EA. A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability. Prev Med 2017; 100:167-172. [PMID: 28455223 PMCID: PMC5675015 DOI: 10.1016/j.ypmed.2017.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/04/2017] [Accepted: 04/23/2017] [Indexed: 11/20/2022]
Abstract
Each year in the United States, about 4000 deaths are attributed to cervical cancer, and over 40,000 deaths are attributed to breast cancer (U.S. Cancer Statistics Working Group, 2015). The purpose of this study was to identify predictors of full, partial, and no screening for breast and cervical cancer among women with and without intellectual disability (ID) who are within the age group for screening recommended by the U.S. Preventive Service Task Force (USPSTF), while accounting for changes in recommendations over the study period. Women with ID and an age matched comparison group of women without ID were identified using merged South Carolina Medicaid and Medicare files from 2000 to 2010. The sample consisted of 9406 and 16,806 women for mammography screening and Papanicolaou (Pap) testing adherence, respectively. We estimated multinomial logistic regression models and determined that women with ID were significantly less likely than women without ID to be fully adherent compared to no screening with mammography recommendations (adjusted odds ratio [AOR]: 0.63, 95% confidence interval [CI] 0.55-0.72), and Pap testing recommendations (AOR: 0.17, 95% CI 0.16-0.19). For the 70% of women with ID for whom we had residential information, those who lived in a group home, medical facility, or supervised community living setting were more likely to be fully adherent with both preventive services than those living alone or with family members. For both outcomes, women residing in a supervised nonmedical community living setting had the highest odds of full adherence, adjusting for other covariates.
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Affiliation(s)
- Xinling Xu
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 915 Greene Street, Columbia, SC 29208, United States
| | - Suzanne W McDermott
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 915 Greene Street, Columbia, SC 29208, United States.
| | - Joshua R Mann
- University of Mississippi Medical Center, Department of Preventive Medicine, 2500 North State Street, Jackson, MS 39216, United States
| | - James W Hardin
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 915 Greene Street, Columbia, SC 29208, United States
| | - Chelsea B Deroche
- University of Missouri Columbia, School of Medicine, Biostatistics and Research Design Unit, Health Management and Informatics Office of Medical Research, One Hospital Drive, Columbia, MO 65212, United States
| | - Dianna D Carroll
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, Disability and Health Branch, Atlanta, GA, United States; Commissioned Corps, U.S. Public Health Service, Atlanta, GA, United States
| | - Elizabeth A Courtney-Long
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability, Disability and Health Branch, Atlanta, GA, United States
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Trétarre B, Bourgarel S, Stoebner-Delbarre A, Jacot W, Bessaoud F, Satge D. Breast cancer and screening in persons with an intellectual disability living in institutions in France. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:266-278. [PMID: 27624823 DOI: 10.1111/jir.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening. METHODS Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary. RESULTS In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42-1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4-3.66). This risk was not significantly different from that of the general population (2.4%, 1.0-3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period. CONCLUSIONS The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population.
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Affiliation(s)
- B Trétarre
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - S Bourgarel
- Centre régional d'études, d'actions et d'information sur le handicap (CREAI) PACA et Corse, Marseille, France
| | - A Stoebner-Delbarre
- Institut regional du Cancer de Montpellier, Department of Supportive Care, Montpellier, Languedoc-Roussillon, France
| | - W Jacot
- Institut regional du Cancer de Montpellier, Department of Medical Oncology, Montpellier, Languedoc-Roussillon, France
| | - F Bessaoud
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - D Satge
- Oncodefi, Montpellier, France, and Institut Universitaire de Recherche Clinique de Montpellier (IURC), Montpellier, France
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Crotty G, Doody O. Transcultural care and individuals with an intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2016; 20:386-396. [PMID: 26669608 DOI: 10.1177/1744629515621466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
Abstract
Healthcare delivery today reflects a history of change, which has responded to lifestyle changes, cultural diversity, population needs and expectations. In today's health-care environment it is crucial for health-care professionals to be mindful of cultural factors that affect health. These factors include the intricate interdependent biological, intellectual, psychological, social and spiritual needs of the individuals they work with. However, challenges exists for those who provide healthcare to people with intellectual disability. This article presents the transcultural care challenges for people with intellectual disability, through highlighting the biomedical/sociocultural perspectives of healthcare, communication and inequality experienced by those with intellectual disability. As a population group, people with intellectual disability can often be considered part of a larger culture rather than a culture within itself, and this article endeavours to emphasize that intellectual disability is in itself a coterminous culture. By highlighting intellectual disability as a cultural community within a larger community, requiring a transcultural response to care on several levels health-care professionals can provide culturally compatible care to those with intellectual disability within a transcultural framework to augment a person-centred approach to care.
