Psychological factors and the health screening process

Psychological factors are important at all stage of the screening process.(3) Many people consider health screening as a result of health education, either as a result health educators efforts or sometimes as a consequence of media attention. The psychological effects of such information is poorly understood. There is limited evidence that such information can have adverse effects, as for example in the 'AIDS panic' in the 1980s. (5) It has been suggested that awareness of the availability of a screening procedure or test is in itself an important factor, because it confronts the person with a decision which they were previously unaware existed. (6,7)

Decision-making represents the beginning of more active participation in the screening process. Decision-making is a complex psychological phenomenon, often described in terms of Prochaska and DiClemente's 'transtheoretical' model.(8) They suggest that the process of change can be divided into phases: precontemplation, contemplation, action, and maintenance. In health screening, most attention has been focused on the transition between contemplation and action and how this can best be achieved whilst maintaining patient autonomy. Traditionally, this has been done using non-directive counselling approaches, in which the counsellor helps the person explore the issues without any attempt to influence the decision itself. However, considerable doubt has been cast on the extent to which non-directiveness is possible to achieve in the context of helping people make decisions about screening. (9) In a series of experimental studies, Wroe, Salkovskis, and colleagues demonstrated that procedures which are widely adopted by counsellors as 'non-directive' (such as exploration of possible negative emotional responses to testing) can systematically bias the outcome of decisions of whether or not to be tested.(1l1 Traditionally, non-directive counsellors have tended, for understandable reasons, to help the patient to explore possible adverse outcomes as a way of preparing them for 'the worst'. The evidence is that to do so without providing equal weight in the discussion to the possible benefits of testing will tend to bias the person against being screened.

Once screening is undertaken, the reactions to the results are influenced by a range of procedural and individual difference factors. Clearly, it is important to understand the range and correlates of psychological and psychiatric effects of health screening in order to then target intervention procedures intended to reduce distress and other adverse effects of screening (including false reassurance and induced failure to engage in preventative measures).

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