The impact of having intellectual or developmental disabilities on breast cancer treatment: A convergent mixed-methods study
Bibliographic record
Abstract
Background: People with intellectual or developmental disabilities (IDD) are more likely to die with and from breast cancer. Exploring how people living with IDD receive or do not receive guideline-recommended treatment for breast cancer can help inform strategies for improving patient-centred care. Methods: This mixed methods project includes three studies: (1) A population-based retrospective cohort study in Ontario among females diagnosed with breast cancer (2007- 2018) using routinely collected provincial health data comparing receipt of guideline-recommended treatment between people with IDD and those without these disabilities; (2) a second population-based retrospective cohort study exploring factors associated with receipt of guideline-recommended treatment among females with breast cancer and IDD; and (3) a critical realist case study exploring how one female breast cancer patient with IDD received guideline-recommended care using interviews and thematic analysis with a critical realist lens. Results of the three studies were integrated using joint display figures. Results: The largest cohort in the first study included 100,679 individuals with breast cancer; 369 individuals with IDD were identified. People with IDD were significantly less likely to receive guideline-recommended surgical resection, radiation, and chemotherapy. Females with breast cancer and IDD were more likely to receive mastectomy but less likely to receive breast conserving surgery than those without IDD. The largest cohort in the second objective included 365 females with IDD and breast cancer. Factors associated with receipt of guideline-recommended treatment included age, stage at diagnosis and consults, such as having a family interview. In objective 3, the female with IDD in the breast cancer case study received guideline-recommended care. Themes facilitating treatment included attitudes, relationships, access to shared-decision making and accommodations, and advocacy. Integration of the studies provided a deeper understanding into why individuals with IDD may be less likely to receive guideline-recommended breast cancer treatment. Conclusion: People with IDD experience guideline-recommended breast cancer treatment inequities relative to those without IDD. These findings can help us develop strategies that can target gaps in the patient-centred care delivered to breast cancer patients with IDD to improve the stark survival disparities experienced by this patient group.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.047 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".