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15
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Asthma and asthma-related health care utilization among people without disabilities and people with physical disabilities. Disabil Health J 2016; 9:646-54. [PMID: 27302533 DOI: 10.1016/j.dhjo.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/22/2016] [Accepted: 05/12/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous research has shown that people with disabilities have higher rates of some chronic diseases and receive poorer disease-specific care than their counterparts without disabilities. Yet, little is known about the relationship between asthma and disability. OBJECTIVE This study examines whether differences in the prevalence of asthma, asthma flare, and asthma-related measures of health care quality, utilization and cost exist among people with physical limitations (PL) and without any limitations. METHODS Data from the 2004-2010 Medical Expenditure Panel Survey were pooled to compare outcomes for working-age adults (18-64) with PL to those with no limitations. RESULTS People with PL had higher rates of asthma (13.8% vs. 5.9%, p < 0.001) and recent asthma flare (52.6% vs. 39.6%, p < 0.001) than people without limitations. There were no differences in health care quality, utilization or cost between people with PL and people without limitations in multivariate analyses. CONCLUSIONS Although there are no differences in asthma-related quality or utilization of health care, people with PL have poorer asthma control than people without limitations. Research is needed to determine what factors (e.g., focus on other acute ailments, perceptions that asthma control cannot improve) are related to this outcome. Future research must also examine differences in asthma severity, and its impact on asthma control and health care-related outcomes, among people with and without disabilities.
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Sinclair LB, Taft KE, Sloan ML, Stevens AC, Krahn GL. Tools for improving clinical preventive services receipt among women with disabilities of childbearing ages and beyond. Matern Child Health J 2016; 19:1189-201. [PMID: 25359095 DOI: 10.1007/s10995-014-1627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Efforts to improve clinical preventive services (CPS) receipt among women with disabilities are poorly understood and not widely disseminated. The reported results represent a 2-year, Centers for Disease Control and Prevention and Association of Maternal and Child Health Programs partnership to develop a central resource for existing tools that are of potential use to maternal and child health practitioners who work with women with disabilities. Steps included contacting experts in the fields of disability and women's health, searching the Internet to locate examples of existing tools that may facilitate CPS receipt, convening key stakeholders from state and community-based programs to determine their potential use of the tools, and developing an online Toolbox. Nine examples of existing tools were located. The tools focused on facilitating use of the CPS guidelines, monitoring CPS receipt among women with disabilities, improving the accessibility of communities and local transportation, and training clinicians and women with disabilities. Stakeholders affirmed the relevance of these tools to their work and encouraged developing a Toolbox. The Toolbox, launched in May 2013, provides information and links to existing tools and accepts feedback and proposals for additional tools. This Toolbox offers central access to existing tools. Maternal and child health stakeholders and other service providers can better locate, adopt and implement existing tools to facilitate CPS receipt among adolescent girls with disabilities who are transitioning into adult care as well as women with disabilities of childbearing ages and beyond.
