Adaptation and Validation of the Psychological Consequences of Screening Questionnaire (PCQ) for Cognitive Screening in Primary Care

Rebecca M. Lovett*, Sarah Filec, Jeimmy Hurtado, Mary Kwasny, Alissa Sideman, Stephen D. Persell, Katherine Possin, Michael Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Context-specific measures with adequate external validity are needed to appropriately determine psychosocial effects related to screening for cognitive impairment. Methods: Two-hundred adults aged ≥65 y recently completing routine, standardized cognitive screening as part of their Medicare annual wellness visit were administered an adapted version of the Psychological Consequences of Screening Questionnaire (PCQ), composed of negative (PCQ-Neg) and positive (PCQ-Pos) scales. Measure distribution, acceptability, internal consistency, factor structure, and external validity (construct, discriminative, criterion) were analyzed. Results: Participants had a mean age of 73.3 y and were primarily female and socioeconomically advantaged. Most had a normal cognitive screening result (99.5%, n = 199). Overall PCQ scores were low (PCQ-Neg: (Formula presented.) = 1.27, possible range 0–36; PCQ-Pos: (Formula presented.) = 7.63, possible range 0–30). Both scales demonstrated floor effects. Acceptability was satisfactory, although the PCQ-Pos had slightly more item missingness. Both scales had Cronbach alphas >0.80 and a single-factor structure. Spearman correlations between the PCQ-Neg with general measures of psychological distress (Impacts of Events Scale–Revised, Perceived Stress Scale, Kessler Distress Scale) ranged from 0.26 to 0.37 (P’s < 0.001); the correlation with the World Health Organization–Five Well-Being Index was −0.19 (P < 0.01). The PCQ-Neg discriminated between those with and without a self-reported subjective cognitive complaint ((Formula presented.) = 2.73 v. 0.89, P < 0.001) and was associated with medical visit satisfaction (r = −0.24, P < 0.001) on the Patient Satisfaction Questionnaire. The PCQ-Pos predicted self-reported willingness to engage in future screening ((Formula presented.) = 8.00 v. 3.00, P = 0.03). Conclusions: The adapted PCQ-Neg is an overall valid measure of negative psychological consequences of cognitive screening; findings for the PCQ-Pos were more variable. Future studies should address measure performance among diverse samples and those with abnormal screening results. The PCQ scale is an overall valid measure of psychological dysfunction related to cognitive screening in older adults receiving normal screen results. PCQ scale performance should be further validated in diverse populations and those with abnormal cognitive screening results. The adapted PCQ may be useful to both health research and policy stakeholders seeking improved assessment of psychological impacts of cognitive screening.

Original languageEnglish (US)
Pages (from-to)914-926
Number of pages13
JournalMedical Decision Making
Volume44
Issue number8
DOIs
StatePublished - Nov 2024

Funding

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Persell receives unrelated research funding from Omron Healthcare Co. Ltd. Dr. Wolf reports unrelated research funding from the Gordon and Betty Moore Foundation, RRF Foundation for Aging and Eli Lilly, Glaxo Smith Klein, and personal fees from Pfizer, Sanofi, Luto UK, University of Westminster, and Lundbeck. All other authors have no conflicts of interest to disclose. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was self-funded. Additional training support was provided to the corresponding author by the National Institute of Aging-funded Claude D. Pepper Older Americans Independence Center at Northwestern University (P30AG059988). The supporting agency had no role in designing the study, interpreting the data, writing, and publishing the report.

Keywords

  • cognitive impairment
  • psychological consequences
  • screening

ASJC Scopus subject areas

  • Health Policy

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