Information for healthcare professionals

Cervical screening for people with disability

• How can I make cervical screening easier for patients with disability?

  The most important thing you can do is to listen to the patient and their support network.

  Take the time to understand their concerns or needs. Doing a Cervical Screening Test can be intimidating given the vulnerability and discomfort associated with screening.

  Many people with disability have experienced trauma, so taking a trauma-informed approach is essential. Trauma-informed approaches respect and recognise that people with disability are experts in their own lives.

• What is trauma-informed care?

  Trauma-informed care is based on the understanding that:

  • a significant number of people with physical or intellectual disability have experienced trauma in their lives
  • trauma may be a factor for people in distress
  • the impact of trauma may be lifelong
  • trauma can impact the person, their emotions and relationships with others.

  Core trauma-informed principles include:

  • safety – emotional as well as physical e.g. is the environment welcoming?
  • trust – is the service sensitive to people’s needs?
  • choice – do you provide opportunity for choice?
  • collaboration – do you communicate a sense of ‘doing with’ rather than ‘doing to’?
  • empowerment – is empowering people a key focus?
  • respect for diversity – do you respect diversity in all its forms?

  You can find this information and more on trauma-informed care on the Blue Knot Foundation website.

• What can I provide to make cervical screening more comfortable for patients with disability?

  It is about making sure your patient is as comfortable as possible and that you respect their needs.

  You can offer some important disability access adjustments in your practice or clinic, including:

  • an Auslan interpreter  
  • a female doctor or nurse to do the test or speak with the patient about the test
  • information in an accessible format like large print or Easy Read
  • a sensory friendly environment with less noise, light or smells
  • having fidget toys or music for distraction
  • allowing a short break during the appointment.

  Listing information about disability access on your practice or clinic website is also helpful. For example, you could provide information about:

  • accessible parking
  • access ramps, including the location if it is not the main entrance
  • the height range of your exam tables
  • whether the clinic has equipment like a hoist or transfer boards.
• Where can I learn more about cervical screening for people with disability?

  To learn more you can:

  • watch our webinar Optimising cervical screening for people with disability produced in partnership with the Royal Australian College of General Practitioners (RACGP) 
  • read the National Cervical Screening Program’s healthcare provider toolkit on supporting people with disability
  • contact your local intellectual disability advocacy organisation – it may offer training in supported decision-making and inclusive practice.

Self-collection for people with disability

• What is assisted self-collection?

  Assisted self-collection is an option for people who would prefer not to have a speculum examination but have difficulty doing self-collection themselves.

  A healthcare provider can help the patient by using the self-collection swab to take a vaginal sample. The swab is still only inserted 4 to 5 centimetres into the vagina so you won’t need a speculum.

  It is important to label the sample as ‘self-collected’ to ensure it is processed correctly.

• Doesn’t self-collection mean we lose the opportunity to visually check the vulva and cervix?

  There is no evidence to support pelvic examinations as the preference for patients with no symptoms of cervical cancer.

  If the patient’s test results find human papillomavirus (HPV), their cervix can be visualised during a follow up appointment for cytology or colposcopy. Decisions to perform a pelvic examination or visual inspection should be:

  • patient-centred
  • clinically indicated
  • made collaboratively.

  Self-collection is a valuable and welcomed option for most people with a cervix. This is especially the case for those who delay cervical screening or don’t screen at all.

Consent

• How do I know if a patient with intellectual disability can consent to cervical screening?

  Every adult is entitled to the presumption of capacity. This means you should always assume that a person can make their own health decisions. The only exception is if the patient has a legally appointed substitute decision-maker.  

  The processes for substitute decision-making vary by state and territory. Even if your patient is a person with intellectual disability who has a substitute decision-maker, you should still:  

  • direct your questions and explanations to them 
  • include them in decisions about their care.
• What if a patient is non-verbal?

  Being non-verbal doesn’t mean not understanding and having nothing to say. It also doesn’t mean the person cannot provide consent regarding matters relating to their body and their health.

  Most people who are non-verbal have other ways of communicating what they want and need. This might be by using:

  • Auslan
  • augmentative and alternative communication (AAC) technology
  • sounds
  • gestures
  • body language.

  Take the time to learn how your patient communicates. It’s important to agree on a way for the patient to tell you to stop if they need to halt a procedure or withdraw their consent.

This information has been provided by Daffodil Centre and the Centre for Disability Studies.