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Affiliation(s)
- Lisa B Sinclair
- Disability and Health Branch, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, E-88, Atlanta, GA, 30333, USA,
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Merten JW, Pomeranz JL, King JL, Moorhouse M, Wynn RD. Barriers to cancer screening for people with disabilities: A literature review. Disabil Health J 2015; 8:9-16. [DOI: 10.1016/j.dhjo.2014.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 11/30/2022]
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Ouellette-Kuntz H, Cobigo V, Balogh R, Wilton A, Lunsky Y. The Uptake of Secondary Prevention by Adults with Intellectual and Developmental Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:43-54. [DOI: 10.1111/jar.12133] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- H. Ouellette-Kuntz
- Department of Public Health Sciences; Queen's University; Kingston ON Canada
- Ongwanada; Kingston ON Canada
| | - V. Cobigo
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | - R. Balogh
- University of Ontario Institute of Technology; Toronto ON Canada
| | - A. Wilton
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | - Y. Lunsky
- Centre for Addiction and Mental Health; Toronto ON Canada
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Greenwood NW, Dreyfus D, Wilkinson J. More than just a mammogram: breast cancer screening perspectives of relatives of women with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:444-455. [PMID: 25409131 DOI: 10.1352/1934-9556-52.6.444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.
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20
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Lai HT, Kung PT, Tsai WC. Factors influencing the mammography utilization among Taiwanese women with intellectual disabilities, a nationwide population-based study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3372-3378. [PMID: 25194512 DOI: 10.1016/j.ridd.2014.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/06/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.
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Willis D, Kilbride L, Horsburgh D, Kennedy C. Paid- and family-carers' views on supporting women with intellectual disability through breast screening. Eur J Cancer Care (Engl) 2014; 24:473-82. [DOI: 10.1111/ecc.12245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- D.S. Willis
- Nursing and Health Care, School of Medicine, Veterinary and Life Sciences; University of Glasgow; Glasgow Scotland
| | - L. Kilbride
- Nursing and Community Health, School of Health & Life Sciences; Glasgow Caledonian University; Glasgow Scotland
| | - D. Horsburgh
- School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences; Edinburgh Napier University; Edinburgh Scotland
| | - C.M. Kennedy
- Department of Nursing and Midwifery; University of Limerick; Limerick Ireland
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Wang CT, Greenwood N, White LF, Wilkinson J. Measuring preparedness for mammography in women with intellectual disabilities: a validation study of the Mammography Preparedness Measure. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:212-22. [PMID: 25266546 DOI: 10.1111/jar.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Women with intellectual disabilities have similar breast cancer rates as the general population, but lower rates of regular mammography and higher breast cancer mortality rates. Although prior qualitative work demonstrates that women with intellectual disabilities face unique, disability-specific barriers to mammography, the present authors lack standardized, validated instruments for measuring knowledge of breast cancer screening in this population. In addition, much research related to adults with intellectual disabilities focuses on family or carer perspectives, rather than involving women with intellectual disabilities, themselves. METHODS The present authors first pilot tested a general population instrument measuring breast cancer knowledge, and found that it did not perform adequately in women with intellectual disabilities. In response, the present authors developed the Mammography Preparedness Measure (MPM), a direct short interview tool to measure knowledge and preparedness in women with intellectual disabilities, themselves, rather than relying on caregiver or other reports, and using inclusive methodology. The present authors validated the MPM by assessing test-retest reliability. RESULTS Average test-retest per cent agreement of 84%, ranging from 74 to 91% agreement per item, with an overall kappa of 0.59. CONCLUSION The MPM appears to be a valid instrument appropriate for measuring mammography preparedness in women with intellectual disabilities. The success of this innovative tool suggests that direct, rather than informant-directed tools can be developed to measure health knowledge and cancer screening readiness in adults with intellectual disabilities, an important measure in studying and reducing disparities.
