Author, Year, Country	Aim	Type of Study	Key Findings	Conclusion	Quality
[36] Scotland	Investigate the perspectives and experiences of paid and family carers in supporting women with intellectual disabilities during breast screening.	Qualitative	Active Caregiver Involvement: Carers actively ensured the breast health of women with intellectual disabilities. Dichotomy in Abilities: Recognition of varying abilities among women in undertaking breast checks themselves. Need for Assistance: Most carers acknowledged the need for assistance, highlighting unique challenges. Communication Challenges: Difficulties in explaining breast cancer screening, symbolized by the metaphor, “It could be broccoli.” Universal Support: Decision-makers unanimously believed women with intellectual disabilities should be offered breast screening. Obstacles Reported: The main barriers included limited time, pain, and fear, with external factors influencing accessibility to screening.	Caregiver reassurance is vital for women’s support, emphasizing the need for improved working relationships with screening staff. Policymakers should extend screening to community levels, addressing resource challenges. Tensions persist between encouraging attendance and resource limitations. Varied support needs depend on women’s intellectual abilities and caregivers. Findings indicate potential shortcomings across the breast screening process.	****
[37] UK	Examine the necessity for a targeted breast cancer awareness intervention for women with mild/moderate intellectual disabilities, gathering insights into preferred intervention processes and content.	Qualitative	Low Focus on Health: Individuals with intellectual disabilities (IDs) may have jobs and income, but their attention to diet, lifestyle, and exercise is generally low. Varied Health Consciousness: Some healthcare professionals acknowledged that individuals with IDs can be health-conscious, especially regarding activities like walking and jogging. Lack of Education and Support: Caregivers and healthcare professionals lack educational, training, and support needs for breast cancer awareness in women with IDs. Poor Caregiver Awareness: Healthcare professionals noted caregivers’ poor awareness levels, similar to the general population, regarding breast cancer risk, outcomes, prognosis, and treatment. Need for Accessible Resources: Caregivers emphasized the absence of easy-to-read formats and educational resources specific to breast cancer awareness for women with IDs. Limited Knowledge: Overall, caregivers demonstrated limited knowledge about breast cancer.	-A combined healthy living and breast awareness educational intervention is recommended for women with mild/moderate levels of intellectual disability (ID). -Engaging caregivers and healthcare professionals (HCPs) in education and training is crucial.	*****
[38] USA	Understand barriers and opportunities for improving cancer screening in adults with intellectual and developmental disabilities through a survey of nurses working in developmental disability settings.	Qualitative	Perceived Disparities: Nurses perceive lower cancer screening rates among adults with intellectual and developmental disabilities. Instances of Undetected Cancer: Half of the nurses encountered cases where cancer developed without prior screening for individuals with intellectual and developmental disabilities. Barriers to Successful Screenings: Various reasons for unsuccessful cancer screenings include lack of cooperation, test completion issues, screenings not ordered during preventive visits, fear, refusal, and lack of understanding. Proposed Interventions: Nurses suggest interventions encompassing education, training, accessibility improvements, financial support, procedure modifications, and tracking measures for enhanced cancer screening.	Identifying Successful Models: Acknowledges the potential existence of successful cancer screening models for individuals with disabilities, urging further identification, study, and replication for broader implementation. Inclusive Perspectives: Highlights the importance of diverse perspectives from self-advocates, direct support professionals, hospital technicians, and physicians for a comprehensive understanding of factors contributing to disparities in cancer screening for persons with disabilities. Tailored Approaches: Nurses emphasize the need for tailored approaches addressing educational, logistical, and personal barriers to cancer screening for individuals with disabilities.	****
[29] UK	Explore how community nurses and residential staff support women with intellectual disabilities in accessing breast screening services.	Qualitative	Nurse Support: Community intellectual disability nurses (CIDNs) assist women with intellectual disabilities (IDs) in attending medical appointments, including breast screening, by providing transport and accompanying them for mammograms. Limited Knowledge: Women with IDs may have limited knowledge about breast cancer due to poor literacy, communication, and understanding. Barriers to Attendance: Negative emotions and attitudes, such as privacy concerns, fear, discomfort, practical issues (distance, cost, wheelchair access), and other health problems contribute to refusals to attend breast screening. Awareness Challenges: Women, family carers, and residential staff are informed about breast screening appointments only after receiving invitation letters. Some family carers may decide not to inform their daughters/siblings, citing various reasons such as priority, taboo, or inappropriateness.	-There are disparities in access to breast screening. -Disparities in access are attributed to a lack of appropriate health educational material. -Health promotional activities are insufficient, contributing to the disparities. -There continues to be a lack of understanding among women with IDs regarding what to expect and the potential consequences of screening. -This format summarizes the key points from the conclusion, focusing on the disparities in access to breast screening and the contributing factors highlighted in the study.	****
