psychosocial consequences of false- positive screening results - breast cancer as an example john...
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Psychosocial consequences of false-positive screening results - breast cancer as an example
John Brodersen MD, GP, PhD
The Department of General PracticeInstitute of Public Health
Centre of Health and SocietyUniversity of Copenhagen
Psychosocial consequences of false-positive screening results - breast cancer as an example 2
Content of presentation
Medical screening Breast cancer screening Psychosocial consequences Conclusions and perspectives
Psychosocial consequences of false-positive screening results - breast cancer as an example 3
Content of presentation
Medical screening Breast cancer screening Psychosocial consequences Conclusions and perspectives
Psychosocial consequences of false-positive screening results - breast cancer as an example 4
Screening the coal
Psychosocial consequences of false-positive screening results - breast cancer as an example 5
Outcome of medical screening
Disease
Healthy
Positive screening result
True positive False positive
Negative screening result
False negative True negative
Psychosocial consequences of false-positive screening results - breast cancer as an example 6
Outcome of medical screening
Disease
Healthy
Positive screening result
True positive
False positive ‘False alarm’
Negative screening result
False negative
True negative
Psychosocial consequences of false-positive screening results - breast cancer as an example 7
Outcome of medical screening
Healthy
Disease
Arbitrary scale
Psychosocial consequences of false-positive screening results - breast cancer as an example 8
Content of presentation
Medical screening Breast cancer screening Psychosocial consequences Conclusions and perspectives
Psychosocial consequences of false-positive screening results - breast cancer as an example 9
Proportion
2,000 women, age 50 – 69, screened every second year for 10 years – 5 rounds:
1 death of breast cancer prevented> 200 false-positive result
1:200
P. C. Gotzsche and M. Nielsen. Screening for breast cancer with mammography. Cochrane Database.Syst.Rev. (4):CD001877, 2006.
Psychosocial consequences of false-positive screening results - breast cancer as an example 10
Content of presentation
Medical screening Breast cancer screening Psychosocial consequences Conclusions and perspectives
Psychosocial consequences of false-positive screening results - breast cancer as an example 11
Adequacy of measurement
23 studies identified Most commonly used measures:
The General Health Questionnaire (GHQ)The Hospital Anxiety and Depression Scale (HADS)The Psychological Consequences Questionnaire (PCQ)The State-Trait Anxiety Inventory (STAI)
These 4 measures used in 17 studies
Brodersen J., Thorsen H., Cockburn J. The adequacy of measurement of short and long term consequences of false-positive screening mammography. Review. Journal of Medical Screening 11 (1):39-44. 2004.
Psychosocial consequences of false-positive screening results - breast cancer as an example 12
Focus groups - content validity
Examinations Ultrasound & clini-cal mammography
Plus needle biopsy
Plus surgical biopsy
No. of women 5 7 7
Mean age 58.2 58.7 55.8
Examinations Plus earlyrecall
Plus needlebiopsy
Plus surgical biopsy
No. of women 5 5 7
Mean age 59.6 53.6 57.7
J. Brodersen and H. Thorsen. Consequences Of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand.J Prim.Health Care 26 (4):251-256, 2008.
Psychosocial consequences of false-positive screening results - breast cancer as an example 13
Result from interviews
Part I: 33 items on negative psychosocial consequences
At invitationAt screeningAfter diagnosis
Part II: 13 items on long-term psychosocial consequences
After diagnosisJ. Brodersen and H. Thorsen. Consequences Of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand.J Prim.Health Care 26 (4):251-256, 2008.
Psychosocial consequences of false-positive screening results - breast cancer as an example 14
Statistical methods
ReliabilityCronbach’s alphaPerson Separation IndexTest-retest (part II)
ValidityRasch analysisConfirmatory factor analysisConcurrent validityKnow group validity
J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4):294-304, 2007.
