Searching for safety signals: the experience of medical surveillance amongst men with testicular teratomas.

The aim of this study is to compare the experience of a group of men with Stage 1 testicular teratomas who were being managed through a surveillance programme (n=25) with a group of patients who had received chemotherapy for more advanced disease (n=22). The study employed a two-phase sequential design that combined quantitative and qualitative methods of data analysis. In the first phase, the hospital anxiety and depression scales (HADS) were used to screen for psychological morbidity. Twelve (48%) of the men assigned to the surveillance programme scored in the 'borderline' or 'clinical case' range on the anxiety subscale of the HADS, compared with six (27%) in the chemotherapy group. There was a significant negative correlation in the surveillance group between 'time since diagnosis' and an elevated anxiety subscale score on the HADS. Interviews were then conducted with 25 participants; a grounded theory approach was used to analyse the transcripts. The hypothesis that human beings are seekers of safety signals provided an explanatory model to account for the higher incidence of self-reported anxiety amongst the men in the surveillance programme. Copyright 2000 John Wiley & Sons, Ltd.