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Narasimman M, Hernaez R, Cerda V, Lee M, Sood A, Yekkaluri S, Khan A, Quirk L, Liu Y, Kramer JR, Craddock Lee S, Murphy CC, Tiro JA, Singal AG. Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis. Hepatology 2024; 79:107-117. [PMID: 37401857 DOI: 10.1097/hep.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND AIMS The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms. APPROACH AND RESULTS We fielded surveys measuring psychological harms to patients with cirrhosis in a multicenter randomized trial of HCC surveillance outreach. All patients with positive or indeterminate surveillance results and matched patients with negative results were invited to complete surveys measuring (1) depression through the Patient Health Questionnaire-ninth version, (2) anxiety through State-Trait Anxiety Inventory, (3) HCC-specific worry through Psychological Consequences Questionnaire, and (4) decisional regret. Patients were classified into 4 groups: true positive (TP), false positive (FP), indeterminate, and true negative (TN). Multivariable longitudinal regression analysis using the generalized estimating equation method was performed to compare the means of measures across groups. We conducted 89 semistructured interviews in a subset of patients stratified by health system and test results. Of 2872 patients in the trial, 311 completed 1+ follow-up survey (63 FP, 77 indeterminate, 38 TP, and 133 TN). Moderate depression decreased in TN patients, increased in TP, and had intermittent but mild increases in those with FP and indeterminate results. High anxiety temporarily increased in patients with TP results but resolved over time and was stable in those with FP and indeterminate results. Decisional regret was low and did not differ across groups. In semistructured interviews, patients reported apprehension, anxiety, emotional distress, and coping related to HCC surveillance. CONCLUSIONS Psychological harms of HCC surveillance appear mild but differ by test result. Future research should determine the impact of psychological harms on the value of HCC surveillance programs.
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Affiliation(s)
- Manasa Narasimman
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ruben Hernaez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Vanessa Cerda
- Peter O'Donnell Jr. School of Public Health, Houston, Texas, USA
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, Houston, Texas, USA
| | - Anubha Sood
- Peter O'Donnell Jr. School of Public Health, Houston, Texas, USA
| | - Sruthi Yekkaluri
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Aisha Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Lisa Quirk
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yan Liu
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Caitlin C Murphy
- Peter O'Donnell Jr. School of Public Health, Houston, Texas, USA
| | - Jasmin A Tiro
- Peter O'Donnell Jr. School of Public Health, Houston, Texas, USA
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Yoshida Y. Risk communication regarding radiation exposure by experts using two concepts of regulatory science and ALARA. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:011508. [PMID: 36634359 DOI: 10.1088/1361-6498/acb274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
In the Tohoku region of Japan, risk communication programs on radiation exposure are of great importance, especially with respect to reducing the stress and anxiety among those affected by radiation exposure. Although the concepts of 'as low as reasonably achievable' (ALARA) and regulatory sciences (RS) were very important for the smooth operation of risk communication among a wide range of stakeholders, our previous research showed that only 23.5% and 16.5% of medical doctors in Japan had an accurate awareness of them, respectively. To make risk communication more effective, this study examined the levels of awareness of the concepts of ALARA and RS among academic experts in Japan and compared their level of awareness of technical terms regarding radiation to that of the expected level for a layperson. This study also showed that, even among faculty working at graduate schools in Japan, only 29.8% and 39.4% had an accurate knowledge of ALARA and RS. To improve the knowledge of laypeople and experts on these concepts, they should be added to the primary education curriculum. This study demonstrated that among experts in many academic fields, a significant range of estimates existed of lay knowledge of technical terms regarding radiation. The highest scores were assigned by faculty in the field of humanities. Thus, before conducting risk communications, experts from all fields should identify the expected level of awareness among laypeople on the topic. In addition, risk communications regarding radiation should be conducted by academic experts and healthcare professionals together with facilitators or lecturers.
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Affiliation(s)
- Yoshitoku Yoshida
- Faculty of Medical Sciences, Shubun University, 6 Nikko-cho, Ichinomiya, Japan
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Technology Behavior Model—Impact of Extended Reality on Patient Surgery. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Smart surgery is a new way to utilize smart devices to change existing surgeries. Smart glasses can enhance the surgical procedure so that the patient can understand the procedure more intuitively. Surgery is for patients, and patient acceptance of extended reality surgery is the purpose of this study. This study uses the technology behavior model, which is more in line with the user’s assessment of the acceptance behavior of the new technology. A triangulated research approach was used, which applies to this study for a specific patient population. Primary data were collected from hospitals through questionnaires and were statistically analyzed by CB&PLS-SEM multimodel using SmartPLS software. It was concluded that patients were influenced by operational emotional factors in undergoing extended reality surgery. The study provides a basis for future research related to the practical application of smart surgery from the patient’s perspective in viewing and accepting surgery.
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