Psychosocial consequences of false-positive screening results - breast cancer as an example 15
COS-BC part I
Psychosocial consequences of false positive screening results
Anxiety – 6 items
Behavioural aspects - 7 items
Sense of dejection – 6 items
Sleep problems - 4 items
Breast examination - 2 items
Sexuality - 2 items
Single items – 3 items
J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4):294-304, 2007.
Psychosocial consequences of false-positive screening results - breast cancer as an example 16
COS-BC part II
Psychosocial consequences of false positive screening results
Anxious about/belief in (not) having breast cancer – 2 itemsMore or less relax - 2 itemsSocial relationship – 3 itemsExistential values - 6 items
J. Brodersen. Measuring psychosocial consequences of false-positive screening results - breast cancer as an example, Department of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen:Månedsskrift for Praktisk Lægegerning, Copenhagen. ISBN: 87-88638-36-7, 2006.
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Scores of anxiety (0-18)
Group Mean score
Abnormal screening 6.39
Breast cancer 7.38
False-positive 3.04
Undiagnosed 4.38
Normal screening 0.97
J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4):294-304, 2007.
Psychosocial consequences of false-positive screening results - breast cancer as an example 18
5 response category
After the examinations I have thought about the broader aspects of life:
Much less Less The same as
before More Much
more
Fewer thoughts about
life
More thoughts about life
Psychosocial consequences of false-positive screening results - breast cancer as an example 19
Know group validity - 1
Breast cancer - anxiety/mistrust
0%
20%
40%
60%
80%
100%
muchgreater
greater same asbefore
less muchless
Response categories
Normal
False positive
Psychosocial consequences of false-positive screening results - breast cancer as an example 20
Know group validity - 2
Feeling relaxed and calm
0%
20%
40%
60%
80%
100%
muchless
less same asbefore
greater muchgreater
Response categories
Normal
False positive
Psychosocial consequences of false-positive screening results - breast cancer as an example 21
Know group validity - 3
Relation to social network
0%
20%
40%
60%
80%
100%
much less less same asbefore
greater muchgreater
Response categories
Normal
False positive
Psychosocial consequences of false-positive screening results - breast cancer as an example 22
Know group validity - 4
Existential values
0%
20%
40%
60%
80%
100%
muchless
less same asbefore
greater muchgreater
Response categories
Normal
False positive
Psychosocial consequences of false-positive screening results - breast cancer as an example 23
Know group validity - 4
Existential values
0%
20%
40%
60%
80%
100%
muchless
less same asbefore
greater muchgreater
Response categories
Normal
False positive
Psychosocial consequences of false-positive screening results - breast cancer as an example 24
Content of presentation
Medical screening Breast cancer screening Psychosocial consequences Conclusions and perspectives
Psychosocial consequences of false-positive screening results - breast cancer as an example 25
Conclusion 1
The conclusions drawn from previously conducted studies regarding long-term psychosocial consequences of false-positive screening mammography should remain tentative
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Conclusion 2a
A valid and reliable condition-specific instrument measuring psychosocial consequences of abnormal and false-positive screening mammography has been established
Psychosocial consequences of false-positive screening results - breast cancer as an example 27
Conclusion 2b
Consequences of Screening on Breast Cancer (COS-BC)1.Psychosocial consequences of
abnormal and false-positive screening mammography
2.Long-term psychosocial consequences of false-positive screening mammography
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Conclusion 3
There are substantial negative psychosocial consequences associated with having an abnormal screening mammography later confirmed to be false-positive
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Implications for practice
Letters and folders posted at invitation to screening should contain information on the negative psychosocial consequences arising from abnormal and false-positive screening results
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Implications for research
Need for valid instruments in the area of psychosocial consequences of screening for any cancers
To establish core-items and core-subscales relevant for any kind of cancer screening
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Consequences Of Screening
Lung cancer P1: 17 items P2: 4 items
Cervical cancer P1: 40 items
Breast cancer P1: 4 items
Core P1: 26 itemsP2: 22 items