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Affiliation(s)
- Claire Tienwey Wang
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
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23
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Swaine JG, Parish SL, Luken K, Son E, Dickens P. Test of an intervention to improve knowledge of women with intellectual disabilities about cervical and breast cancer screening. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:651-663. [PMID: 23796162 DOI: 10.1111/jir.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is a critical need for evidence-based health education interventions for women with intellectual disabilities (IDs) to promote receipt of preventive health screenings. Previous research has established Women Be Healthy, an 8-week classroom-style intervention designed to teach women with IDs about breast and cervical cancer screenings, as a promising practice. However, additional research is needed to determine how to further improve screening-related knowledge gains. This study aimed to test a modified version of Women Be Healthy, Women Be Healthy 2, and compare its effectiveness in increasing knowledge gains to the original intervention. METHOD Women living in the community across one state in the United States were randomly assigned to a treatment (n = 98), delayed treatment, (n = 35), or no intervention group (n = 65). Women in the treatment group received Women Be Healthy, and women in the delayed treatment group received the modified Women Be Healthy 2. Baseline and post-intervention interviews were conducted to measure knowledge of cervical and breast cancer screening. Knowledge scores were compared across groups. RESULTS Among the nine knowledge items measured, one breast knowledge measure and one cervical knowledge measure showed statistically significant group differences; marginally significant differences were observed for two other knowledge measures. After adjusting for covariates, women who received Women Be Healthy 2 had increased knowledge overall compared with the women receiving no intervention. CONCLUSION Women Be Healthy 2 is promising, but additional efforts appear necessary to increase the knowledge women with IDs have about cervical and breast cancer screening.
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Affiliation(s)
- J G Swaine
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Satgé D, Sauleau EA, Jacot W, Raffi F, Azéma B, Bouyat JC, El Hage Assaf N. Age and stage at diagnosis: a hospital series of 11 women with intellectual disability and breast carcinoma. BMC Cancer 2014; 14:150. [PMID: 24593240 PMCID: PMC3943992 DOI: 10.1186/1471-2407-14-150] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 02/21/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Breast cancer has been poorly studied in women with intellectual disability (ID), which makes designing a policy for screening the nearly 70 million women with ID in the world difficult. As no data is available in the literature, we evaluated breast cancer at diagnosis in women with ID. METHODS Women with ID were searched retrospectively among all women treated for invasive breast cancer in a single hospital over 18 years. Age at diagnosis was compared among the whole group of women. Tumor size, lymph node involvement, SBR grade, TNM classification, and AJCC stage were compared to controls matched for age and period of diagnosis using conditional logistic regression. RESULTS Among 484 women with invasive breast cancer, 11 had ID. The mean age at diagnosis was 55.6 years in women with ID and 62.4 years in the other women. The mean tumor size in women with ID was 3.53 cm, compared to 1.80 cm in 44 random controls from among the 473 women without ID. Lymph node involvement was observed in 9 of the 11 women with ID compared to 12 of the controls (OR = 11.53, p = 0.002), and metastases were found in 3 of the 11 women with ID compared to 1 of the 44 controls (OR = 12.00, p = 0.031). The AJCC stage was higher in women with ID compared to controls (OR = 3.19, p = 0.010). CONCLUSIONS Women with ID presented at an earlier age with tumors of a higher AJCC stage than controls despite no significant differences in tumor grade and histological type. Thus, delayed diagnosis may be responsible for the differences between disabled and non-disabled women.
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Affiliation(s)
- Daniel Satgé
- Epidemiology and Biostatistics department (EA 2415) Oncodéfi project, University Institute for Clinical Research IURC Montpellier 1 University, 641, avenue du Doyen G. Giraud, 34093 Montpellier, France
| | - Eric-André Sauleau
- Biostatistics Department, University of Strasbourg, Faculté de Médecine, 4 rue Kirschleger, 67085 Strasbourg, France
| | - William Jacot
- Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), 208 rue des Apothiaires, Cedex 5, 34298 Montpellier, France
| | - Fernand Raffi
- Obstetrics and Gynecology, Tulle hospital, Place Maschat, 19012 Tulle, France
| | - Bernard Azéma
- CREAI-ORS Languedoc-Roussillon, Q.E. Tournezy 135 allée Sacha Guitry, B.P. 35567 34072 Montpellier, France
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Wee LE, Koh GCH, Auyong LS, Cheong A, Myo TT, Lin J, Lim E, Tan S, Sundaramurthy S, Koh CW, Ramakrishnan P, Aariyapillai-Rajagopal R, Vaidynathan-Selvamuthu H, Ma-Ma K. Screening for cardiovascular disease risk factors at baseline and post intervention among adults with intellectual disabilities in an urbanised Asian society. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:255-268. [PMID: 23279280 DOI: 10.1111/jir.12006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) face significant barriers to screening participation. We determined predictors for regular cardiovascular health screening at baseline among adults with ID in Singapore, and evaluated the effectiveness of a 3-month screening intervention. METHODS The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Over 3 months in 2011, adult clients not screened regularly at baseline for hypertension, diabetes and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose and lipid testing; data on other cardiovascular disease risk factors were also collected. Chi-square and logistic regression identified predictors of regular screening at baseline. RESULTS Participation was 95.0% (227/239). At baseline, among adults with ID, 61.8% (118/191), 24.8% (52/210) and 18.2% (34/187) had gone for regular hypertension, diabetes and dyslipidaemia screening respectively; post intervention, rates rose to 96.9%, 89.5% and 88.8% respectively. Prevalence of cardiovascular disease risk factors (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 10.7% obese and 90.6% lacking regular exercise) was high compared against the general population. While receiving residential services was associated with regular hypertension screening, receiving non-residential services and being independently mobile were associated with regular participation in fasting blood tests (all P < 0.05). CONCLUSION Cardiovascular disease risk factors are common among adults with ID and clinicians should proactively screen such populations. Provision of free and convenient screening for cardiovascular disease risk improved screening participation.
