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Primary care providers’ attitudes and experiences recommending cancer screening to patients with Intellectual Disabilities Breau, Genevieve Marie

Abstract

Individuals with Intellectual Disabilities receive breast, cervical, and colorectal cancer screening at rates lower than the general population. The reasons for this disparity are poorly understood. Additionally, in the general population, a primary care provider’s recommendation for cancer screening is one of the key determinants of whether an individual obtains cancer screening. This mixed methods study explored the role of primary care providers in recommending cancer screening to patients with Intellectual Disabilities. First, 106 primary care providers (family physicians, family medicine residents, and nurse practitioner students from across British Columbia) were surveyed regarding their attitudes towards people with Intellectual Disabilities in general, and their anticipated likelihood of recommending breast, cervical, and colorectal cancer screening to fictional patients with Intellectual Disabilities presented in vignettes. In the second phase, 10 family medicine residents and two family physicians were interviewed regarding their experiences recommending cancer screening to patients with Intellectual Disabilities. The quantitative and qualitative analysis revealed that: (1) participants with negative attitudes towards the community inclusion of individuals with Intellectual Disabilities were less likely to recommend breast and colorectal cancer screening to fictional patients with Intellectual Disabilities; and (2) participants balance applying evidence-based guidelines with exercising clinical judgement to determine the best course of care for each patient, and this balance is situated within the larger medical environment that physicians practice within. In conclusion, this study determined that aspects of attitudes are related to cancer screening recommendations, but given that attitudes are one of many factors related to screening recommendations, future studies should not solely focus on this factor. Second, it appears that clinicians individualize care for all patients, and a patient’s Intellectual Disability is one of many factors considered prior to a screening recommendation. Finally, participants were aware of the evolving nature of cancer screening guidelines, and changed their practice accordingly as guidelines change. More research is needed to determine if these findings are applicable to more experienced primary care providers, given that the majority of participants in the interview phase were residents.

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