Narasimman Manasa, Hernaez Ruben, Cerda Vanessa, Lee MinJae, Sood Anubha, Yekkaluri Sruthi, Khan Aisha, Quirk Lisa, Liu Yan, Kramer Jennifer R, Craddock Lee Simon, Murphy Caitlin C, Tiro Jasmin A, Singal Amit G
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Hepatology. 2024 Jan 1;79(1):107-117. doi: 10.1097/HEP.0000000000000528. Epub 2023 Jul 4.
The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms.
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.
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.
肝癌监测的价值取决于获益与危害之间的平衡；然而，尚无研究列举出其心理危害。
在一项肝癌监测推广的多中心随机试验中，我们对肝硬化患者进行了测量心理危害的调查。所有监测结果为阳性或不确定的患者以及匹配的监测结果为阴性的患者均被邀请完成相关调查，这些调查测量了：（1）通过患者健康问卷第九版测量抑郁；（2）通过状态-特质焦虑量表测量焦虑；（3）通过心理后果问卷测量肝癌特异性担忧；（4）决策后悔。患者被分为4组：真阳性（TP）、假阳性（FP）、不确定和真阴性（TN）。使用广义估计方程法进行多变量纵向回归分析，以比较各组测量指标的均值。我们对按卫生系统和检测结果分层的部分患者进行了89次半结构化访谈。在该试验的2872名患者中，311名完成了1次或更多次随访调查（63名假阳性、77名不确定、38名真阳性和133名真阴性）。真阴性患者中中度抑郁有所下降，真阳性患者中有所增加，而假阳性和结果不确定的患者中有间歇性但轻微的增加。真阳性结果的患者中高焦虑暂时增加，但随时间推移有所缓解，而假阳性和结果不确定的患者中则保持稳定。决策后悔程度较低，且各组之间无差异。在半结构化访谈中，患者报告了与肝癌监测相关的担忧、焦虑、情绪困扰和应对情况。
肝癌监测的心理危害似乎较轻，但因检测结果而异。未来的研究应确定心理危害对肝癌监测项目价值的影响。
