Table 2.

Themes and Recommendations

Theme	Recommendation
Inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis	• Install accessible medical diagnostic equipment including wheelchair accessible weight scales, height-adjustable exam tables, and/or transfer devices (e.g., Hoyer lift) • For specific equipment requirements, seek guidance from the federal Standards for Accessible Medical Diagnostic Equipment (e.g., height-adjustable exam tables should lower to 17–19 in. above ground to facilitate transfers) • Develop procedures for appropriate patient positioning (e.g., for MRI or biopsy)
Attitudes of clinical staff about accommodating disability	• Staff training should include modules on disability cultural competence • Develop policies and procedures for proactively inquiring about patients’ accommodation needs to anticipate accessibility difficulties • Train staff in their legal responsibilities for accommodating patients with disability and how decisions about reasonable accommodations are made • Train staff in ergonomic transferring and patient positioning techniques to maximize patients’ comfort, reduce risk of injury to clinical staff, and improve technical quality of diagnostic test (e.g., appropriately and comfortably positioned patients have better diagnostic imaging quality)
Dismissal of cancer signs/symptoms as patients’ emotional responses to chronic health conditions	• Improve staff training about risks of misattributing patients’ signs/symptoms to psychological factors • Improve staff training about potentially biased attitudes towards disability (e.g., through taking an online disability implicit association test)
Misattributing cancer signs/symptoms to underlying disability	• Train staff about the risks of “diagnostic overshadowing” in the context of pre-existing conditions including mobility disability • Consider consultation with physician experts in disability (e.g., physiatrists)
Attitudes about pursuing legal action for substandard care	• Train staff about their responsibilities towards patients under the Americans with Disabilities Act (ADA)