An official website of the United States government
Here's how you know
Official websites use .gov
A
.gov website belongs to an official
government organization in the United States.
Secure .gov websites use HTTPS
A lock (
) or https:// means you've safely
connected to the .gov website. Share sensitive
information only on official, secure websites.
As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with,
the contents by NLM or the National Institutes of Health.
Learn more:
PMC Disclaimer
|
PMC Copyright Notice
Editor—Pearson et al were concerned to find that only a quarter of eligible women with learning disability in Exeter and District Community Health Services NHS Trust had undergone cervical screening in the previous five years, compared with 82% of the rest of the eligible population.1 In 1997, Horizon NHS Trust, Hertfordshire Health Promotion, and the Women’s Nationwide Cancer Control Campaign cooperated over an intensive programme to screen the 126 eligible women in the learning disability hospital. As previous experience had shown the importance of securing carers’ support, staff and some patients participated in educational sessions. The members of the trust’s sex education team provided advice and educational models and made themselves available in case the process should provoke disturbing memories, as might happen in the case of previous sexual abuse.
Given the screening—as opposed to curative—nature of the procedure, no resident was tested who withheld consent (whether valid or not) or failed to cooperate passively. Despite the procedure being a routine public health measure, relatives were, as a matter of good practice, informed unless the patient indicated on direct questioning that they should not be.
Of the 128 eligible women, 40 were withdrawn because they were considered to be behaviourally or physically unable to participate. Of the remainder, 25 proved to be virgins or behaviourally unsuitable or refused consent; 18 did not cooperate. Forty five (35%) underwent cervical screening; 39 smears gave negative results, five were inadequate, and one showed an abnormality. The difficulties encountered because of the high proportion of psychiatric cases and cases of challenging behaviour and of physical disability in the trust’s population compared with people living in the community may to an extent be offset by the logistically easier task of arranging the resource intensive programme in a relatively small organisation.
The lessons learnt from this programme were that the numbers screened can be optimised by a focused initiative that includes education of carers to support the programme and the patients; the procedure should be carried out only by women staff to avoid embarrassment; it is not possible to predict who has had sexual experience; and the doctor taking the smears must be skilled and flexible enough to be able to take them in any position offered.
References
1.Pearson V, Davis C, Ruoff C, Dyer J. One quarter of women with learning disability in Exeter have cervical screening. BMJ. 1998;316:1979. doi: 10.1136/bmj.316.7149.1979. . (27 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 1999 Feb 20;318(7182):536.
Concerted effort is needed to ensure these women use preventive services
Editor—A recent review of cervical and breast screening in Brent and Harrow Health Authority showed similarly low levels of cervical screening among women with learning difficulties (19%) to that reported from Exeter (24%).1-1 Altogether 336 women aged 20-64 were identified from Brent and Harrow’s learning disability registers, and their screening records were reviewed. Only 64 (19%) of the 336 women had had a cervical smear within the past 5 years, 13 (4%) had had a total hysterectomy, and the remaining 259 (77%) did not have any screening records. Breast screening had been performed in 32 (43%) of 73 women (figure)
Coverage rates for cervical and breast screening in women with learning disability in comparison with general poulation. Source: Department of Health’s statistical bulletins for breast (1996-7, 1998 (10)) and cervical (1996-7, 1997 (27)) screening programme in England
We sent 259 questionnaires to the 133 general practitioners of all the women without a cervical screening record; 87 general practitiones returned 166 questionnaires (64%). For most women, more than one reason was given. An assumption that women were sexually inactive was stated in 121 questionnaires and was the commonest reason why general practitioners failed to perform a smear test, although no real evidence exists to confirm this assumption. Difficulties in performing the examination were stated for 56 women, because of their sexual inactivity, physical disability, or insufficient understanding of the examination. In 39 questionnaires the general practitioners expressed concern that examination could not be performed because consent could not be obtained from the women, their families, or their carers. Twelve women were not screened because they had left the practice and could not be traced or did not respond to the invitation letters. Screening was not offered to six women.
People with learning disabilities have much greater health needs then the general population but use preventive services less than is expected.1-2,1-3 In addition, general practitioners’ role as providers of health promotion and routine screening for these patients is not generally accepted.1-4 The review identified several obstacles to the successful implementation of routine screening among women with learning disabilities. Only concerted effort between healthcare professionals, this particular group of people, and their carers will result in the delivery of good quality health services for those who are most in need.
References
1-1.Pearson V, Davis C, Ruoff C, Dyer J. Only one quarter of women with learning disability in Exeter have cervical screening. BMJ. 1998;316:1979. doi: 10.1136/bmj.316.7149.1979. . (27 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
1-2.Lindsey M. Signposts for success in commissioning and providing health services for people with learning disabilities. Leeds: NHS Executive; 1998. [Google Scholar]
1-3.Piachaud J, Rohde J. Screening for breast cancer is necessary in patients with learning disability. BMJ. 1998;316:1979–1980. doi: 10.1136/bmj.316.7149.1979a. . (27 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
1-4.Keer M, Dunstan F, Thapar A. Attitudes of general practitioners to caring for people with learning disability. Br J Gen Pract. 1996;46:92–94. [PMC free article] [PubMed] [Google Scholar]
BMJ. 1999 Feb 20;318(7182):536.
Sefton has multidisciplinary group to promote sexual health care for these women
Editor—Southport and Formby NHS Trust shares the experience of Exeter and District Community Health Services NHS Trust with regard to cervical screening and women with learning disability.2-1 In 1995 a survey of 50 women with learning disability in one locality in Sefton, Merseyside, was performed to assess accessibility of primary healthcare services and to identify the nature of the problems with access as experienced by service users. This survey showed that 43 (86%) of 50 women with learning disability who were eligible for cervical screening had never had a smear test.
To promote sexual health care and to address this and similar issues, Sefton now has a multidisciplinary group, comprising representatives from social services, health, education, voluntary services, carers’ groups, and people with learning disability. Recently a local general practice has requested help from the group regarding the best way to ensure that women with learning disability (of whom it has a relatively high number) receive the same opportunity to access the cervical screening programme as women without learning disability. Despite efforts by the practice nurse to target these women, uptake of cytological screening remained disappointingly low. In response to this a research study is planned to investigate the barriers that prevent women with learning disability from accessing cervical screening and to identify features of good practice in the delivery of preventive health care to this vulnerable group. The training needs of the primary health team will subsequently be assessed.
The Department of Health has recommended that “people with learning disability should be helped to overcome any difficulties in using the full range of general health services.”2-2 The results of our research may identify the most effective way of achieving this for cervical cytology.
References
2-1.Pearson V, Davis C, Ruoff C, Dyer J. Only one quarter of women with learning disability in Exeter have cervical screening. BMJ. 1998;316:1979. doi: 10.1136/bmj.316.7149.1979. . (27 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
2-2.Lindsey M. Signposts for success in commissioning and providing health services for people with learning disabilities. Leeds: NHS Executive; 1998. [Google Scholar]