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Affiliation(s)
- L E Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
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Greenwood NW, Wang CT, Bowen D, Wilkinson J. Testing the feasibility of a DVD-based intervention to promote preparedness for mammography in women with intellectual disabilities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:99-105. [PMID: 24197688 PMCID: PMC3946052 DOI: 10.1007/s13187-013-0554-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Women with intellectual disabilities (ID, formerly mental retardation) have a similar breast cancer incidence as the general population, but they have higher breast cancer mortality and lower rates of regular screening mammography. We conducted a feasibility study evaluating acceptability, demand, and limited efficacy of a health education DVD about mammography for women with ID. The DVD was developed in order to address disability-specific barriers to mammography identified in prior studies, such as anxiety related to navigating the logistics of obtaining a mammogram. The DVD was found to be acceptable and feasible, and led to a moderate increase in mammography preparedness in this population. Study results suggest that this DVD-based intervention is an appropriate candidate for further study measuring efficacy and effectiveness in increasing regular mammography in women with ID, a disparity population.
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Affiliation(s)
- Nechama W Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany St., Boston, MA, 02118, USA,
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Reidy M, Denieffe S, Foran S. Cancer screening in women with intellectual disabilities: an Irish perspective. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:51-60. [PMID: 24591427 DOI: 10.1177/1744629514521067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the Republic of Ireland, more than 8000 women with intellectual disabilities (IDs), aged 20 years and over, are registered for service provision. Their health needs challenge preventative health services including breast and cervical cancer screening programmes. This review explores the literature about cancer screening participation rates and issues related to screening for Irish women with IDs. Low cancer screening participation rates are evident in Irish women with IDs; and the women shed light on the barriers they perceive related to the screening experience. These experiences are reflected in the international literature for women with IDs. Further research involving the assessment of the breast and cervical cancer awareness in Irish women with IDs and their participation in cancer screening programmes is recommended. Strategies are required to increase their participation in screening programmes that may lead to the earlier diagnosis with better outcomes.
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Affiliation(s)
- Mary Reidy
- Waterford Institute of Technology, Ireland
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Wilkinson J, Greenwood NW, Wang CT, White LF, Culpepper L. Measuring staff empowerment regarding health care for clients with intellectual disabilities. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2014; 2014:678127. [PMID: 24719760 PMCID: PMC3955629 DOI: 10.1155/2014/678127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 06/03/2023]
Abstract
Background. Women with intellectual disabilities (ID) contract breast cancer at the same rate as the general population but have higher breast cancer mortality and lower rates of breast cancer screening. Many women with ID live in group homes or supported residences where they are cared for by direct support workers. While direct support workers are thought to influence client health, this effect is underresearched, and we lack tools for measuring staff empowerment and perceptions regarding client health. Methods. We developed and validated an instrument, the staff empowerment tool (SET), to measure staff empowerment as related to supporting clients in preventive health. Results. The SET was found to be a reliable instrument for measuring staff activation and empowerment in helping clients access mammography screening. Discussion. Quantifying staff empowerment and perspectives is important in studying and reducing disparities among adults with ID, a vulnerable population. Further research to determine the impact of staff empowerment levels on their clients' health and health care access is suggested. The SET is a valuable tool for measuring the construct of staff empowerment, evaluating interventions, and collecting data regarding variation in staff empowerment.
