Development of Assessment Tool for Psychological Effect of Thyroid Cancer Screening

Background: Nation cancer screening program is provided to all population who reached a certain age in Korea. Also individualized cancer screening also widely conducted in private screening units. The harms associated with cancer screening have rarely been reported. Moreover there have been few studies on the psychological effects associated with cancer screening. Aim: This study aimed to evaluate the psychological effects occurring in thyroid cancer screening which is frequently conducted in Korea. We evaluate the validity and reliability of developing measuring tools. Methods: The psychological effects on cancer screening were classified into 3 domains (quality of life, stress response and anxiety) through the review of previous studies and expert discussion. Four assessment tools were selected for measuring quality of life (WHOQOL-BREF), stress level (PSS, SRI), anxiety level (GAD-7). We conducted 2-step of survey. First step was conducted on the day of cancer screening. And second step survey was conducted after reporting cancer screening results. Inclusion criteria of participation is subjects who received thyroid cancer screening for the first time or who has not had thyroid cancer screening for the past 3 years. Based on the survey results, the final assessment tool for psychological effect of thyroid cancer screening was developed through the second expert meeting. The final assessment tool was verified the reliability and the validity through 2-step surveys before and after screening. Results: The new Assessment tool for Psychological Effect of Cancer Screening (APECS) was developed in 4 domains (quality of life, stress-anxiety level, stress responses, and thyroid cancer screening related psychological problems). A total of 143 patients were surveyed on the day of thyroid cancer screening using the developed assessment tool. Second survey was conducted for 99 patients who visited the hospital for counseling the screening results. Test-retest reliability showed high internal consistency with 0.859, P < 0.001, and Cronbach's alpha showed high value with 0.918 in all domains. The reliability of the stress-reaction level domain was the highest in the all domains (0.878). Factor analysis identified 5 factors, including quality of life, stress-anxiety level/response, and thyroid cancer screening–related psychological problems domain were combined. Conclusion: Both of reliability and validity of the newly developed assessment tool for psychological effect of thyroid cancer screening were measured high in all domains. In the future, a strategy for minimizing psychological harms could be suggested from the results of a large scale survey with the new assessment tool on the psychological impact of thyroid cancer screening.