[39] UK	Investigate the knowledge, attitudes, and decision-making processes surrounding cervical and breast cancer screening in women with learning disabilities, involving input from family and paid carers.	Mixed design	-A paid carer emphasized that sexual status should not determine eligibility, as underlying issues may exist. -Family carers noted a reliance on them to explain screening-related information to women with learning disabilities upon receiving screening letters. -Participants expressed concerns about women with learning disabilities having limited awareness of cancer symptoms and believed they might not be informed due to societal hesitance to discuss such issues. -Suggestions for enhancing screening experiences included sharing positive experiences, ensuring healthcare professionals are informed about women with learning disabilities’ needs, utilizing accessible materials like passport books, and actively involving women with learning disabilities in discussions about making the screening process more manageable.	-Implementing easy-to-read documentation throughout the screening process is crucial to facilitate understanding. -Actively inviting women with learning disabilities to attend cancer screening helps promote inclusivity and accessibility. -Emphasizing awareness of cancer symptoms among women with learning disabilities is essential for informed decision-making. -Ensuring carers are well-informed and supportive of women with learning disabilities decisions is a key factor in the screening process. -Recognizing the need for reasonable adjustments at every stage of the cancer screening pathway, from invitation to result communication, is essential for providing effective care to women with learning disabilities.	****
[40] USA	Explore family caregivers’ perspectives on various aspects of cervical and breast cancer screening for women with intellectual disabilities.	Qualitative	Caregiver Beliefs: Caregiver beliefs significantly influence decision-making, with some deeming breast exams unnecessary. History of Sexual Abuse: Women with intellectual disabilities may feel uncomfortable due to a history of sexual abuse. Doctor’s Gender and Familiarity: The gender of the doctor and the woman’s familiarity with them impact decision-making. Clear Explanations: Clear explanations from caregivers and doctors positively influence decision-making. Emotional Factors: Embarrassment, shyness, and fear contribute to decision-making, affecting comfort levels. Sexual Activity and Pain Perception: Women not sexually active or perceiving the exam as painful may choose to avoid it. Caregiver Consent and Support: Caregiver consent and support, including staying in the exam room, influence decisions. Insurance Coverage: Insurance coverage, ability to pay, and changes in coverage impact decision-making. Medical History: A history of hysterectomy or specific medical conditions may affect the perceived necessity of the exam. Anti-Anxiety Medications: The use of anti-anxiety medications may influence the decision to undergo the exam. Transportation: The cost and availability of transportation contribute to decision-making.	-Family caregivers emphasized the significance of adequate preparation, relaxation, and their own participation in the examination room to facilitate cervical and breast cancer screening for their loved ones with intellectual disabilities. -Preliminary evidence suggests that family caregivers often lack sufficient knowledge regarding the necessity of cervical and breast cancer screening for women with intellectual disabilities. -Efforts must be directed toward including family caregivers in health promotion interventions aiming to increase cervical and breast cancer screening for women with intellectual disabilities.	*****
[3] UK	Investigate healthcare professionals’ perspectives on their roles in supporting women with intellectual disabilities in accessing breast cancer screening.	Qualitative	Practice Nurses’ Advocacy: Practice nurses emphasize equal access to health screening for women with intellectual disabilities, advocating against discrimination. Challenges in Self-Examination: Breast care nurses highlight challenges in self-examination for women with intellectual disabilities due to cognitive deficits and communication barriers. GP Encouragement: GPs use opportunistic encounters to encourage breast screening, often collaborating with the community intellectual disability team or family. Roles of Breast Care Nurses: Screening unit breast care nurses explain the screening process, offer health promotion, and provide post-screening or breast cancer diagnosis support. Breast Cancer Risk Factors: Primary healthcare staff identify various risk factors, including literacy, exercise, family history, and environmental factors. Importance of Carer Support: Lack of carer support is acknowledged as a potential barrier, highlighting the need for accompaniment to appointments. Professional Attitudes as Barriers: Healthcare professional attitudes and experience, including misconceptions about screening appropriateness, may serve as barriers.	A comprehensive approach involving heightened awareness, continuous education, and interdisciplinary collaboration is pivotal to break down the barriers hindering women with intellectual disabilities from accessing crucial breast cancer screening services. By reinforcing the roles of healthcare professionals and fostering collaborative efforts, we can work toward achieving equitable breast cancer prevention and control for all women, irrespective of intellectual ability.	***
[41] Ireland	Explore the proficiency, motivation, and knowledge levels related to breast cancer screening and awareness among nurses working in intellectual disability settings.	Quantitative	-Nurses expressed uncertainty about their proficiency in detecting personal breast anomalies. -Participants’ motivation for engaging in personal breast self-examination (BSE) and their self-perceived susceptibility to breast cancer was measured. -A significant majority of nurses considered BSE valuable for detecting breast lumps/changes themselves. -Nurses demonstrated a knowledge deficit regarding specific breast cancer risk factors, as evidenced by a portion of nurses disagreeing or being unsure about factors such as the incidence of breast cancer with age, the impact of childbirth, and menopause-related factors.	The study reveals deficiencies in supporting breast awareness initiatives for women with intellectual disabilities, exposing knowledge and skill deficits among nurses. These findings indicate potential gaps in nursing professionals’ training and preparation, extending beyond the intellectual disability perspective. The study underscores broader concerns and challenges faced by nurses in promoting breast awareness. Emphasizing the need for comprehensive strategies, the conclusion calls for systemic interventions to address these challenges at a broader level.	***
