A systematic review to identify anxiety measures for use in populations undergoing abdominal aortic aneurysm screening

Objective: To identify the most appropriate patient reported outcome measure (PROM) to quantify anxiety of participants in the United Kingdom (UK) National Abdominal Aortic Aneurysm Screening Programme (NAAASP).

Methods: Comprehensive electronic searches were undertaken to identify studies reporting development or validation of PROMs used in the measurement of anxiety in screened populations. Study selection, data extraction and analysis were conducted independently by two reviewers; the “COnsensus-based Standards for the selection of health Measurement INstruments” (COSMIN) classification of measurement properties was used in the evaluation of included PROMs enabling a recommendation to be made for the most appropriate PROM for use in the NAAASP.

Results: The systematic review identified three PROMS that met the specified quality criteria and of these the Psychological Consequences of Screening questionnaire (PCQ) was judged to be the most appropriate PROM for use in populations undergoing screening for abdominal aortic aneurysm (AAA). Though the PCQ was developed for use in breast screening the individual items are appropriate to a population undergoing screening for AAA with minimal modification.

Discussion: The review was undertaken as part of a wider research initiative aiming to introduce routine measurement of anxiety alongside the UK NAAASP. A significant number of individuals participating in this screening programme will have an AAA that will never progress to a stage where it will directly cause ill health or require treatment. For these individuals the knowledge that they have an AAA could create anxiety that has a significant impact on quality of life, there is a potential for this to outweigh the benefits of screening and surveillance.

Conclusion: In the absence of a PROM with proven validity and reliability in populations undergoing AAA screening the PCQ is a pragmatic choice as a measure of anxiety in this population and appropriate for the purposes of the NAAASP.