BreastScreen anxiety feasibility study

Abstract

Background: Breast cancer is the leading cancer affecting women in Australia and worldwide. Negative psychological impact of breast screening is widely reported, with heightened levels of anxiety experienced by women recalled for assessment due to an abnormality detected on their screening mammogram. Methods: This study was designed to test the feasibility of the study design for the implementation of a larger scale BreastScreen Anxiety (BSAnx) study. The design of this study is complex, taking a pragmatic approach this feasibility study was used to test the implementation of methodology, and provide baseline data for current depression, anxiety and stress levels in women using the BreastScreen program and determine any barriers or limitations prior to implementing a larger scale national study. Participants: Phase One (Screening Population): Women attending BreastScreen ACT for a screening mammogram, and Phase Two (Recall for Assessment) women subsequently recalled for assessment. Design: Small-scale time-clustered randomised controlled trial with two groups (Control and Intervention) using different delivery methods of statistical information. Outcome Measures: Primary: Depression, Anxiety and Stress Scale – 21 Items (DASS-21). Secondary: Understanding of a screening false positive result. Data Analysis: Demographic data presented as descriptive statistics. Summary statistics reported as means and standard deviations. Linear mixed model testing group differences. Nominal data evaluated using Chi squared test (휒2). Calculation of sample size for larger scale study. Results: Barriers and Facilitators: Issues concerning staff training and education and data collection impacted upon recruitment and retention of participants and data collection. Sample Size Calculations: For a large scale BreastScreen Anxiety study a sample size of 568 participants/group is required, with a cluster size of 80 participants/month. Participation: Phase One: 2754 women attended BreastScreen ACT for a screening mammogram with 1583 (57%) participating in Phase One. Phase Two: Of the 2754 women screened, 83 women were recalled for assessment due to an abnormality detected on their screening mammogram. The Control group had 43 women assigned, with 21 (48%) participating in both Phase One and Phase Two. The Intervention group had 40 women assigned, with 23 (57%) participating in both Phase One and Phase Two. DASS Results: Participants for both Phase One and Phase Two predominately self-reported normal levels of depression, anxiety, and stress. In Phase Two, the Intervention group self-reported higher levels of depression, anxiety, and stressed comparative to the normative female non-clinical cohort. The Control group reported higher levels for the anxiety scale, comparative to the normative data. Assessing between and within group effects, a time effect was notable for all three scales (depression ρ = 0.03, anxiety ρ = 0.10 and stress ρ = 0.00), however no group effect existed (depression ρ = .931, anxiety ρ = .982 and stress ρ = .667). Additionally, no relationship between participant understanding of a screening false positive result and group allocation (χ2 (4, N = 44) = 6.2, ρ > 0.05) was identified. Due to a small sample size, limited data analysis could be achieved to make conclusive statements. Conclusion: This study could be successfully undertaken on a larger scale with minor alterations to methodology, staff training and education, and data collection. Sample size calculated for a larger scale study. The majority of the participant’s in Phase One and Phase Two reported normal levels of depression, anxiety and stress in relation to having a screening mammogram performed and subsequently being recalled for assessment. In assessing the data, no between/within effect was determined for the three scales and no relationship between a participants’ understanding of screening false positive result and group allocation was identified.

Date of Award	2020
Original language	English
Supervisor	Rob Davidson (Supervisor), Angie Fearon (Supervisor) & Dominic Upton (Supervisor)