AHRQ Study Finds Evidence Lacking on Psychological Harms for Five Screening Guidelines

An AHRQ-funded study and abstract in the August issue of the Journal of General Internal Medicine revealed that only a small number of studies have addressed the psychological harms of selected screening services. According to the study, more evidence exists on the physical harms of screening services compared with psychological harms, which can include anxiety, distress and reduced quality of life. A team led by researchers at the University of North Carolina, Chapel Hill, examined the literature assessing psychological harms of screening services reviewed by the U.S. Preventive Services Task Force for the following five conditions: prostate and lung cancers, abdominal aortic aneurysm, osteoporosis and carotid artery stenosis. Among the available evidence, only one-third of the studies on psychological harm used both a longitudinal design and included condition-specific measures, which provide the best level of evidence on psychological harm. The authors called on clinicians and guideline panels to use a wider consideration of screening harms in research design. The study is titled, “The Psychological Harms of Screening: the Evidence We Have Versus the Evidence We Need.”

2014 Aug 23. [Epub ahead of print]

The Psychological Harms of Screening: the Evidence We Have Versus the Evidence We Need.

DeFrank JT1, Barclay C, Sheridan S, Brewer NT, Gilliam M, Moon AM, Rearick W, Ziemer C, Harris R.

Author information

Abstract

BACKGROUND:

Systematic reviews for the US Preventive Services Task Force have found less high-quality evidence on psychological than physical harms of screening. To understand the extent of evidence on psychological harms, we developed an evidence map that quantifies the distribution of evidence on psychological harms for five adult screening services. We also note gaps in the literature and make recommendations for future research.

METHODS:

We systematically searched PubMed, PsycInfo, and CINAHL from 2002 to 2012 for studies of any research design that assessed the burden or frequency of psychological harm associated with screening for: prostate and lung cancers, osteoporosis, abdominal aortic aneurysm (AAA) and carotid artery stenosis (CAS). We also searched for studies that estimated rates of overdiagnosis (a marker for unnecessary labeling). We included studies published in English and used dual independent review to determine study inclusion and to abstract information on design, types of measures, and outcomes assessed.

RESULTS:

Sixty-eight studies assessing psychological harms met our criteria; 62 % concerned prostate cancer and 16 % concerned lung cancer. Evidence was scant for the other three screening services. Overall, only about one-third of the studies used both longitudinal designs and condition-specific measures (ranging from 0 % for AAA and CAS to 78 % for lung cancer), which can provide the best evidence on harms. An additional 20 studies that met our criteria estimated rates of overdiagnosis in lung or prostate cancer. No studies estimated overdiagnosis for the non-cancer screening services.

DISCUSSION:

Evidence on psychological harms varied markedly across screening services in number and potential usefulness. We found important evidence gaps for all five screening services. The evidence that we have on psychological harms is inadequate in number of studies and in research design and measures. Future research should focus more clearly on the evidence that we need for decision making about screening.