Pathways of disability-based discrimination in cancer care

ABSTRACT

Disabled people often report poorer health outcomes and increased barriers to accessing healthcare, compared to the general population. Our aim was to foreground lived experiences of disability-based discrimination, often indirect, and identify pathways through which this operates. We used a case study approach to explore the experiences of people with physical impairment accessing cancer services in England and Wales, from screening to therapy and follow-up, and investigated the complex and interacting nature of factors that affect their experiences. Participants described how they had to navigate a healthcare system that often was not responsive to their needs, leading to poor experiences of care. The barriers experienced by the participants operated at different levels. We identify three specific pathways through which discrimination is embodied: normativity expectations, lack of disability-awareness, and discontinuity of care. Our study is of particular importance to health professionals and policy makers, since there is limited evidence available on how people with physical impairment in the United Kingdom experience access to cancer care services. We argue that in order to advance the conversation on healthcare access for disabled people, it is important to reconceptualise the observed barriers as disability-based discrimination, reflective of broader structural processes, and to analyse in depth the pathways through which this discrimination operates.

KEYWORDS:

• Access to healthcare
• cancer
• disabled people
• health inequities
• UK

Acknowledgements

We thank all study participants for sharing their stories. We also thank the editor and two anonymous reviewers for insightful comments and helpful suggestions, and the members of the wider research team: Vivienne Cooper, Eleri Girt, Daniel Kelly, Gillian Knight, Barbara Moore, Roger Pratt, Gill Tyrer, and Wendy Wilkinson.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Tenovus Cancer Care [iGrant TIG2017-05].