Fichtner Urs Alexander, Maun Andy, Farin-Glattacker Erik
Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
Department for General Practice, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.
PLoS One. 2025 Apr 29;20(4):e0319488. doi: 10.1371/journal.pone.0319488. eCollection 2025.
Medical screening is employed to detect early signs of diseases in asymptomatic populations, potentially improving patient outcomes through early intervention. However, the psychosocial impact of screenings remains a field of discussion. Inconsistent findings from studies, mainly originally from cancer research, are not easily transferable to the context of liver screening. This study aimed to identify predictors of psychosocial consequences in asymptomatic adults screened for early-stage liver cirrhosis, thereby contributing to the current knowledge on screening impact.
We analyzed data from 487 participants who underwent a systematic liver disease screening in Germany from January 2018 to February 2021. The screening involved blood tests, advanced diagnostics, and potentially, liver biopsies. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on psychosocial outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ).
The results show that severity of comorbidities (beta = 0.44-2.72), subjective social status (beta = -0.30--0.86), and social support (beta = -0.33--0.98) were consistent predictors across all psychosocial outcome measures by not covering zero in the confidence intervals. Older age (beta = -0.03--0.08), the existence of a steady partnership (beta = -1.08--0.48) and higher health literacy regarding the application of medical information (beta = 0.33-0.48) were associated with less psychosocial dysfunction, indicating their protective roles to prevent psychosocial burden of screening.
The study underscores the importance of considering individual patient characteristics in predicting psychosocial consequences of medical screening. Medical practitioners should consider personalized communication strategies taking into account the individual context of patients. The protective role of social support and stable personal relationships suggests that integrating psychosocial support services within screening programs could mitigate negative outcomes. Furthermore, increasing patient health literacy might help to demystify the screening process and can reduce psychosocial burden even if patients come from a segment of lower subjective social status.
医学筛查用于在无症状人群中检测疾病的早期迹象，有望通过早期干预改善患者预后。然而，筛查的社会心理影响仍是一个讨论的领域。研究结果不一致，主要源于癌症研究，不易应用于肝脏筛查的背景。本研究旨在确定无症状成年人早期肝硬化筛查中社会心理后果的预测因素，从而为当前关于筛查影响的知识做出贡献。
我们分析了2018年1月至2021年2月在德国接受系统性肝病筛查的487名参与者的数据。筛查包括血液检查、高级诊断以及可能的肝活检。我们使用带有10倍交叉验证的自抽样LASSO回归来评估各种预测因素对通过筛查问卷心理后果（PCQ）测量的社会心理结果的影响。
结果表明，共病严重程度（β = 0.44 - 2.72）、主观社会地位（β = -0.30 - -0.86）和社会支持（β = -0.33 - -0.98）是所有社会心理结果测量指标的一致预测因素，其置信区间不包含零。年龄较大（β = -0.03 - -0.08）、存在稳定伴侣关系（β = -1.08 - -0.48）以及在医学信息应用方面较高的健康素养（β = 0.33 - 0.48）与较少的社会心理功能障碍相关，表明它们在预防筛查的社会心理负担方面的保护作用。
该研究强调了在预测医学筛查的社会心理后果时考虑个体患者特征的重要性。医生应考虑个性化的沟通策略，同时考虑患者的个体情况。社会支持和稳定个人关系的保护作用表明，在筛查项目中整合社会心理支持服务可以减轻负面结果。此外，提高患者健康素养可能有助于揭开筛查过程的神秘面纱，即使患者来自主观社会地位较低的群体，也可以减轻社会心理负担。
