Differential impact of different types of screening

Different types of screening may vary in a number of ways which may have an impact on the nature of the psychological reaction to testing.

1. People's perceptions of the condition being screened for are likely to be important. For example, screening for conditions which are regarded as being possibly fatal and/or incurable (e.g. cancer, AIDS) appears to evoke more negative reactions than screening for what are perceived to be a less serious condition that can be prevented (e.g. osteoporosis). People often perceive AIDS as being associated with social stigma which may add to the burden of a positive HIV test result.

2. The way in which people have been recruited for screening may have an impact on their psychological reactions. (42> People who are tested because they are already known to be at high risk are likely to be more distressed before testing. In this case, testing may bring reassurance to those with a negative result and relief from uncertainty for those with a positive result. In contrast, those for whom problems are detected through routine population-based screening may be unprepared for the shock of the test result. Another difference between population and some high-risk screening may be the issue of self-selection.

3. Adverse effects may be more likely to occur where a whole population is screened(43) (such as an entire workforce) than where people volunteer for screening, because in the latter case those who are more likely to react badly may choose not to attend. For example, only a small proportion of those at risk for Huntington's disease choose to undergo testing, possibly those people who are more psychologically robust. It is possible that people may also take care over the timing of voluntary screening, avoiding testing at a time when they would also be under considerable stress from other sources.

4. For some types of testing (e.g. genetic testing or HIV) there is pre- and/or post-test counselling, and it possible that this will have a significant impact on the person's reactions.

5. The way in which the test result is conveyed may be important. For example, after some screening the result is sent through the post and the person may not have the opportunity to ask questions immediately or share their feelings. The information provided at the time of the test result may make a significant difference to psychological outcome.

6. Screening programmes may also vary in terms of the length of time between testing and the result being conveyed to the person. There is some evidence to suggest that a longer wait may be associated with greater distress in response to a positive or high-risk result. (44> For some people this may be related to concern that the disease could have worsened since the time of testing.

7. The factor that is being screened for—either existing pathology or merely a risk factor—is likely to have an effect on psychological reactions. Not surprisingly, reactions to screening procedures which detect existing cancer are generally much more negative than to tests which detect a risk factor such as high cholesterol or high blood pressure, even though heart disease is a condition of similar seriousness. The extent of risk posed by the risk factor is also important. Tests for a risk factor which carries a very high chance of causing the condition, such as HIV or the genes for Huntington's disease or cancer, are likely to evoke more adverse reactions than tests for blood pressure or low bone density which are associated with a lower risk.

8. The implication of test results for relationships with others can vary significantly. For example, HIV testing has implications regarding infection of partners or children, and genetic testing has implications regarding inheritance.

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