Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer

Abstract

BACKGROUND: Mobility disability is the most common disability among adult Americans, estimated at 13.7% of the US population. Cancer prevalence is higher among people with mobility disability compared with the general population, yet people with disability experience disparities in cancer screening and treatment. OBJECTIVE: We explored experiences of patients with mobility disability with the process of cancer diagnosis. DESIGN: Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis. PARTICIPANTS: We interviewed 20 participants with preexisting mobility disability that required the use of an assistive device or assistance with performance of activities of daily living and who were subsequently diagnosed with cancer (excluding melanoma). KEY RESULTS: Concerns coalesced around five broad categories: inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis, attitudes of clinical staff about accommodating disability, dismissal of cancer signs/symptoms as emotional responses to chronic health conditions, misattributing cancer signs/ symptoms to underlying disability, and attitudes about pursuing legal action for substandard care. Participants provided examples of how erroneous assumptions and potentially biased attitudes among clinicians interfered with the process of their cancer diagnosis, sometimes contributing to an insufficient workup and diagnostic delays. CONCLUSIONS: Physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. Though people with mobility disability may be clinically complex, clinicians should be aware of the risks of diagnostic overshadowing (i.e., the misattribution of cancer signs/symptoms to underlying disability) and other erroneous assumptions that may affect timeliness of cancer diagnosis and quality of care. Further efforts, including educating clinicians about challenges in caring for persons with disability, should be considered to improve the process of cancer diagnosis for this population.

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses

“…The term then took on the meaning of physical illness misattributed to comorbid mental illness. The term now appears in descriptions of the misdiagnosis of one physical malady as being caused by a different, already diagnosed physical illness (Agaronnik et al 2021;Barnett et al 2021;Chhugani et al 2021;Iezzoni 2019). Further developments may occur if diagnostic overshadowing achieves wider recognition within the realm of healthcare biases (Hinde et al 2021;Jamieson & Mason 2019;Molloy et al 2021a,b).…”

“…The term has since evolved to encompass misattribution of one undiagnosed mental illness to an already diagnosed, comorbid mental illness (Becker-Haimes et al 2021;Kaufman & Baucom 2014). More recently, diagnostic overshadowing has been used to describe symptoms of undiagnosed physical illness attributed to comorbid physical ailments (Agaronnik et al 2021;Barnett et al 2021;Chhugani et al 2021;Iezzoni 2019).…”

Social Work Leadership for Patient Safety

“…It is not only people with mental illnesses who experience diagnostic overshadowing. Evidence of the negative impact of diagnostic overshadowing has been identified, for example, in patients with schizophrenia [46], people with intellectual disabilities [47], people with learning disabilities [48], with physical disabilities [49], children and young people including children with Down's Syndrome [50,51] and with autism [52].…”

Cancer Disparities Experienced by People with Disabilities

“…Not only do people with disabilities experience barriers to screening services, but they also experience barriers to receiving an early cancer diagnosis which impacts chances of long-term survival [ 47 ]. In addition to experiencing transportation barriers and inaccessible facilities and diagnostic equipment, people with disabilities often encounter providers who fail to acknowledge their disability-related needs and provide disability-related accommodations; disregard cancer signs and symptoms as emotional responses to a chronic health condition; and erroneously attribute physical signs and symptoms of cancer to the underlying disability [ 48 , 49 ]. The barriers to accessing healthcare are exacerbated in a rural context [ 50 ].…”