Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms

Objective: to describe the potential psychological consequence of screening for abdominal aortic aneurysms (AAAs). Methods: the participants were prospectively and randomly sampled form a ra ndomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material: case-control study: ScreenQL was completed once by 168 (48%) of 3 50 non-responders to screening, 271 (81%) of 335 attenders before screening , 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not b e offered screening for AAA (controls). Prospective study (paired data): 12 7 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated af ter initial conservative treatment. Results: initially, the QL score was 5% lower among men with a small AAA co mpared to the controls (p<0.05), mainly because of poorer health perception . The QL score declined significantly further to 7% below control values du ring the period of conservative treatment. This impairment was mainly due t o a 21% and 15% reduction in score relating to health perception and psycho somatic distress, respectively. However, all scores improved to control lev els in patients operated on. The QL of attending men for screening was sign ificantly lower than that of the controls and the attenders after the scree ning. no differences were noticed concerning the non-attenders. Conclusion: the offer of screening causes transient psychological stress in subjects found not to have AAA. However, diagnosis of an AAA seems to impa ir QL permanently and progressively in conservatively treated cases. This i mpairment seems reversible by operation. Nevertheless, the impairment seems considerable,a nd must be considered in the management of AAA and in the f inal evaluation of screening for AAA.