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Affiliation(s)
- Joanne Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Nechama W. Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
| | - Claire Tienwey Wang
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
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Wilkinson J, Dreyfus D, Bowen D, Bokhour B. Patient and provider views on the use of medical services by women with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:1058-1067. [PMID: 22974084 DOI: 10.1111/j.1365-2788.2012.01606.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) receive primary care in community-based practices and are encouraged to participate in the physician-patient relationship. However, the nature of this participation is not known. METHODS Qualitative data were analysed to obtain perspectives from patients and providers regarding clinic visits. Patient participants were recruited from community organisations, while physician participants were recruited from emails and phone calls to local and regional practices and a national and regional list serve. Analysis methods derived from grounded theory were used. RESULTS Twenty-seven women with ID and 22 family physicians were interviewed. Themes important to both groups included time, how the support worker should be used in the encounter and the nature of the physician-patient relationship. Patients expressed frustration at how little time they spent with their physician, and wished that physicians would speak directly to them instead of to their support worker. Physicians felt that patients with ID took too much time, and said that they preferred communicating with the support worker. The interviews also revealed unconscious biases about people with ID. CONCLUSIONS Patient participation is encouraged for people with ID, but is limited because of both physician and patient factors. Greater awareness of these factors may improve care for patients with ID.
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Affiliation(s)
- J Wilkinson
- Family Medicine, Boston University School of Medicine, Boston, MA, USA Community Health Sciences, Boston University School of Public Health, Boston, MA, USA Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Swaine JG, Parish SL, Luken K. Breast and cervical cancer screening for women with intellectual disabilities. HEALTH & SOCIAL WORK 2013; 38:183-186. [PMID: 24437024 DOI: 10.1093/hsw/hlt012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jamie G Swaine
- School of Social Work, University of North Carolina at Chapel Hill, USA
| | - Susan L Parish
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA
| | - Karen Luken
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, USA
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Cobigo V, Ouellette-Kuntz H, Balogh R, Leung F, Lin E, Lunsky Y. Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:478-488. [PMID: 23506206 DOI: 10.1111/jir.12035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Effective cancer screening must be available for all eligible individuals without discrimination. Lower rates of cervical and breast cancer screening have been reported in certain groups compared with women from the general population, such as women with intellectual and developmental disabilities (IDD). Research on the factors explaining those observed differences is crucial to determine whether practices are unfair and could be improved. The aim of this population-based study was to describe cancer screening utilisation by women with IDD in Ontario, Canada compared with other women in Ontario. The specific objectives were (1) to estimate the rates of cervical and breast cancer screening among eligible women with IDD in Ontario; (2) to compare the rates of cervical and breast cancer screening between eligible women with and without IDD; and (3) to examine if any observed differences between women with and without IDD persist after factors such as age, socio-economic status, rurality and healthcare utilisation are accounted for. METHOD This study draws women with IDD from an entire population, and draws a randomly selected comparison group from the same population. It controls for important confounders in cancer screening within the limitations of the data sources. The study was conducted using health administrative databases and registries in Ontario, Canada. Two cohorts were created: a cohort of all women identified as having an IDD and a cohort consisting of a random sample of 20% of the women without IDD. RESULTS The proportion of women with IDD who are not screened for cervical cancer is nearly twice what it is in the women without IDD, and 1.5 times what it is for mammography. CONCLUSIONS Findings suggest that women with IDD experience inequities in their access to cancer screening. Public health interventions targeting this population should be implemented.
