Patients like doing tests for themselves
Self-testing kits allowing individuals to assess their risk of developing a serious illness in their own homes would have far greater uptake than the diagnostic tests currently available in a clinical environment.
Research just completed by a team at the School of Nursing and Human Sciences at Dublin City University (DCU) has found that while people are reluctant to undergo a test by a doctor or consultant that delivers a diagnosis, they would be far more willing to take a test that would quantify their risk of becoming ill.
In short, while individuals may avoid tests that tell them they are sick, they would more readily take a test that tells them they may get sick.
If the findings of the research were proved applicable across the population, the development of such risk-assessment tests could greatly assist prevention of disease.
Dr Simon Dunne, who led the research team, set out to gather and analyse data on a device being developed by the Biomedical Diagnostic Institute (BDI) based at DCU.
Autonomy for patients
The Cardiovascular Disease (CVD) Risk Biochip was being designed to measure levels of several different proteins in the blood, which, taken together, could indicate a person’s risk of developing heart problems.
The BDI proposed that this device would be ideal for use in primary care settings such as the GP office and even in the home.
While the project to develop the CVD Risk Microchip was abandoned, Dr Dunne’s research revealed that such tests and the autonomy they would grant to patients for assessing their own risk of becoming ill would be popular with patients.
“Someone finding out they are at risk of CVD is very different to someone being told they have symptoms that would suggest they already have CVD,” Dr Dunne explained.
“If you are saying a person is at risk, people feel there is some way that they can be responsible from that point on, that there are internal factors they can change in their behaviour and their lifestyle.
“It’s about control, it’s about the fact that if you receive a diagnosis, there’s a feeling this has been imposed on me and it’s already too late and people can tend to see that as a catastrophe.”
Health threat detection
Referring to various studies that suggest people avoid screening tests that are currently available to them, Dr Dunne said the fact that many of these screening devices deliver diagnoses leads to a reluctance in many people to take part.
“Health threat detection can lead to avoidance. This research – and the development of these type of devices – have implications for people and the control and autonomy they feel they have.
“The more autonomy – or the greater the autonomy – given to the patient, the greater the chance the patient will have a sense of responsibility and will feel in control.”
The research also found that the prevalence in many homes of blood pressure testing devices and blood glucose monitors has helped create an acceptance and normality around having such kits in the home – and some sense of duty to respond to whatever such a monitor indicates in terms of need to change habits or behaviour.
“The feedback suggests that certain people who encountered blood glucose monitors thought this was a great idea that you could try to catch it early. Also, this idea that you could adapt behaviour depending on risk factor came across,” Dr Dunne said.
It is accepted at both risk assessment and diagnostic level that the psychological benefits of placing the tools for indicating health concerns in the hands of individuals are many.
“It’s about changing the setting, it’s taking it out of the hands of the medical practitioner, so that he or she isn’t the only one who can carry out this test,” Dr Dunne said.
The Biomedical Diagnostic Unit at DCU is currently engaged in researching and developing a number of devices for use at a primary care level, including the Colorectal Cancer Device.
According to Dr Gregor Kijanka of the BDI, the ultimate aim is to develop a device for use at a GP clinic that would indicate the urgency with which a colonoscopy may or may not be needed for a particular patient.
“In colorectal cancer, the earlier the detection of the disease, the more likely it is to be curative, therefore a diagnostic test which identifies at-risk patients early in their disease will lead to better patient outcomes,” Dr Kijanka explained.
“To be offered a test in a relatively familiar environment whereby patients know their physician/GP is a much more personal, less stressful experience compared with attending a major tertiary centre, which can be more daunting.”
But, according to Dr Dunne, in the wider industry, there is an appetite to go one step further by developing devices that are so user-friendly that they can be used in a domestic setting.
“Ultimately these devices would be as user friendly as possible. One of the ways in which they are developing these things is that everything is done on one chip or one device – a ‘lab on a chip’ device,” he said.
“They allow for a blood or tissue sample to travel down into the detection zone with antibodies that will bind the proteins of relevance to that sample and to give a reading.
“Because they are geared to be as user friendly as possible, we will see them develop quickly and we will see them used in homes and that will change things.”
However, he added, the means by which these tests are marketed will be vital if and when they come on stream to ensure they are understood by the public.
How it is broached
“The device can be developed, but how it’s broached with the public is key and the framing of these devices from health practitioners will be key.
“It is all about framing these messages in a positive way so that people understand the benefits,” Dr Dunne said.