Feasibility of familial PSA screening: psychosocial issues and screening adherence

Abstract

This study examined factors that predict psychological morbidity and screening adherence in first-degree relatives (FDRs) taking part in a familial PSA screening study. Prostate cancer patients (index cases -ICs) who gave consent for their FDRs to be contacted for a familial PSA screening study to contact their FDRs were also asked permission to invite these FDRs into a linked psychosocial study. Participants were assessed on measures of psychological morbidity (including the General Health Questionnaire; Cancer Worry Scale; Health Anxiety Questionnaire; Impact of Events Scale); and perceived benefits and barriers, knowledge; perceived risk/ susceptibility; family history; and socio-demographics. Of 255 ICs, 155 (61%) consented to their FDRs being contacted. Of 207 FDRs approached, 128 (62%) consented and completed questionnaires. Multivariate logistic regression revealed that health anxiety, perceived risk and subjective stress predicted higher cancer worry (P ¼ 0.05). Measures of psychological morbidity did not predict screening adherence. Only past screening behaviour reliably predicted adherence to familial screening (P ¼ 0.05). First-degree relatives entering the linked familial PSA screening programme do not, in general, have high levels of psychological morbidity. However, a small number of men exhibited psychological distress.

The feasibility and results of a population-based approach to evaluating prostate-specific antigen screening for prostate cancer in men with a raised familial risk

“…Psychosocial factors are explored further in the accompanying paper (refer Sweetman et al, 2006). Counselling of FDRs in our study was restricted because of the ethical requirement that they could not be contacted directly until the IC and FDR had given signed consent.…”

“…In our study, 31% of FDRs reported having had a previous PSA test. In the accompanying psychosocial paper (refer Sweetman et al, 2006), it is reported that out of the 60% of FDRs who took part in the study, 41% (52 out of 128) had a blood test screening for prostate cancer. The true rate of prior screening cannot be accurately estimated from self-reported data, but the rate of prior testing in the study participants is certainly higher than that reported in the general UK population (Melia et al, 2004).…”

“…The study was not designed to investigate the efficacy of screening. The results of a psychosocial study conducted in conjunction with the screening study (refer Sweetman et al, 2006) are reported separately.…”

Increased cancer risk for individuals with a family history of prostate cancer, colorectal cancer, and melanoma and their associated screening recommendations and practices

“…Men with a high level of anxiety associated with screening tend to avoid it, while many men who are aware of their own risk, but are less anxious, tend to participate more often [61]. Men were shown to be anxious both about receiving a diagnosis of prostate cancer and also taking the time off work to get screened, but the screening itself has not been found to be a source of anxiety [62,66]. Improving screening for family members remains a vital strategy even though rates of screening for men with a family history of prostate cancer (between 55% and 70%) outnumber those in the general population (34-57% of men over 50 years) [58,61,[63][64][65].…”

“…Many factors are associated with first-degree relatives seeking screening: older age, higher income, discussions Cancer Causes Control (2008) 19:1- 12 3 with physicians, greater knowledge about prostate cancer and having a real or elevated sense of risk [58,63,66,[69][70][71]. The inconvenience of going to the doctor, and simply putting off the test are other known barriers [72].…”