Best Medicine Matters Fall 2009 - Mount Sinai Hospital

Lowering Barriers to
Mammogram Access
When Linda Muraca, Nurse-Clinician in Mount Sinai’s Marvelle
Koffler Breast Centre, was asked in 2007 by the Centre for
Independent Living in Toronto (CILT) to do presentations on
breast health for women with disabilities, she thought, “That’s
interesting.” And so it was.
“I thought the problems they were sharing with us were
isolated, but I kept hearing more disturbing stories,” said
Muraca. Women told her about going for a mammogram, only
to find that the machine couldn’t move to accommodate them.
They talked about encounters with health care staff who would
speak only to their caregivers or family members. They talked
about entering a mammography room in a wheelchair, and
being asked to “hop up on the table.”
“Many of these women had a family history of breast cancer,
but their doctors would gloss over it, saying they had enough to
deal with already,” says Muraca.
The CILT sessions inspired Gateways to Cancer Screening,
a project that became part of Muraca’s Masters in Nursing
coursework at the Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto. Muraca teamed up with Nancy Barry,
CILT’s peer support and volunteer co-ordinator, whose own
negative mammogram experience inspired her to invite Muraca
to CILT in the first place. Five focus groups were led in Toronto
and Peel Region.
“Accessibility issues are very widespread,” says Barry. Fortunately,
the Marvelle Koffler Breast Centre offers quite good access. “The
doorways are wide enough so that women can comfortably
wheel in, the machines move up and down, and that lowers
the patients’ anxiety,” says Muraca. The change rooms aren’t
wheelchair accessible, but staff now suggest that women with
disabilities simply change in the mammography room.
Mount Sinai Breast Imaging staff, Muraca adds, have been
extremely supportive. “Some women who have had horrible
previous experiences have come here and been very happy,”
she says. By asking all new patients if they need any special
accommodation, staff ensure that women with disabilities
receive extra appointment time and an extra technician to
assist with the mammogram procedure.
The Gateways momentum continues. Muraca, Barry and colleagues
have received funding from the Canadian Breast Cancer Foundation
to develop an educational strategy designed to improve the breast
cancer experience for women with disabilities.
“The idea is to get the information from the women right to
the health-care providers,” says Barry. The program will employ
scenarios revealed by Gateways to develop DVDs that can be
used in training health-care staff. Barry describes their plan as
“a Disability Awareness 101.”
“We work in a rushed environment at times, but it’s all about
listening and respect,” says Muraca.
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