Cancer Disparities Experienced by People with Disabilities

Differences in HPV Vaccine Information Usefulness and Understanding Between Parents With and Without a Child with Special Healthcare Needs

INTRODUCTION

Youth HPV vaccination rates have yet to reach the national goal of 80 percent. One understudied population with respect to the HPV vaccine is youth with special healthcare needs. This study seeks to understand differences in HPV vaccine health information preferences and ratings of narrative content of parents with children with special healthcare needs to inform future communication efforts to improve HPV vaccine rates.

METHODS

A national sample of U.S. parents and caregivers (N = 512) were recruited through Qualtrics panels. Parents completed a survey about their oldest child aged 9-14. Parents who answered yes to "Does this child need or use more medical, mental health, or education services than most children who are the same age?" were classified as having an index child with special healthcare needs. The survey also measured social media use and information seeking, narrative engagement, and perceptions of usefulness and understanding of vaccine messages.

RESULTS

Fifteen percent (N = 77) of parents indicated that their index child had special healthcare needs. These parents were more likely to have a male index child, report social media as a first source of health information, and report greater understanding of HPV vaccine information presented in the stimulus materials. There were no differences for most demographics, social media use, HPV vaccine information source, and perceived usefulness of the HPV vaccine information.

CONCLUSION

Overall, parents in this sample with and without an index child with special healthcare needs are similar in terms of how useful they found the materials. Parents with children who have special healthcare needs may have a greater preference for accessing information on social media, and may be better able to understand narrative health messages.

Exploring Intersectionality in the Medical Care of a Latino Child With Autism

Felix is a boy aged 10 years with autism and attention-deficit/hyperactivity disorder who presents to the pediatric emergency department for acute behavior change, including decreased interactivity, decreased speech, bruxism, and new urinary incontinence. He is admitted during the weekend, and scheduling of magnetic resonance imaging is delayed. Eventually, he has a computed tomography scan of his head, which shows an abnormal diffuse hypodensity involving the frontal lobe with extension into the cortex, all concerning for ischemia, and he is ultimately diagnosed with Moyamoya disease complicated by stroke. Felix and his family self-identify as Latino and Black and prefer to use a language other than English for medical discussions. Through this case, we (1) reflect on the barriers to clinical care faced by patients with autism; (2) define intersectionality and explore how neurodivergence, race, ethnicity, and parental-provider language discordance can augment and inhibit the provision of equitable care; and (3) discuss strategies that may mitigate the impact of oppression on clinical care.

Why Cancer Care Systems are Insufficient for People with Disabilities? A Middle Eastern Perspective

BACKGROUND

Cancer care systems in the Middle East face significant challenges, with people with disabilities experiencing compounded barriers to accessing equitable care, leading to suboptimal outcomes for this vulnerable population. Despite advancements in oncology, the unique needs of this population remain insufficiently addressed within the region's healthcare systems. We discuss the present drawbacks and challenges in the Middle Eastern cancer care systems for people with disability, providing practical recommendations to improve the quality of care for this vulnerable population.

METHODS

Based on the current literature, policy documents, and expert opinions, a critical discussion is presented in this article, adopting a conceptual framework from the Model of Healthcare Disparities and Disability.

RESULTS

Key findings were categorized into environmental factors, personal factors, and healthcare access issues. Widespread inadequacies in healthcare accessibility were recorded, including physical barriers in healthcare infrastructure, limited availability of disability-sensitive services, and lack of training in disability-sensitive care for healthcare professionals in region's most countries. Personal factors, such as low health literacy and sociocultural stigmas surrounding both disability and cancer further affect access to care, probably more significantly in women. Environmental factors, such as financial difficulties, compounded by the lack of targeted subsidies for cancer patients with disabilities, double the burden from policy and data gaps, preventing effective implementation of inclusive healthcare strategies.

CONCLUSIONS

Addressing barriers to cancer care for people with disabilities in the Middle East requires a coordinated, multisectoral approach. Recommendations include policy reforms to enforce accessibility standards, investments in inclusive infrastructure, expansion of financial support mechanisms, and integration of disability-sensitive training into medical education.

