Agaronnik Nicole, El-Jawahri Areej, Iezzoni Lisa
Health Policy Research Center-Mongan Institute, Massachusetts General Hospital.
Department of Medicine, Harvard Medical School.
J Disabil Policy Stud. 2022 Jun;33(1):46-54. doi: 10.1177/10442073211010124. Epub 2021 May 10.
More than 30 years since enactment of the Americans with Disabilities Act, people with disability continue to face physical access barriers, notably inaccessible medical diagnostic equipment, in clinical settings. Access barriers affect breast cancer screening and treatment for women with disability.
We used standard diagnosis codes and natural language processing to screen electronic health records (EHRs) in a digital data repository from a large healthcare delivery system for patients with pre-existing mobility disability diagnosed with breast cancer between 2005-2017. We reviewed EHRs of 20 patients, using conventional content analysis to examine breast cancer diagnosis and treatment experiences.
Clinicians noted challenges positioning patients for routine procedures including manual breast exam, screening mammography, and breast biopsies. Given challenges accommodating disability for adjuvant therapies, mastectomy was favored over breast-conserving options despite early stages of diagnosis. Notations contained little information about proactive problem-solving for arranging accommodations.
Notations described physical access barriers for breast cancer detection and treatment, with limited planning for mitigating barriers. Despite 2017 promulgation of federal Standards for Accessible Medical Diagnostic Equipment, implementing these standards requires further rulemaking.
自《美国残疾人法案》颁布30多年来，残疾人在临床环境中仍继续面临身体通行障碍，尤其是医疗诊断设备无法使用的问题。通行障碍影响了残疾女性的乳腺癌筛查和治疗。
我们使用标准诊断代码和自然语言处理技术，在一个大型医疗服务系统的数字数据存储库中筛选2005年至2017年间被诊断患有乳腺癌且已有行动障碍的患者的电子健康记录（EHR）。我们审查了20名患者的电子健康记录，采用传统内容分析法来研究乳腺癌的诊断和治疗经历。
临床医生指出，在进行包括手动乳房检查、乳房X光筛查和乳房活检等常规程序时，让患者摆好体位存在挑战。鉴于辅助治疗在适应残疾方面存在困难，尽管处于诊断早期，乳房切除术还是比保乳手术更受青睐。记录中几乎没有关于积极解决安排便利设施问题的信息。
记录描述了乳腺癌检测和治疗中的身体通行障碍，减轻这些障碍的规划有限。尽管2017年颁布了联邦《无障碍医疗诊断设备标准》，但实施这些标准还需要进一步制定规则。
