Psychosocial consequences of receiving false-positive colorectal cancer screening results: a qualitative study

Abstract Objective: The objective of this study was to investigate the psychosocial consequences of receiving false-positive colorectal cancer (CRC) screening results, following a positive immunochemical faecal occult blood test. Design, setting, and subjects: We conducted a qualitative study with four semi-structured focus group interviews with 16 participants aged 50–74, all of whom had received a false-positive result in the national Danish CRC screening programme. We selected, recruited, and grouped participants to ensure maximum variation, and to enable a level of confidence to speak openly about experiences of screening. We subjected interview data, audio-recordings, and transcripts to a strategy of qualitative analysis called systematic text condensation. Results: We identified four main themes which described the psychosocial consequences of false-positive CRC screening results: anxiety; discomfort; changed self-perception and behaviour; and considerations on participation in screening. Each of these themes covered a wide range of experiences which were relevant to the informants and broadly shared by them in many aspects. Conclusions: Receiving false-positive results from CRC screening can lead to negative psychosocial consequences such as changes in self-perception and anxiety: some participants may experience subsequent relief, others not. These negative psychosocial consequences might persist over time. Implications: Negative psychosocial consequences from false-positive CRC screening results may result in a greater use of general practitioner services by healthy people who need reassurance or further tests. More research using condition-specific measures is required to further understand the degree and potential persistence of psychosocial consequences of false-positive results from CRC screening. Key Points Participants who receive false-positive colorectal cancer (CRC) screening results may experience negative psychosocial consequences e.g. anxiety and subsequent relief. Participants who receive false-positive CRC screening results may experience discomfort during the screening process. Participants who receive false-positive CRC screening results may experience longer term changes of self-perception. Participants who receive false-positive CRC screening results may experience ambivalence about the offered diagnostic down-stream procedures including colonoscopy.

[1]  Stacey L. Sheridan,et al.  The Psychological Harms of Screening: the Evidence We Have Versus the Evidence We Need , 2015, Journal of General Internal Medicine.

[2]  Lisa M. Schwartz,et al.  Overdiagnosis: How cancer screening can turn indolent pathology into illness , 2014, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[3]  K. Marshall Prevention. How much harm? How much benefit? 3. Physical, psychological and social harm. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[4]  J. Brodersen,et al.  Informed participation in cancer screening: The facts are changing, and GPs are going to feel it , 2010, Scandinavian journal of primary health care.

[5]  F. Griffiths,et al.  Health professionals, their medical interventions and uncertainty: a study focusing on women at midlife. , 2006, Social science & medicine.

[6]  J. Elmore,et al.  Increased patient concern after false-positive mammograms , 2001, Journal of General Internal Medicine.

[7]  I. Gram,et al.  Quality of life following a false positive mammogram. , 1990, British Journal of Cancer.

[8]  B. Hofmann Ethical issues with colorectal cancer screening—a systematic review , 2017, Journal of evaluation in clinical practice.

[9]  G. Divine,et al.  The economic impact of false-positive cancer screens. , 2004, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[10]  Harminder Singh,et al.  Anxiety Associated with Colonoscopy and Flexible Sigmoidoscopy: A Systematic Review , 2018, The American Journal of Gastroenterology.

[11]  Carl Heneghan,et al.  Overdiagnosis: what it is and what it isn’t , 2018, BMJ Evidence-Based Medicine.

[12]  K. Malterud Systematic text condensation: A strategy for qualitative analysis , 2012, Scandinavian journal of public health.

[13]  F. Griffiths,et al.  Screening for breast cancer: Medicalization, visualization and the embodied experience , 2010, Health.

[14]  A. Dirksen,et al.  Participation bias in a randomised trial of screening for lung cancer. , 2011, Lung cancer.

[15]  J. Wardle,et al.  Psychological impact of colorectal cancer screening. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[16]  J. Wardle,et al.  The Psychological Impact of Being Offered Surveillance Colonoscopy following Attendance at Colorectal Screening Using Flexible Sigmoidoscopy , 2009, Journal of medical screening.

[17]  J. Brodersen,et al.  Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: a registry study. , 2014, Lung cancer.

[18]  A. Farmer,et al.  Experiences of patients with false positive results from colorectal cancer screening. , 1990, The British journal of general practice : the journal of the Royal College of General Practitioners.

[19]  Marshall Kg,et al.  Prevention. How much harm? How much benefit? 3. Physical, psychological and social harm , 1996 .

[20]  J. Brodersen,et al.  Consequences of Screening in Breast Cancer (COS-BC): development of a questionnaire , 2008, Scandinavian journal of primary health care.

[21]  S. Orbell,et al.  Women's Experiences at Cervical Screening , 1995, Scottish medical journal.

[22]  M. Lilja,et al.  Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer , 2013, Scandinavian journal of primary health care.

[23]  E. Kuipers,et al.  Quality of life in participants of a CRC screening program , 2012, British Journal of Cancer.

[24]  T. Jørgensen,et al.  Psychological distress following fecal occult blood test in colorectal cancer screening – a population-based study , 2010, Scandinavian journal of gastroenterology.

[25]  Len Lichtenfeld,et al.  Overdiagnosed: Making People Sick in Pursuit of Health , 2011 .

[26]  J. Scholefield,et al.  Psychiatric morbidity and screening for colorectal cancer , 2002, Journal of medical screening.

[27]  Atle Fretheim,et al.  Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. , 2013, The Cochrane database of systematic reviews.

[28]  J. Brodersen,et al.  Psychosocial consequences among women with false-positive results after mammography screening in Norway , 2018, Scandinavian journal of primary health care.