IMPLICATIONS FOR NURSING PRACTICE

To provide equitable cancer care, nurses must adopt a disability-sensitive approach emphasizing personalized, compassionate, and culturally aware practices. This requires specialized training in understanding the unique needs of patients with physical, sensory, or cognitive impairments, as well as the integration of assistive technologies and effective communication strategies into daily care routines. Nurses should also advocate for accessibility within healthcare institutions of the Middle East, identifying and addressing structural gaps affecting access to care for patients with disabilities.

From the 4Ms to a Disability-Friendly Healthcare System

There are approximately 3,922 Age-Friendly Health Systems (AFHS) sites in the United States. These systems promote better healthcare for adults aged 65 and older by implementing the following 4 elements, referred to as the "4Ms," into care provision: (1) what matters; (2) medication; (3) mentation; and (4) mobility. There are no equivalent parameters to ensure high-quality care for adults with disabilities. This is problematic because many individuals with disabilities experience conditions associated with aging well before their 65th birthday. For example, adults with Down syndrome are more likely to develop earlier-onset dementia and many will be diagnosed with Alzheimer's disease in their early 50s. While AFHS are of critical importance, by focusing solely on adults over age 65, we are missing an opportunity to improve the health and well-being of people with disabilities. Many adults living with disabilities would likely benefit from providers deliberately and thoughtfully addressing what matters, medication, mentation, and mobility. In this paper, we posit that implementing the 4Ms framework with younger adults with disabilities has the potential to both enhance compliance with the Americans with Disabilities Act and lay the groundwork for making an equitable, disability-friendly health system a reality.

An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities

AIM(S)

To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities.

DESIGN

Discussion paper.

METHODS

We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health.

DATA SOURCES

We conducted a systematic review of literature published from 2001 to 2024 in four databases.

RESULTS

Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes.

CONCLUSION

The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women.

IMPLICATIONS FOR NURSING

Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps.

IMPACT

The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.

Stakeholder Perceptions of the School Vaccination Program in Special Schools for Adolescents With Intellectual and Developmental Disability

BACKGROUND

Adolescents with intellectual and developmental disability (IDD) are reported to have lower uptake of routine vaccines than their peers. Little research has explored stakeholders' perceptions and support of school-based vaccinations for this population in NSW, Australia.

METHODS

Focus groups and interviews were conducted with four stakeholder groups involved in the vaccination program in special education schools in New South Wales, Australia: students with IDD, parents, education staff, and health professionals.

RESULTS

Stakeholders mostly supported vaccinating adolescents with IDD in school settings. Students valued the familiar environment and emotional support from teachers. Parents appreciated the convenience and accessibility of the program. Education staff regarded vaccinations as vital for student health and mostly supported school-based delivery but faced practical and ethical challenges, such as insufficient resourcing, confusion around holding students for safety and emotional support, and concerns about losing students' trust in the school as a safe environment if vaccination was experienced as traumatic. Health staff identified a need for better prevaccination communication with families and schools to improve vaccine uptake and student preparation.

CONCLUSION

Findings highlight a need for increased support for special schools that act as key program facilitators between those who deliver and those who receive this vital health service.

Population-based cancer screening access needs of disabled people: A qualitative evidence synthesis

BACKGROUND

Cancer is one of the most common causes of mortality among disabled people, and population-based screening is an effective method to identify some cancers early; however, its uptake is lower among the disabled population. There is a lack of evidence regarding why they access less, and their need to access population-based screening programmes.

AIM

To synthesise evidence of the experience of accessing population-based screening programmes for disabled people.

METHOD

A qualitative evidence synthesis (QES) was carried out by searching electronic databases including Medline, CINAHL, Web of Science Core Collection, and Scopus. Grey literature was also searched for. The search yielded 32 relevant publications.

RESULTS

The findings are based on Levesque's conceptual framework. Several factors affect the accessibility of screening services, including people's perceptions, family support, affordability, literacy, and accessibility.

CONCLUSION

Screening services need to acknowledge the needs of disabled people and integrate reasonable accommodations to facilitate their needs.

Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey

Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

BACKGROUND

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research.

METHODS

Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460.

RESULTS

Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities.

CONCLUSIONS

Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.