From the Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts (NDA, LII); Department of Medicine, Harvard Medical School, Boston, Massachusetts (AE-J, LII); Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts (AE-J); Departments of Medical Education, and Neurology and Rehabilitation, University of Illinois College of Medicine, Champaign, Illinois (KK); and Department of Disability and Human Development, College of Allied Health Sciences, University of Illinois, Chicago, Illinois (KK).
Am J Phys Med Rehabil. 2021 Feb 1;100(2):113-119. doi: 10.1097/PHM.0000000000001622.
We explored the process of cancer care for patients with preexisting mobility disability, focusing on treatment decisions and experiences.
We recruited 20 participants with preexisting mobility disability, requiring use of an assistive device or assistance with activities of daily living, subsequently diagnosed with cancer (excluding skin cancers). We conducted open-ended individual interviews, which reached data saturation and were transcribed verbatim for conventional content analysis.
Concerns coalesced around 4 themes: disability-related healthcare experiences affect cancer treatment decisions; concerns about cancer treatment worsening functional impairments; access barriers; and limited provider awareness and biases about treating people with disability. Residual fear from previous medical interventions and concerns about exacerbating functional impairments influenced cancer treatment preferences. Participants also raised concerns that their underlying disability may be used to justify less aggressive treatment. Nevertheless, cancer treatment did exacerbate mobility difficulties for some participants. Inaccessible hospital rooms, lack of accessible medical equipment, and attitudinal barriers complicated treatments.
People with preexisting mobility disability experience barriers to cancer treatment, compromising quality of care and potentially outcomes. Further training and proactive planning for accommodating disability during cancer treatment and rehabilitation are warranted.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of the article, the reader should be able to: (1) Recognize inadequate accommodations that compromise the diagnosis and treatment of a new cancer in patients with preexisting disability; (2) Recommend involving rehabilitation specialists in the process of care and clinical decision making from the time of cancer diagnosis for patients with preexisting disability newly diagnosed with malignancy; and (3) In the setting of accessibility barriers, facilitate efforts to accommodate patients with preexisting disability to improve quality of care in diagnosing and treating cancer.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
我们探讨了患有预先存在的行动障碍的患者的癌症治疗过程，重点关注治疗决策和体验。
我们招募了 20 名患有预先存在的行动障碍的参与者，这些参与者需要使用辅助设备或日常生活活动的帮助，随后被诊断出患有癌症（不包括皮肤癌）。我们进行了开放式个人访谈，这些访谈达到了数据饱和，并逐字转录进行了常规内容分析。
关注点集中在 4 个主题上：与残疾相关的医疗保健经验会影响癌症治疗决策；担心癌症治疗会恶化功能障碍；获得障碍；以及提供者对治疗残疾患者的认识和偏见有限。以前的医疗干预产生的残余恐惧和对功能障碍恶化的担忧影响了癌症治疗偏好。参与者还担心他们的潜在残疾可能被用来证明治疗不那么激进是合理的。然而，癌症治疗确实使一些参与者的行动能力恶化。无法进入的医院病房、缺乏无障碍医疗设备以及态度障碍使治疗变得复杂。
患有预先存在的行动障碍的人在接受癌症治疗方面面临障碍，这会影响护理质量并可能影响治疗结果。在癌症治疗和康复期间，需要进一步培训并积极规划以适应残疾。
索取 CME 学分：在 http://www.physiatry.org/JournalCME 上完成自我评估活动和评估。
CME 目标：完成文章后，读者应该能够：（1）识别出不充分的适应措施，这些措施会影响患有预先存在的残疾的新癌症患者的诊断和治疗；（2）建议在新诊断出患有恶性肿瘤的预先存在残疾的患者的护理过程和临床决策中，让康复专家参与进来；（3）在存在无障碍障碍的情况下，促进为患有预先存在的残疾的患者提供便利，以改善诊断和治疗癌症的护理质量。
高级。
学术物理治疗医师协会由继续医学教育认证委员会认可，可为医师提供继续医学教育。学术物理治疗医师协会将这项基于期刊的 CME 活动指定为最多 1.0 个 AMA PRA 类别 1 学分。医师应仅声明与其参与活动的程度相符的学分。