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Affiliation(s)
- V Cobigo
- School of Nursing Sciences, University of East Anglia, Norwich, UK
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Mathers SA, McKenzie GA, Robertson EM. ‘It was daunting’: Experience of women with a diagnosis of breast cancer attending for breast imaging. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Swaine JG, Dababnah S, Parish SL, Luken K. Family caregivers' perspectives on barriers and facilitators of cervical and breast cancer screening for women with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 51:62-73. [PMID: 23360409 DOI: 10.1352/1934-9556-51.01.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Women with intellectual disability do not receive cervical and breast cancer screening at the same number as women without disabilities. Numerous barriers to receipt of screening have been reported by individuals with intellectual disability, paid caregivers, nurses, and other medical professionals. This study utilized semi-structured qualitative interviews to assess barriers to care from the perspective of female familial caregivers (n = 32). Caregivers reported a number of barriers to care including not knowing or not believing the exam was needed for their family member and discomfort during exams. Caregivers also described enablers to screening. The most common response to what enabled the woman with an intellectual disability to receive the exam was preparation prior to the exam. A significant portion of the sample of family caregivers lacked knowledge about the need for cervical and breast cancer screening by women with intellectual disability. Policy recommendations are discussed.
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Kung PT, Tsai WC, Chiou SJ. The assessment of the likelihood of mammography usage with relevant factors among women with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:136-143. [PMID: 22093658 DOI: 10.1016/j.ridd.2011.08.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 05/31/2023]
Abstract
Research that identifies the determinants of low mammography use among disabled people is scant. This study examines the determining factors related to the low usage of mammography among women with disabilities. To identify the barriers that prevent women with disabilities from participating in mammography screening can help authorities conceive feasibly useful strategies for avoiding worse suffering. With women aged between 50 and 69 as subjects, this study was conducted using the database of Ministry of the Interior, Taiwan, in 2008, coupled with information gathered between 2006 and 2008 on preventive health care and medical claim data from the Bureau of Health Promotion and the National Health Research Institutes, respectively. This study examined the factors determining the use of mammography with logistic regression analysis. Only 8.49% of the disabled women used mammographies. When women with disabilities were in higher income level, they were more likely to use mammography for breast cancer screening. Similar findings were found for education levels. Moreover, subjects with a more severe form of disability were less likely to use mammography with ORs of 0.84, 0.63, and 0.52. Disabled women with major organ malfunction, chronic mental illness, or mental retardation had a higher likelihood to use mammography services, whereas women with multiple disabilities had the lowest likelihood of usage. Those with experience using other preventive services showed 1.9 times to 7.54 times (95% CI: 1.82-1.98, 7.15-7.95, respectively) increased likelihood of mammography usage. In summary, mammography usage is relatively different for disabled and nondisabled populations. To mitigate the disparities, we can use community healthcare institutions or public health nurses and social workers to provide related preventive health services through community events to implement integrated cancer screening services.
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Affiliation(s)
- Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City 41354, Taiwan, ROC
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Abstract
BACKGROUND Women with intellectual disabilities have the same rate of breast cancer as other women but are less likely to undergo screening mammography. Characteristics associated with mammography for women with intellectual disabilities in the United States are unknown. METHODS This study was based on a secondary data analysis of the Massachusetts Department of Developmental Services database, comparing women who had a mammogram within 2 years with women who had not on variables related to the ecological model. Bivariate analyses, logistic regression, and assessment of interactions were performed. RESULTS The study sample's (n = 2907) mean age was 54.7 years; 58% lived in 24-hour residential settings, 52% received nursing health coordination, and more than 25% had clinical examination needs (eg, sedation). Residential setting, health coordination, and recent influenza vaccination were all associated with mammography. Having a guardian, higher level of activities of daily living needs, and examination needs (requiring sedation or limited wait time for examinations) were associated with lower rates. Interactions between health coordination and examination needs confirmed the potential of the nurse to ameliorate barriers to mammography. CONCLUSION Several system-level variables were significantly associated with mammography and, in some cases, seemed to ameliorate intrapersonal/behavioral barriers to mammography. Community agencies caring for intellectually disabled women have potential to impact mammography rates by using health coordination.
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Frey JJ. In this issue: Back to basics: talking, listening, and low-tech primary care. Ann Fam Med 2011; 9:98-100. [PMID: 21520678 PMCID: PMC3056854 DOI: 10.1370/afm.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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