Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2021 May;36(5):1250-1257. doi: 10.1007/s11606-020-06327-7. Epub 2020 Nov 17.
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.
We explored experiences of patients with mobility disability with the process of cancer diagnosis.
Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis.
We interviewed 20 participants with pre-existing 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).
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.
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.
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行动障碍是美国成年人最常见的残疾类型，据估计占美国总人口的 13.7%。与普通人群相比，行动障碍患者的癌症发病率更高，但他们在癌症筛查和治疗方面存在差异。
我们探讨了行动障碍患者在癌症诊断过程中的经历。
采用开放式个体访谈，直至数据饱和。对访谈进行逐字转录，以便进行常规内容分析。
我们采访了 20 名患有预先存在的行动障碍的参与者，这些障碍需要使用辅助设备或需要他人协助才能进行日常生活活动，并且随后被诊断出患有癌症（不包括黑色素瘤）。
关注点集中在五个广泛的类别上：影响癌症诊断过程的医疗诊断设备的不可用性、临床工作人员对适应残疾的态度、将癌症迹象/症状视为对慢性健康状况的情绪反应而不予理会、将癌症迹象/症状错误归因于潜在的残疾、以及对因护理标准不达标而采取法律行动的态度。参与者提供了一些例子，说明临床医生的错误假设和潜在偏见如何干扰了他们的癌症诊断过程，有时导致检查不足和诊断延迟。
身体和态度障碍会影响行动障碍患者的癌症诊断过程。尽管行动障碍患者可能具有临床复杂性，但临床医生应该意识到诊断遮蔽（即将癌症迹象/症状错误归因于潜在的残疾）和其他可能影响癌症诊断及时性和护理质量的错误假设的风险。应考虑进一步努力，包括教育临床医生应对残疾患者的挑战，以改善这一人群的癌症诊断过程。
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