Physical Access Barriers to Care for Diagnosis and Treatment of Breast Cancer Among Women With Mobility Impairments

Abstract

Objective-To explore the perceptions of breast cancer patients with mobility impairments of the physical accessibility of health care equipment and facilities Research Approach-One-to two-hour individual interviews, audiotaped Setting-Interviews in homes or workplaces or by telephoneParticipants-20 women with chronic mobility impairments who developed early-stage breast cancer before age 60; 3 recruited from oncologist panels and 17 from informal networks of disabled women nationwide Methodologic Approach-Qualitative analyses of interview transcripts to identify common themesMain Research Variables-Extent and nature of mobility impairments; concerns raised by interviewees about barriers to careFindings-The 20 participants identified problems with inaccessible equipment, including mammography machines, examining tables, and weight scales. Sometimes women needed to insist on being transferred to an examining table when physicians preferred to examine them seated in their wheelchairs. When staff would transfer them, patients feared injury; patients felt badly when clinical personnel were injured during transfers. Other problems included difficulties with positioning and handling patients' uncontrollable movements. Even when clinical sites had accessible equipment, this equipment was sometimes unavailable when the woman arrived for her appointment.Conclusions-Women with major mobility problems who developed breast cancer confronted numerous physical barriers during the course of their breast cancer diagnosis and treatment.Interpretation-With the aging of "baby boomers," increasing numbers of persons seeking health care services will have mobility impairments. Health care providers should plan proactively to accommodate these patients by considering accessibility whenever they acquire new equipment, renovate older structures, or build new facilities. They should also establish policies and procedures to assure that accessible equipment is available during appointments of people who Most findings relating to mammography and breast cancer care disparities come from large population-based surveys or cancer registry data, without sufficient detail to identify specific causes (Chan et al., 1999;Chevarley et al., 2006;Iezzoni et al., 2000;Iezzoni et al., 2001;Iezzoni et al., 2008; McCarthy, Ngo, Roetzheim, Chirikos, Li, Drews, & Iezzoni, 2006a;Wei et al., 2006). To explore how physical access affects breast cancer diagnosis and treatment experiences, we conducted in-depth, individual interviews with 20 women with chronic mobility impairments who developed early stage breast cancer. Although this study focuses specifically on breast cancer, we identify issues that all clinicians and health care facilities should consider more generally to improve physical access for their patients. Methods Conceptual ModelAs our conceptual model, we used definitions from the International Classification of Functioning, Disability and Health ( Study ParticipantsWe recruited English-speaking women diagnosed with early stage breast ca...

Trends in colorectal cancer screening over time for persons with and without chronic disability

“…12,15 Women with movement difficulties confront obvious barriers to mammography, when women cannot stand and facilities have not accommodated them through wheelchair accessible equipment, specialized mammography chairs, additional technician support, or other adaptations. 12,32 …”

Implications of Mobility Impairment on the Diagnosis and Treatment of Breast Cancer

“…36 These barriers might help explain broader findings about lower mammography use among women with physical disabilities. [6][7][8][9][10][11] Partnerships between patients and clinicians or other staff (radiology technicians) can produce solutions that work, such as assisting with position during mammography and for complete physical examinations.…”

Eliminating Health And Health Care Disparities Among The Growing Population Of People With Disabilities

“…33 Interviews with women with disabilities who had developed early-stage breast cancer found that they frequently confronted physical barriers to care, such as inaccessible examining tables, weight scales, infusion chairs, mammography machines, and radiology equipment. 35,36 For example, a woman who is paraplegic reported that the cancer clinic at a major academic medical center she was referred to did not have a weight scale that was accessible by wheelchair. A woman's weight determines certain chemotherapy dosages.…”