Screening for Ovarian Cancer: Psychobehavioral Outcomes

描述（由申请人提供）：经阴道超声检查（TVS）可以促进卵巢癌（OC）的早期检测，然而，与所有癌症筛查试验一样，TVS也会产生一定比例的“异常”结果。虽然绝大多数异常的TVS结果是良性的，但这种潜在的压力筛选经验对情感，认知和行为结果的影响尚未得到充分研究。拟议的研究建立在我们当前对与常规TVS筛查相关的心理和行为结果的研究（R 01 CA 84036）的基础上，明确关注异常TVS结果的影响。在常规筛选期间（异常筛选（AS）组）接受异常TVS结果并在4 - 8周后返回接受重复TVS检测的女性（n=400）将与在常规筛选期间（常规筛选（RS）组）接受正常TVS结果的女性（n=400）匹配（年龄、既往筛选史）。所有女性将在常规（RS组）或重复（AS组）TVS筛查前完成基线评估，并在基线后1、4和18个月进行随访评估。AS组中的一些女性（n=120）将在常规TVS测试产生异常结果之前完成额外的“真实”基线评估。在基线和情感（例如，OC特异性痛苦）、认知（例如，OC风险认知、TVS疗效信念、获益发现）和行为（例如，将纵向评估OC特异性监测行为、情绪应对方法、参与乳腺癌/结肠癌筛查）终点。将通过OC筛查项目记录监测对常规TVS筛查建议的依从性。一些当代的理论模型（认知社会健康信息处理，监测过程，社会认知处理）的压力事件的反应指导选择的研究变量，并提供具体的假设进行测试。将讨论三个具体目标：（1）描述异常TVS结果对结局的性质、程度、效价和轨迹的影响;（2）识别与这些结局的程度和持续性相关的临床、人口统计学、性格和心理社会变量;及（3）发展及试行适当的心理教育干预措施，以尽量减少异常TVS结果后的负面结果。结果将增强对OC筛查异常结果反应的理解，也将增强对其他恶性和非恶性疾病异常筛查结果反应的理解。

DESCRIPTION (provided by applicant): Transvaginal sonography (TVS) can facilitate early detection of ovarian cancer (OC), however, like all cancer screening tests, TVS yields a proportion of "abnormal" findings. While the vast majority of abnormal TVS results are benign, the impact of this potentially stressful screening experience upon affective, cognitive, and behavioral outcomes has not been adequately examined. The proposed research builds on our current study (R01 CA84036) of psychological and behavioral outcomes associated with routine TVS screening by focusing explicitly on the impact of an abnormal TVS result. Women (n=400) receiving an abnormal TVS result during routine screening (Abnormal Screening (AS) group) and returning for a repeat TVS test four-eight weeks later will be matched (age, prior screening history) with women (n=400) receiving a normal TVS result during routine screening (Routine Screening (RS) group). All women will complete a baseline assessment prior to either routine (RS group) or repeat (AS group) TVS screening and follow-up assessments 1,4, and 18 months post-baseline. Some women (n=120) in the AS group will complete an additional "true" baseline assessment prior to the routine TVS test yielding their abnormal result. Measures of dispositional variables (optimism, monitoring, emotional approach coping) are obtained at baseline and affective (e.g., OC-specific distress), cognitive (e.g., OC risk perception, TVS efficacy beliefs, benefit finding), and behavioral (e.g., OC-specific monitoring behavior, emotional approach coping, participation in screening for breast/colon cancers) endpoints will be assessed longitudinally. Adherence with recommendations for routine TVS screening will be monitored by OC screening program records. Several contemporary theoretical models of response to stressful events (Cognitive-Social Health Information Processing, Monitoring Process, Social-Cognitive Processing) guide selection of study variables and provide specific hypotheses for testing. Three specific aims will be addressed: (1) characterize the impact of an abnormal TVS result with regard to the nature, magnitude, valence, and trajectory of outcomes; (2) identify clinical, demographic, dispositional, and psychosocial variables associated with magnitude and persistence of these outcomes; and (3) develop and pilot test an appropriate psycho educational intervention for minimizing negative outcomes after an abnormal TVS result. Results will enhance understanding of response to abnormal results in response to screening for OC and will also enhance understanding of response to abnormal screening results for other malignant and nonmalignant conditions.