Breast Health and Beyond: A Provider’s Guide to the Examination and Screening of
Women with Disabilities - 2nd Edition
TABLEOFCONTENTS
Addressing Disability Concerns………………………...........
The Americans with Disabilities Act (ADA) of 1990
The Rehabilitation Act of 1973
Access” Where does it begin?
Tax Incentives for Improving Accessibility
Barriers to Care……………………………….......................
Physical/Architectural Barriers
Attitudinal Barriers: Health Care Providers
Attitudinal Barriers: Clients
Informational Barriers
Data and Research Barriers
Accessibility & Universal Design………………………......
Recommended Universal Design Features
Architectural Features
Equipment Features
Accessible Communication Features
Communication…………………………………………….......
Communication Access
Providing Culturally Competent Services..........................
Mobility Disabilities
Blind or Visual Disabilities
Deaf or Hard of Hearing Disabilities
Speech Disabilities
Size: Large or Small Stature
Cognitive and Intellectual Disabilities
Case Studies………………………………………………….
Goals and Discussion
Preparation for the Examination………………...............
Telephone to Assess Needs
Additional Time for Exam
Describe and Discuss Exam Process
Gather Medical History
Transportation
Examination……………………………………………….....
Accessible Equipment
Exam Tables
Scales
Mammography Chairs
Mechanical lifts
Manual Transfer Tips
Screening and Mammography Management…….........
Mammography Exam Adaptation
Breast Screening Protocols……………………………....
Clinical Breast Examination (CBE) Protocol…………..
Introduction to the Examination
Preparing for the Exam
Four Positions for Visual Inspection
Position on Exam Table
Lymph Node and Axilla Exam
Breast Palpation
Completion of the Exam
Cognitive and Intellectual Disabilities
The Uncompleted Exam
Follow-up Care
Breast Self Exam (BSE) Protocol………………………….
Visual Disability
Deaf and Hard of Hearing
Cognitive and Intellectual Disabilities
Adapted Protocols
Breast Palpation
Mammography Protocol…………………………..…..........
Scheduling the Exam
Preparing for the Exam
Craniocaudal (CC) View
Mediolateral Oblique (MLO) View
Completion of the Exam
Cognitive and Intellectual Disabilities
Additional Technologies
Conclusion…………………………….………..…………......
Appendix 1: BHAWD Services and Contact Information
Appendix 2: Algorithms
Clinical Breast Exam
Breast Self Exam
Mammography
Appendix 3: BHAWD Tools
Mammography Client Questionnaire
Sample Scheduling Phone Script
Preparing for the Mammogram- Mammogram Facility
Preparing for the Mammogram- Women with Disabilities
Appendix 4: Breast and Cervical Cancer Screenings Among California Women with Disabilities
Appendix 5: Continuing Education Credit Information
General Information
Ordering Information
Evaluation
Post-Test
Answer Key Sheet
Appendix 6: Resources
Agencies and Suppliers
Notes
COURSE OBJECTIVES
Upon completion of this course, participants will:
Acknowledgements
Author
Florita Toveg (Maiki), MA
BHAWD Manager
Breast Health Access for Women with Disabilities (BHAWD) would like to extend a special thanks to the following reviewers who provided excellent input and expert knowledge with the development of the current edition of Breast Health and Beyond: A Provider’s Guide to the Examination and Screening of Women with Disabilities.
Contributors
Mela Angleman, RN, NP
BHAWD Nurse Practitioner
Lisa Bailey, M.D., F.A.C.S.
Medical Director – Alta Bates Summit Medical Center, Carol Ann Read Breast Health Center
Surgical Oncology -Bay Area Breast Surgeon
Martha Barajas
BHAWD Administrative Assistant
Cleo S. Berkun, Ph.D.
Older Women’s League
Carol J. Bradley, JD
Disability Access Coordinator
Sutter Health Office of the General Counsel
Doreen Canton, RN, BS, CDDN
Golden Gate Regional Center
Geraldine Collins-Bride, RN, MS, ANP
Department of Community Health Systems
University of California, San Francisco
Kathleen Colloton, RNC, WHNP
Alta Bates Summit Medical Center, Breast Health Center
Carol N. D’Onofrio, Dr.PH
Professor Emeritus, School of Public Health,
University of California, Berkeley
Rosemary Frasso-Jaramillo, MSPH, MS
University of Pennsylvania
Jon M. Greif, DO, FACS
Bay Area Breast Surgeons, Inc.
Dolores Hill-Newman, R.T. (R) (M)
Alta Bates Summit Medical Center, Breast Health Center
Risa Kagan, MD, FACOG
East Bay Physicians Medical Group
Department of Ob/Gyn -University of
California, San Francisco
Rebecca MacEwan, R.T., C.R. T. (R) (M) (ARRT)
Alta Bates Summit Medical Center, Imaging and Mammography Center
J. Dougal MacKinnon, MD, Ph.D.
BHAWD Medical Director
Mary E. Smith, MS
BHAWD Client Educator
Judith G. Rogers, OTR/L
Through the Looking Glass
Judith Sweet, RN, MS, FNP
School of Nursing -University of
California, San Francisco