Use of Screening and Preventive Services Among Women With Disabilities

Iezzoni, Lisa I.; McCarthy, Ellen P.; Davis, Roger B.; Harris-David, L; O’Day, Bonnie

doi:10.1177/106286060101600405

Cited by 169 publications

(109 citation statements)

References 25 publications

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“…1 With regards to chronic disability, research has shown that women with major lower extremity mobility difficulties are less likely to receive Pap tests. 36 We could not ascertain this distinction with the NHIS data.…”

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confidence: 85%

Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

et al. 2008

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BACKGROUND: Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy. OBJECTIVE:To examine national trends in the association between cervical cancer screening and age, health and hysterectomy status. DESIGN AND PARTICIPANTS:Cross-sectional data from the 1993, 1998, 2000, and 2005 National Health Interview Surveys (NHIS) were used to examine trends in screening for women age 35-64 and 65+ years of age. We investigated whether health is associated with Pap testing among older women using the 2005 NHIS (N= 3,073). We excluded women with a history of cervical cancer or who had their last Pap because of a problem. MEASUREMENTS:The dependent variable was having a Pap test within the past 3 years. Independent variables included three measures of respondent health (the Charlson comorbidity index (CCI), general health status and having a chronic disability), hysterectomy status and sociodemographic factors.MAIN RESULTS: NHIS data showed a consistent pattern of lower Pap use among older women (65+) compared to younger women regardless of hysterectomy status. Screening also was lower among older women who reported being in fair/poor health, having a chronic disability, or a higher CCI score (4+). Multivariate models showed that over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap. CONCLUSIONS:Though age, health and hysterectomy status appear to influence Pap test use, current national data suggest that there still may be overutilization and inappropriate screening of older women.

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confidence: 85%

Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

et al. 2008

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“…The use of screening among disabled women may depend on the type and severity of the disability, which is discussed in greater detail by Iezzoni et al in an analysis of 1994 -1995 NHIS data. 19 Education gradients for women are found in the use of mammography and Pap tests. Some of the factors that limit analysis of these data over time are inherent in research and in the medical care system.…”

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confidence: 99%

Progress in cancer screening practices in the United States

Swan

Breen

Coates

et al. 2003

Cancer

685

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BACKGROUNDUnderstanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys.METHODSData from the 2000 NHIS and earlier surveys were analyzed to discern patterns and trends in cancer screening practices, including Pap tests, mammography, prostate specific antigen (PSA) screening, and colorectal screening. The data are reported for population subgroups that were defined by a number of demographic and socioeconomic characteristics.RESULTSWomen who were least likely to have had a mammogram within the last 2 years were those with no usual source of health care (61%), women with no health insurance (67%), and women who immigrated to the United States within the last 10 years (61%). Results for Pap tests within the last 3 years were similar. Among both men and women, those least likely to have had a fecal occult blood test or endoscopy within the recommended screening interval had no usual source of care (14% for men and 18% for women), no health insurance (20% for men and 18% for women), or were recent immigrants (20% for men and 18% for women). An analysis of changes in test use since the 1987 survey indicates that the disparities are widening among groups with no usual source of care.CONCLUSIONSNo striking improvements have been observed for the groups with greatest need. Although screening use for most groups has increased since 1987, major disparities remain. Some groups, notably individuals with no usual source of care and the uninsured are falling further behind; and, according to the 2000 data, recent immigrants also experience a significant gap in screening utilization. More attention is needed to overcome screening barriers for these groups if the population benefits of cancer screening are to be achieved. Cancer 2003;97:1528–40. Published 2003 by the American Cancer Society.DOI 10.1002/cncr.11208

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“…1 Emotional distress and fear of pain are cited as reasons for reduced adherence to cervical screening especially among adolescents, 2 racial/ethnic [3][4][5] and sexual minority groups, 6 obese women, 7 victims of sexual assault and other trauma, 8 and women with disabilities. 9 Therefore, examination should be limited to components with proven utility and should be performed with cultural sensitivity and procedural excellence, especially in clinical situations that require particular finesse. Accordingly, we review the clinical evidence as it exists, and in areas that lack evidence offer our own experience to optimize technical aspects of speculum choice and insertion, and suggest strategies to manage challenging circumstances.…”

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confidence: 99%

The Challenging Pelvic Examination

2011

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While there is a large body of evidence on the effectiveness of Pap smears for cervical cancer screening and on screening for cervical gonorrhea and Chlamydia, there is sparse evidence to support other portions of the pelvic examination and little guidance on examination logistics. Maximizing comfort should be the goal; lubrication use and careful speculum selection and insertion can ease this intrusive procedure. This is particularly important in adolescent and menopausal women, sexual minorities, obese women, women with disabilities, and women with a history of trauma or prior instrumentation affecting the genitalia. We review the evidence and provide guidance to minimize physical and psychological discomfort with pelvic examination. P elvic examinations are performed to evaluate pain, bleeding, and vaginal discharge and to screen for cervical cancer and sexually transmitted infections. Little attention has focused on the mechanics of pelvic examination technique, yet the examination is an intrusive experience for many women who feel exposed and lack control. 1 Emotional distress and fear of pain are cited as reasons for reduced adherence to cervical screening especially among adolescents, 2 racial/ethnic 3-5 and sexual minority groups, 6 obese women, 7 victims of sexual assault and other trauma, 8 and women with disabilities. 9 Therefore, examination should be limited to components with proven utility and should be performed with cultural sensitivity and procedural excellence, especially in clinical situations that require particular finesse. Accordingly, we review the clinical evidence as it exists, and in areas that lack evidence offer our own experience to optimize technical aspects of speculum choice and insertion, and suggest strategies to manage challenging circumstances. When recommendations are not referenced, we are relating our experience in the absence of evidence. Bimanual examination is not useful as a screening test for ovarian cancer because of limited sensitivity and specificity. In one study, ovaries were palpable in 55% of women under 200 lbs during examination under anesthesia, but in only 9% of women over 200 lbs. 14 In another study under similar circumstances, uterine size and contour were correctly assessed in over 50% of patients; however, sensitivity of examination for adnexal masses of 5 cm or greater was only 28% among attending gynecologists and 16% among gynecology residents. 15 The USPFTF acknowledges poor performance characteristics of the bimanual examination in its recommendation about screening for ovarian cancer. 11 In the non-screening setting, bimanual examination is inadequate to evaluate acute abdominal pain or vaginal bleeding, 16 since ultrasound is so much more sensitive and specific. COMPONENTS OF THE FEMALE PELVIC EXAMINATIONThe most evidence-based approach would therefore suggest Pap smear collection alone and the speculum examination required to achieve that goal. We suggest that bimanual and sometimes rectovaginal examinations may be important in evaluating pelvi...

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Use of Screening and Preventive Services Among Women With Disabilities

Cited by 169 publications

References 25 publications

Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

Progress in cancer screening practices in the United States

The Challenging Pelvic Examination

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