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"Breast Health and Beyond for Women with Disabilities: A Provider's Guide to the Examination and Screening of Women with Disabilities"


This manual was produced by Breast Health Access for Women with Disabilities (BHAWD) and made possible through generous grants from The California Endowment, The Hearst Foundation, Inc., The San Francisco Bay Area Affiliate of The Susan G. Komen Breast Cancer Foundation

This guide has been designed for health care providers to increase knowledge and enhance clinical practice in providing breast health screening services to women with disabilities. It offers health care providers and their staff a better understanding of how to improve access to clinical services and also how to improve in their personal interaction with women with disabilities.

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TABLE OF CONTENTS

Introduction

What is BHAWD………………………………………… 3
Goals…………………………………………………...
Collaborative Partners………………………………..
Contact Information…………………………………...

Addressing Disability Concerns……………………… 5
The Americans with Disabilities Act (ADA) of 1990
and The Rehabilitation Act of 1973

The Need for Services ..........................................7
Barriers to Care ………………………………………
Physical Barriers………………………………
Attitudinal Barriers: Client……………………………
Attitudinal Barriers: Provider………………………..

Accessibility and Universal Design………………. 11
Recommended Universal Design Features

Communication……………………………………… 13
Communication Access

Disability Awareness Information…………….. 15
Mobility Disabilities.
Blind or Visual Disabilities
Deaf or Hearing Disabilities
Speech Disability
Cognitive Disabilities
Size: Extra Large or Small Stature
Case Studies

Preparation for the Examination……… 21
Women with Developmental Disabilities

Examination………………
Accessible Equipment………………………………25
Transfer Tips and Equipment………………………..
Mammography Machine

Clinical Breast Examination (CBE)Protocol… 29
Introduction to the Examination……………….
Preparing for the Exam………………………...
Performing the Four Positions for Visual
Inspection……………………..
Position on the Exam Table……………………
Lymph Node and Axilla Exam…………………
Breast Palpation…………………………………
Women with Cognitive Disabilities
Completion of the Exam………………………..

Breast Self Exam (BSE) Protocol………………… 33
Information
Visual Disability
Deaf or Hard of Hearing
Cognitive Disability
Adapted Protocols: BSE………………………….
Breast Palpation
Reduced Ability to Reach
Difficulty Holding Still

Mammography Protocol…………… 37
Scheduling the Exam…………………………..
Preparing for the Exam………………………..
Craniocaudal (CC) View……….
Mediolateral Oblique (MLO) View…………….
Completion of the Exam………………… ….
Adapted Protocols: Mammography…………..
Developmental Disabilities

After the Examination………… 41
The Uncompleted Exam……………………………..
Follow-Up Care……………………………………….

Conclusion………………… 43

Appendix I–CBE Algorithm……… 45
Appendix II–BSE Algorithm……… 47
Appendix III – Mammography Algorithm… 49
Appendix IV– Transfer Information… 51
Appendix V–Pre-Education Curriculum for Clients with Developmental Disabilities 53…………

Resource Guide……………………… 55

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