[21] UK	Investigate how care staff actively participate in cancer prevention and health promotion activities for individuals with intellectual disabilities.	Qualitative	-Only a small fraction of staff members reported receiving any form of training related to cancer awareness and health promotion activities designed for individuals with intellectual disabilities. -Further exploration revealed that the training received by the few staff members was minimal, and in some instances, it only consisted of passing on written information to the staff. -The lack of formal and comprehensive training indicates potential gaps in the preparation of residential care staff to address cancer-related issues in individuals with intellectual disabilities. -Gaps were identified not only in general cancer awareness but also specifically in understanding the signs, symptoms, and risk factors associated with cancers such as stomach, breast, cervical, and prostate cancer. -Respondents demonstrated a lack of awareness regarding both the risk factors that contribute to cancer development and the protective factors that may mitigate the risk. -The majority of respondents had not received training in health promotion tailored for individuals with intellectual disabilities.	-Individuals with intellectual disabilities deserve equal access to cancer prevention services, necessitating tailored strategies for their unique needs. -There is a clear need for improved education and training among staff, focusing on raising awareness of cancer signs, symptoms, risk factors, and protective measures for individuals with intellectual disabilities. -Collaboration between intellectual disability and cancer professionals is vital to developing effective, accessible health promotion strategies.	*****
[42] Canada	Examine family members’ views on preventive healthcare decision-making and their perceptions of quality healthcare for relatives, and discern barriers and facilitators of mammography.	Qualitative	-Some participants associated mammography with challenges related to their loved one’s sexuality, impacting the decision-making process. -Mammography was seen as a means for women with intellectual disabilities to connect with a larger community of women, emphasizing a sense of belonging. -The decision to undergo mammography held significant meaning, with participants viewing it as a civil rights issue and emphasizing the need for equal opportunities. -Decision-making focused on preserving the quality of life, avoiding suffering, and prioritizing comfort over dramatic interventions. -Past medical scares influenced decision-making, reflecting a desire to prioritize the well-being of their loved ones. -Fears related to potential cancer diagnoses and concerns about the impact on quality of life were prominent among participants. -Additional support, including time, detailed explanations, facility tours, sedation, and family presence, was deemed necessary for successful mammograms. -Participants emphasized the need for tailored educational approaches based on their loved one’s learning style.	-Cancer screening decisions for women with IDs are intricately linked to family dynamics, emphasizing the complexity of the decision-making process. -Disparities in mammography access for women with IDs within families underscore the need to address and understand family dynamics in intervention strategies. -Obtaining a mammogram involves multi-level preparation and family deliberation, requiring interventions that acknowledge and appreciate these complexities. -There is a significant need for educational interventions targeting families, tailored to address the unique considerations involved in mammography decision-making within families with members with IDs.	****
[43] Canada	Investigate the experiences of primary care providers in recommending cancer screening to patients with intellectual disabilities.	Qualitative	Primary care providers view intellectual disability as one of several factors influencing cancer screening recommendations. They emphasize equal care for all, considering various patient characteristics holistically. Despite evolving guidelines, clinicians’ express commitment to individualized care based on patient needs.	Physicians with favorable attitudes toward intellectual disability are more likely to recommend cancer screening. A nuanced approach balancing guidelines and patient interests characterizes the decision-making process. The study emphasizes the complexity physicians face in recommending preventive measures and calls for further research to explore experienced family physicians’ perspectives on routine cancer screening.	***
[44] USA	Collect data for customizing educational programs to fit the cultural context of Native American women with IDD.	Qualitative	Financial barriers impact cancer care for women with IDD. Hesitancy stems from fear and trauma, while a lack of health education contributes to misinformation. Communication challenges underscore the need for tailored care, respecting preferences and cultural considerations. Legal concerns and room design also influence the healthcare experience for women with IDD.	The conclusion emphasizes the use of an essential elements approach to guide the adaptation of the original cancer screening education program for Native American women with IDD in urban and rural contexts.	****
[12] USA	Investigate barriers and facilitators associated with mammogram participation among individuals with intellectual disabilities.	Qualitative	-Caregivers recognize mammogram importance but face challenges in managing overwhelming responsibilities. -Fatigue and care duties sometimes hinder caregivers from supporting mammogram appointments. -Care coordination support is beneficial, aligning with Pennsylvania 6400 regulations. -A lack of health education, especially for those attending adult day programs for extended hours. -Missed opportunities in social settings for healthcare discussions and education.	-Anxiety and fear deter women with intellectual disabilities from mammograms. -Inadequate care coordination and family support hinder screening. -Adult day programs lack mammogram education, contributing to knowledge gaps. -Physical inaccessibility and sedation issues pose challenges in mammogram accessibility. -Limited awareness about breast ultrasound’s role in screening.	****
(***: 60% quality, **** 80% quality, ***** 100% quality).