Psychosocial consequences of screening-detected abdominal aortic aneurisms: a cross-sectional study

Abstract

Objective In Sweden, an abdominal aortic aneurysm (AAA) screening programme was gradually implemented from 2009 to reduce the incidence of rupture and thereby mortality. AAA screening introduces a variety of unintended, but generally unavoidable, harms, e.g. stress and worry. Such psychosocial consequences have previously only been investigated with generic measures. Therefore, the aim of this study was to describe and compare the psychosocial consequences in men with a screening detected AAA to men with a normal screening result after they participated in the Swedish national AAA-screening programme using a validated psychometric instrument. Material and methods This study was a cross-sectional survey. Data were originally collected to validate the COS-AAA and has previously been published in details. The Consequences of Screening in Abdominal Aortic Aneurysm (COS-AAA) questionnaire was sent to 250 men with a screening detected AAA and 500 with a normal screening result who were randomly selected from a Swedish population-based screening register. Results In total, 158 (63%) men with a screening detected AAA and 275 (55%) men with a normal screening result completed the COS-AAA. We found that men with a screening detected AAA reported negative psychosocial consequences to a greater extent in 10 of 13 COS-AAA Part 1 scales, all statistically significant except three (behaviour, sleep and negative experiences from examination). For COS-AAA Part 2, there was a statistically significant difference between groups in four of five scales. Conclusions Men diagnosed with a screening detected AAA, reported more negative psychosocial consequences compared to men with a normal result. Screening for abdominal aorta aneurism (AAA) introduces intended benefits and unintended harms. Adequate measures are necessary to determine the balance between them. Key points: This study applied a condition-specific questionnaire with high content validity and adequate psychometric properties to measure psychosocial consequences in men participating in AAA screening. We found that men with a screening detected AAA reported more negative psychosocial consequences than men with a normal aorta size. The risk of negative psychosocial consequences is important to include in the decision making on whether to participate in screening or not.

Long-term psychosocial consequences of false-positive screening mammography: a cohort study with follow-up of 12–14 years in Denmark

“…The core questionnaire COS was later used as a basis to develop other questionnaires in the context of screening for lifethreatening diseases. [23][24][25] On that basis, the COS-BC was extended from 12 to 14 dimensions, now including empathy and impulsivity. 26 These two scales are therefore only measured in this follow-up.…”

Ergebnisse eines monozentrischen Gefäßscreeningprogramms in Deutschland

“…Da bei Frauen arteriosklerotische Veränderungen wie das AAA seltener und erst in höherem Alter auftreten, wird für sie in der Regel eine Teilnahme an von Gesundheitssystemen getragenen AAA-Screenings nicht empfohlen. Auch Studien zum Screening mit einem hohen Anteil an Frauen in der untersuchten Population sind selten [ 11 , 13 , 27 ]. Darüber hinaus könnte eine im Länder- und Systemvergleich unterschiedliche Bereitschaft von Menschen mit einem besonders hohen oder niedrigen Risiko für Gefäßerkrankungen, an Screeningprogrammen teilzunehmen, eine Rolle spielen [ 28 ].…”

“…Hiervon wiesen 0,3 % eine > 60 %ige Stenose, 1 % ein behandlungsbedürftiges AAA und 5,8 % einen ABI < 0,9 auf [ 3 ]. Die Prävalenz eines maximalen transversalen Aortendurchmessers > 3 cm bei erstmals zum Screening eingeladenen Männern in England und Schweden betrug 1,3–1,7 % und ist somit ebenfalls mit den Ergebnissen der vorliegenden Studie vergleichbar [ 11 , 13 , 27 ].…”

“…Der Nachweis einer Erkrankung im Rahmen eines Screenings kann zu psychischen Belastungen in Form von Krankheitsängsten und existenziellen Sorgen führen [ 11 ]. Dieser Aspekt konnte in unserer Studie durch die erhobenen Daten nicht näher betrachtet werden, muss aber bei Screeningprogrammen immer Beachtung finden und unter Umständen durch spezifische Aufklärungs- und Betreuungsmaßnahmen adressiert werden.…”

Methodological Quality of PROMs in Psychosocial Consequences of Colorectal Cancer Screening: A Systematic Review

“…1,2 PROMs have previously been used in screening contexts to measure psychosocial consequences of screening. [3][4][5][6][7] In a screening setting, the word patient in PROM should be read as apparently healthy persons. Any PROM should be rigorously developed and its measurement properties should be assessed to ensure that the PROM validly measures the latent trait and reliably assess changes over time.…”