Working with patients who face specific barriers

People with disability 

Find information and resources on how to engage patients with disability in cervical screening.

Resources

For patients

You can provide these resources to patients to help them before, during and post screening. See the full resource library.

Before screening appointment

During screening appointment

Post screening appointment

For healthcare providers

Working with people with intellectual disabilities in healthcare settings discusses barriers and strategies for providing good healthcare. It includes information on attitude, communication, working with carers and for providing proactive healthcare.

Considerations

People with disability are less likely to participate in cervical screening. Barriers to participation are often related to the accessibility of health services, healthcare providers’ perceptions of the priority of cervical screening for people with disabilities and reliance on carers.

Barriers

There are general barriers that people face in participating in cervical screening. People with disabilities can face extra barriers relating to:

  • assumptions from the healthcare provider, caregiver or family that screening is unnecessary because people with a disability are not sexually active or had any sexual contact
  • assumptions that people with disabilities, particularly intellectual disabilities, may not be able to tolerate the test.
  • lack of suitable screening equipment such as adjustable beds and hoists
  • inaccessible transport and cervical screening facilities
  • short appointment times – additional time is often needed for a healthcare provider to support people to understand and undertake the procedure
  • capacity to provide informed consent
  • availability of accessible, plain English information and resources in other formats (e.g. video and audio),including invitation and recall/reminder letters.
  • low awareness or comprehension of the importance and benefits of cancer screening
  • fear of stigma if people disclose their sexual history.
  • fear or embarrassment of the test
  • history of sexual assault
  • lack of training or knowledge of the health care provider on people with disabilities and how to provide appropriate support
  • low awareness of the caregivers and family on the importance and benefits of cancer screening for people with disabilities.
  • physical, sensory and communication barriers
  • healthcare providers prioritising a patient’s disability needs and healthcare concerns over preventative health measures
  • reliance on family and carers when going to medical appointments
  • the Cervical Screening Test being painful and traumatic for some people due to their disability
  • bad experiences with healthcare providers in the past.

Ways to engage

Strategy

Detail

Staff training
  • Encourage staff to complete education and training to raise awareness of the importance of cervical screening (and collection options available) for people with disabilities and develop effective communication skills.

Appropriate communication
  • Offer self-collection as a more comfortable and acceptable screening option.
  • Let the patient know you can help them collect a vaginal sample if they have difficulty or are not confident collecting the sample themselves or you can collect the sample of their behalf using a self-collection swab without using a speculum.
  • Make materials available with information designed for people with disabilities (i.e. plain English, Braille, diagrams, large-print materials, videos). This should include invitations and recall/reminder letters and materials in the waiting room.
  • Use a modified communication style appropriate for each patient (i.e. using clear, short, direct language).
  • Build rapport and trust. Allow time to support patients to understand and undertake the procedure (e.g. allow the patient to visit the clinic before the appointment to view the rooms, see the equipment and ask questions; offer longer consultations). Time is also often needed to build trust with people around these sensitive issues.
  • Acknowledge the patient’s expertise about their own disability, as this will contribute to building a positive interaction. It will also reinforce the patient’s role as an agent of their own healthcare management, which will facilitate communication and comfort during examinations.
  • Include questions about sexual activity/contact in medical histories of people with disability.
  • Let the patient know that the appointment is private and confidential.
  • Let the patient know they can bring a relative, friend or other support person with them to help them feel more comfortable.
  • Patients can ask for a female nurse or doctor.

Informed consent
  • Support patients to provide consent. Explain the procedure using appropriate language and visual cues, revisiting points if necessary.
  • If the patient does not have the capacity to consent, include the 'person responsible' in the consultation. (See Office of the Public Advocate/Guardian/Trustee in your state/territory.)

Accessibility
  • Ensure the clinic is accessible for people who use wheelchairs and that height-adjustable exam tables and equipment are available.

Patient records
  • Identify people with disabilities who are under-screened or never-screened and flag them in the practice database.

Choice of cervical screening provider
  • Most health services have experience supporting people with disabilities. However, healthcare providers could refer patients to services that are better able to cater for their particular needs in cervical screening.  This could include a clinic with rooms and/or equipment designed to be accessible for people with disabilities or specialised health services for people with disabilities.

Choice of screening method
  • Offer the choice of either self-collection or clinician-collection screening options.
  • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.
  • Let the patient know you can help them collect a vaginal sample if they have difficulty or are not confident collecting the sample themselves, or you can collect the sample of their behalf using a self-collection swab without using a speculum.
  • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
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