Step 8: Strategies for enabling people living with disability to participate in cancer screening

Barrier

Reflection questions/processes

Improvement ideas/Follow-up actions

Note: Use the Action plan template to implement your ideas

Accessibility:

• The design of buildings and equipment.²⁹
• Access to suitable transport and transport cost.²⁹
• The duration and lack of flexibility of screening appointment times.³⁰
• An absence of trained service/practice staff to support, encourage and assist people living with a disability with screening.³⁰
• Attendance at screening services was considered challenging for some people requiring complex thinking and organisation.³⁰

• Answer and document the questions outlined in table 1 of ‘Fitting disability into practice’ to better understand if your service meets the needs of people who use wheelchairs.
   
• Does your practice provide patients with disabilities any support to access transport to attend your practice and/or screening services?
   
• Does your practice have height adjustable exam tables and equipment?
   
• Reflect on the barriers and engagement strategies to cervical screening for women with disabilities outlined in the Toolkit for engaging under-screened and never-screened women in the National Cervical Screening Program  and on Family Planning’s ‘Just Checking’ website.
   
• Has your team spoken with your local BreastScreen NSW service or read the BreastScreen information for women with disabilities brochure so that you can support people with disability to understand the breast screening process?
   
• Do you ask patients with disability what support they need to complete a bowel cancer screening kit?
   
• Does your clinical team need further training to feel comfortable:
  • communicating effectively and respectfully with people with disability
  • obtaining consent and performing cervical screening tests for people with disability
     
• Does your practice routinely offer patients with disability longer appointment times?
   
• Is the availability of appropriate appointment slots a barrier to access for people with disability within your practice? (Note: Patient feedback may be required.)

Cost:

• 1 in 5 people with a disability delayed or did not see a GP due to cost.²⁹
• Costs associated with screening is an identified barrier to screening for people with disability.³⁰

• Does your practice have a policy or process for ensuring cost is not a barrier to health care for people with disability (e.g. offering bulk billing when appropriate)?

Lack of communication and education:

• Women with disability who participated in research about cancer screening in Northern NSW reported:

• that health professionals did not talk to them about cancer screening
   
• limited knowledge about the reason for and benefits of cancer screening
   
• wanting women with disabilities to be included in screening education programs and campaigns  to improve the personal relevance of screening messages

• False assumptions about people with disabilities sexual orientation and preferences are a barrier to health professionals discussing cervical screening with people with disability.³¹

• Do you know the screening status of people with disability in your practice?
   
• Does your clinical team have the skills they need to discuss cancer screening with patients with communication limitations?
   
• Does your clinical team ask patients with disabilities about their cancer screening history, including cervical screening?
   
• Does your practice display screening promotional materials that feature people with disability? (See Step 3 for links to materials that can be downloaded or ordered for free.)
   
• Is your team familiar with Family Planning’s ‘Just Checking’ website that includes a range of cancer screening educational resources for:
  • people with intellectual disability
  • building the confidence of health professionals to effectively discuss cancer screening with patients with intellectual disability, including through clarification of common misperceptions about sex and sexuality for people with intellectual disabilities?

Sexual abuse and discrimination:

• Women with disabilities’ attitudes towards breast and cervical screening may be impacted by³⁰:

• Previous past experiences of physical and sexual abuse; and
• Negative experiences and contact with the medical profession

• People with disability, especially those with intellectual disability or mental illness, are at high risk of violence perpetrated against them, especially sexual exploitation.³²
   
• 1 in 6 people with disability aged under 65 experienced discrimination by health staff).²⁹

• Does your clinical team have the skills they need to support trauma-informed:
  • provision of cervical screening tests
  • communication about cancer screening?
     
• Is your team familiar with the following:
  • The strategies for engaging with people who have experienced sexual assault outlined in the Toolkit for engaging under-screened and never-screened women in the National Cervical Screening Program.
  • The RACGP’s Abuse and violence – working with our patients in general practice: Section 10.2 People with disabilities (‘The White Book’).
  • The RACGP and National Aboriginal Community Controlled Health Organisation’s (NACCHO) National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, which includes sections on culturally informed and trauma-informed services.

Competing priorities:

• Contact with health professionals is often focused on care and treatment related to specific health issues (rather than preventative actions such as screening)

• Is screening integrated into your health assessments, so it forms part of routine care for patients with disability?

The attitudes of carers and family members may influence some people’s perceptions of the risks of getting breast and cervical cancer and their motivation to participate in screening programs.

• Do you engage family and carers in discussions about the importance of preventative health care, such as cancer screening?