(P241) PSYCHOLOGICAL REACTIONS, PERCEPTIONS, AND OPINIONS OF CARDIOVASCULAR PRE-PARTICIPATION SCREENING: A MIXED-METHODS STUDY OF YOUNG CANADIAN ATHLETES

Background: Cardiovascular pre-participation screening (PPS) is universally recommended to identify athletes at risk of sudden cardiac arrest. However, no mixed-methods studies have evaluated the psychological burden of PPS on athletes. The study evaluated the psychological reactions, perceptions, and opinions of PPS on young athletes.

METHODS AND RESULTS: This convergent parallel mixed-methods study recruited 222 varsity athletes (18.7 years, 40.1% female) who underwent PPS at a Canadian university. All athletes completed a cardiovascular history questionnaire, whereas team athletes additionally obtained an electrocardiogram (ECG) and physical exam (PE) from their care network. Athletes concurrently completed a self-administered psychological impact survey. Survey components were measured on a 5-point Likert scale, ranging from strongly disagree (-2) to strongly agree (2), and compared across sub-groups of cardiovascular history and ECG/PE screening using the Mann-Whitney U test. A sub-sample of athletes (n=18) participated in 8 focus groups or individual interviews to explore PPS experiences and identify barriers to the screening process. Qualitative data were analyzed using reflexive thematic analysis and coded at a data-derived, inductive level with a critical realist framework. Fifty-one athletes (23.0%) reported prior cardiovascular symptoms or a family history of cardiovascular conditions (Table). Athletes reported minimal symptoms of anxiety (M=-1.29) or stress (M=-1.41) concerning their participation in PPS. Athletes were not worried about the PPS process revealing a cardiovascular condition (M=-1.12) and agreed that PPS was beneficial for their safety (M=1.25). Levels of anxiety, stress, and worry were higher in athletes who reported a cardiovascular history (M=-1.02, M=-1.24, M=-0.73) than those who did not (M=-1.40, p< 0.01; M=-1.49, p< 0.03; M=-1.25, p< 0.01; Figure). Athletes who were screened with an ECG/PE were less stressed (M=-1.54) but more interested in learning about their results (M=1.25) than those screened with only a history questionnaire (M=-1.10, p< 0.01; M=0.92, p< 0.01; Figure). Three themes emerged from qualitative analyses: (1) Importance of communication and service navigation throughout screening; (2) Anxiety and worry surrounding uncertainty of results; (3) Screening as part of ‘being an athlete’. Athletes viewed the PPS process as a reassurance of their health and important for ensuring safety in sport. Clinical resource accessibility was identified as a barrier to the completion of PPS. Athletes desired educational materials and the opportunity to discuss results.

Conclusion: The PPS process does not lead to excessive anxiety, stress, or worry among young Canadian athletes. Elevated levels of distress are noted for athletes who reported a cardiovascular history and were not screened with an ECG/PE.