Psychological consequences of screening for abdominal aorticaneurysm and conservative treatment of small abdominal aortic aneurysms

Abstract

Objective: To describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs). Methods: The participants were prospectively and randomly sampled from a randomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material: Case-control study: ScreenQL was completed once by 168 (48%) of 350 non-responders to screening, 271 (81%) of 335 attenders before screening, 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not to be offered screening for AAA (controls). Prospective study (paired data): 127 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated after initial conservative treatment. Results: Initially, the QL score was 5% lower among men with a small AAA compared to the controls (p<0.05), mainly because of poorer health perception. The QL score declined significantly further to 7% below control values during the period of conservative treatment. This impairment was mainly due to a 21% and 15% reduction in scores relating to health perception and psychosomatic distress, respectively. However, all scores improved to control levels in patients operated on. The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening. No differences were noticed concerning the non-attenders. Conclusion: The offer of screening causes transient psychological stress in subjects found not to have AAA. However diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases. This impairment seems reversible by operation. Nevertheless, the impairment seems considerable, and must be considered in the management of AAA and in the final evaluation of screening for AAA.