High anxiety: Patient worries can hinder prediabetes screening

Sara Berg, MS , News Editor

Early detection of prediabetes is critical to reversing the condition and preventing the onset of type 2 diabetes, yet many patients may avoid screening opportunities for fear of the results. In this behavior, known as “health-information avoidance,” patients often search for outcomes that better meet their needs or beliefs. Understanding when, why and how people avoid information can help physicians reach patients at risk for prediabetes without overwhelming them.

More than 84 million adults in the U.S. have prediabetes, with up to one-quarter of them developing type 2 diabetes within five years, according to the Centers for Disease Control and Prevention (CDC). The progression to diabetes can be prevented or delayed through participation in a lifestyle-change program recognized as part of the CDC’s National Diabetes Prevention Program (DPP).

In June, more than 1,100 practices across California, New York, Michigan and South Carolina were included in a pilot that brought Prevent Diabetes STAT tools to physicians and patients at the point of care. This program works to facilitate dialogue between care teams and patients about diabetes prevention, as well as offering a risk test.

And today, the AMA, CDC and the Ad Council launched a public service announcement ad campaign (see embedded video below) to urge Americans to take the one-minute prediabetes risk test. The campaign highlights the importance of following up with a physician to learn more about prediabetes.

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Information that is beneficial for patients’ health can often be avoided if they think it might be painful to receive. People are adept at selectively directing their attention to information that supports their beliefs or reflects favorably upon them, stated a paper recently published in the Journal of Economic Literature.

“People do it for a reason,” said Russell Golman, PhD, lead author of the paper. “Those who do not take a genetic test can enjoy their life until their illness can’t be ignored.”

Meanwhile, 29 percent of psychology-research participants indicated they would avoid visiting their physician even if they suspected they should, according to a 2016 study by Jennifer L. Howell, PhD, Kate Ratliff, PhD, and James Shepperd, PhD. The study, published in the journal Health Psychology, also showed that 39 percent of respondents agreed or strongly agreed with the following statements:

  • “I would avoid learning some things about my health.”
  • “When it comes to my health, sometimes ignorance is bliss.”

Howell is an assistant professor of health psychology at the University of California, Merced. She focuses her research on the connection between social psychology and health.

“In some cases, people prefer to remain uncertain about their health status than to have to deal with the consequences of bad news,” Howell told AMA Wire®. “The anxiety surrounding testing stems from the same factors. People are anxious about what bad news might mean for their thoughts, feelings and behaviors.”

Health-information avoidance can occur in the context of prediabetes because learning the outcome of a test might upset a patient, perhaps prompting depression or anxiety. Avoidance might also occur because patients don’t want to change their lifestyle behavior, said Howell.

Fortunately, there are steps physicians and their practices can take to encourage appropriate screening, testing and follow-up for patients at risk for prediabetes, health psychology experts say.

“If we can get people to step back and focus on the long-term consequences, it will make them a little bit more likely to make a rational decision rather than an emotionally based decision,” Howell and Shepperd noted in a 2013 study in the Psychological Science journal.

Research completed by Howell and her colleagues has found that people become more willing to screen for diseases or other health conditions when they focus on:

  • Themselves as a person, and their strengths more broadly rather than on the threat of learning bad news.
  • The pros and cons for screening, to help put their emotional reactions in perspective alongside long-term health complications.
  • Considering the controllable aspects of their outcomes, such as controlling their future if they learn to screen.

People are less likely to avoid learning their health status when a disease is controllable, said Howell. Physicians should emphasize areas in which the patient can control their condition, by offering educational materials on prediabetes and how it can be reversed. It is also important for physicians and their health care teams to empower patients by referring them to a National DPP program and encouraging them to complete it.

The Prevent Diabetes STAT toolkit is available to help health care teams screen, test and refer at-risk patients to in-person or online diabetes prevention programs. Physicians are encouraged to:

  • Screen patients for prediabetes using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test.
  • Test patients for prediabetes using one of three blood tests.
  • Act today to help prevent diabetes by referring patients with prediabetes to a diabetes prevention program.

The AMA offers online CME to expand your knowledge in diabetes management. Explore educational content such as “Prevent Diabetes STAT.”