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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 Practice Institute of Public Health Centre of Health and Society University of Copenhagen. Content of presentation. Medical screening

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psychosocial consequences of false positive screening results breast cancer as an example

Psychosocial consequences of false-positive screening results - breast cancer as an example

John Brodersen

MD, GP, PhD

The Department of General Practice

Institute of Public Health Centre of Health and Society

University of Copenhagen

content of presentation
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

content of presentation1
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

screening the coal
Screening the coal

Psychosocial consequences of false-positive screening results - breast cancer as an example

outcome of medical screening
Outcome of medical screening

Psychosocial consequences of false-positive screening results - breast cancer as an example

outcome of medical screening1
Outcome of medical screening

Psychosocial consequences of false-positive screening results - breast cancer as an example

outcome of medical screening2
Outcome of medical screening

Healthy

Disease

Arbitrary scale

Psychosocial consequences of false-positive screening results - breast cancer as an example

content of presentation2
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

proportion
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

content of presentation3
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

adequacy of measurement
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

focus groups content validity
Focus groups - content validity

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

result from interviews
Result from interviews
  • Part I: 33 items on negative psychosocial consequences
    • At invitation
    • At screening
    • After diagnosis
  • Part II: 13 items on long-term psychosocial consequences
    • After diagnosis

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

statistical methods
Statistical methods
  • Reliability
    • Cronbach’s alpha
    • Person Separation Index
    • Test-retest (part II)
  • Validity
    • Rasch analysis
    • Confirmatory factor analysis
    • Concurrent validity
    • Know 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

cos bc part i
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

cos bc part ii
COS-BC part II
  • Psychosocial consequences of false positive screening results
    • Anxious about/belief in (not) having breast cancer – 2 items
    • More or less relax - 2 items
    • Social relationship – 3 items
    • Existential 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.

Psychosocial consequences of false-positive screening results - breast cancer as an example

scores of anxiety 0 18
Scores of anxiety (0-18)

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

5 response category
5 response category

Psychosocial consequences of false-positive screening results - breast cancer as an example

know group validity 1
Know group validity - 1

Psychosocial consequences of false-positive screening results - breast cancer as an example

know group validity 2
Know group validity - 2

Psychosocial consequences of false-positive screening results - breast cancer as an example

know group validity 3
Know group validity - 3

Psychosocial consequences of false-positive screening results - breast cancer as an example

know group validity 4
Know group validity - 4

Psychosocial consequences of false-positive screening results - breast cancer as an example

know group validity 41
Know group validity - 4

Psychosocial consequences of false-positive screening results - breast cancer as an example

content of presentation4
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

conclusion 1
Conclusion 1
  • The conclusions drawn from previously conducted studies regarding long-term psychosocial consequences of false-positive screening mammography should remain tentative

Psychosocial consequences of false-positive screening results - breast cancer as an example

conclusion 2a
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

conclusion 2b
Conclusion 2b
  • Consequences of Screening on Breast Cancer (COS-BC)
    • Psychosocial consequences of abnormal and false-positive screening mammography
    • Long-term psychosocial consequences of false-positive screening mammography

Psychosocial consequences of false-positive screening results - breast cancer as an example

conclusion 3
Conclusion 3
  • There are substantial negative psychosocial consequences associated with having an abnormal screening mammography later confirmed to be false-positive

Psychosocial consequences of false-positive screening results - breast cancer as an example

implications for practice
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

Psychosocial consequences of false-positive screening results - breast cancer as an example

implications for research
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

Psychosocial consequences of false-positive screening results - breast cancer as an example

c onsequences o f s creening
Consequences Of Screening

Lung cancer

P1: 17 items

P2: 4 items

Cervical cancer

P1: 40 items

Core

P1: 26 items

P2: 22 items

Breast cancer

P1: 4 items

Psychosocial consequences of false-positive screening results - breast cancer as an example

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