'I wish I had been better prepared': a mixed-methods study of psychological reactions, perceptions and opinions of cardiovascular preparticipation screening among young competitive athletes.

Abstract

To evaluate the psychological reactions, perceptions and opinions of cardiovascular preparticipation screening (PPS) among young competitive athletes. This convergent parallel mixed-methods study recruited 222 athletes (mean age: 18.7 years) who underwent PPS at a Canadian university. All athletes completed a cardiovascular history questionnaire, and a subgroup (n=165) additionally obtained an ECG and physical exam. On registering for PPS, athletes completed a psychological impact survey. Survey items were measured on a 5-point scale, ranging from -2 (strongly disagree) to 2 (strongly agree) and reported as means. After completing PPS, 18 athletes participated in focus groups or interviews to explore screening experiences. Qualitative data were analysed using reflexive thematic analysis, following an inductive and critical realist approach. Athletes reported minimal symptoms of anxiety (-1.29), stress (-1.41) or worry (-1.12) concerning their participation in PPS and agreed that screening was beneficial for their safety (1.25). Psychological symptoms were higher in athletes who reported cardiovascular symptoms or a family history than those who did not. Athletes required to undergo an ECG and physical exam were less anxious, stressed and worried about PPS but more interested in learning about their results than those screened with only a history questionnaire. Three themes described athletes' responses to PPS: (1) importance of communication and service navigation; (2) distress surrounding the uncertainty of results and (3) screening as a non-disruptive and essential part of 'being an athlete'. The PPS process does not lead to excessive distress among young competitive athletes before, during or after screening. Athletes identified solutions to enhance the PPS experience, including tailored educational resources and an integrated support system to manage psychological symptoms.