Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis

焦虑 医学 后悔 临床心理学 不确定 内科学 担心 肝硬化 苦恼 精神科 纯数学 数学 机器学习 计算机科学
作者
Manasa Narasimman,Rubén Hernáez,Vanessa Cerda,MinJae Lee,Anubha Sood,Sruthi Yekkaluri,Aisha Khan,Lisa Quirk,Yan Liu,Jennifer R. Kramer,Simon J. Craddock Lee,Caitlin C. Murphy,Jasmin A. Tiro,Amit G. Singal
出处
期刊:Hepatology [Lippincott Williams & Wilkins]
卷期号:79 (1): 107-117 被引量:40
标识
DOI:10.1097/hep.0000000000000528
摘要

Background and Aims: The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms. Approach and Results: We fielded surveys measuring psychological harms to patients with cirrhosis in a multicenter randomized trial of HCC surveillance outreach. All patients with positive or indeterminate surveillance results and matched patients with negative results were invited to complete surveys measuring (1) depression through the Patient Health Questionnaire-ninth version, (2) anxiety through State-Trait Anxiety Inventory, (3) HCC-specific worry through Psychological Consequences Questionnaire, and (4) decisional regret. Patients were classified into 4 groups: true positive (TP), false positive (FP), indeterminate, and true negative (TN). Multivariable longitudinal regression analysis using the generalized estimating equation method was performed to compare the means of measures across groups. We conducted 89 semistructured interviews in a subset of patients stratified by health system and test results. Of 2872 patients in the trial, 311 completed 1+ follow-up survey (63 FP, 77 indeterminate, 38 TP, and 133 TN). Moderate depression decreased in TN patients, increased in TP, and had intermittent but mild increases in those with FP and indeterminate results. High anxiety temporarily increased in patients with TP results but resolved over time and was stable in those with FP and indeterminate results. Decisional regret was low and did not differ across groups. In semistructured interviews, patients reported apprehension, anxiety, emotional distress, and coping related to HCC surveillance. Conclusions: Psychological harms of HCC surveillance appear mild but differ by test result. Future research should determine the impact of psychological harms on the value of HCC surveillance programs.
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