1. Anxiety during stressful medical procedures Flashcards
What is anxiety?
Associated with…
• Unpleasant feeling or emotion • Associated with: – Threatening situations or – Thoughts of threatening situations • Range of physiological, emotional, and cognitive symptoms
Medical procedures are inherently threatening as they involve huge amount of __________
Medical procedures are inherently threatening as they involve huge amount of UNCERTAINTY E.g. Surgery, chemo, radiotherapy Surgical and non-surgical procedures Diagnostic tests (e.g. endoscopy) Predictive tests e.g. genetic testing
Name some examples of sources of anxiety for patients?
- Anaesthesia/being unconscious
- Fear of waking during surgery
- Pain (e.g. post-operative)
- Life-threatening procedures
- Post-operative outcome
- Possibility of disfigurement
- Threat of severe illness
- Outcome of test results
- Unfamiliarity of surroundings
- Physical restriction
- Loss of independence
- Being away from home (children, job, other obligations)
Describe the anxiety in surgical patients
- Most surgical patients experience high anxiety when they are admitted to the hospital
- Anxiety remains quite high before and after the operation
why is anxiety in surgical patients important?
Kiecolt-Glaser et al. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology.
Pre-operative anxiety –> affects outcomes of recovery **
Consequences of high pre-operative anxiety?
Experience smore pain post-op Use more analgesic Stay in hosp longer Experience more complications Anxiety and depression post-op
Anxiety influence on surgical recovery e.g.
Anxiety influence on receiving info?
Anxiety influence on adherence?
Anxiety influence on pain manangement?
COMMUNICATION
Anxious patients are less likely to understand the info they are told
ADHERENCE
Patients are more likely to be compliant with:
-Coughing and breathing exercises (which help reduce the likelihood of pneumonia)
-Getting out of bed and moving around (which reduce phlebitis and enhance wound healing)
PAIN MANAGEMENT
Pre-surgery anxiety and stress can influence the type and amount of anaesthetic
How to reduce pre-op anxiety?
Procedural inf Counselling Modelling Sensory info Cognitive coping Behavioural instruction
Benefits post-operatively of administering Procedural Information and Behavioural Instruction to anxious patients
Classic study by Egbert et al. (1964):
– The patients receiving this intervention:
• Were discharged from hospital on average 2.7 days earlier
• Required half as much pain medication as patients receiving usual care.
How have the “Benefits of Procedural Information & Behavioural Instruction” been investigated in reducing medically associated anxiety?
Langer, EJ, Janis, IL & Wolfer, JA. (1975) Journal of Experimental Social Psychology 11, 155-165
4 interventions investigated:
- Teaching cognitive coping
- Cognitive coping + proc prep
- Procedural prep info
- Control group
Result: ** Cognitive coping **
Result of cognitive coping intervention?
Less analgesics
Able to cope with discomfort better
Trend for early discharge (not statistically sign)
Experiment of intervention to reduce pre-op anxiety and hypertenion?
Experiment: Anderson, EA. (1987). J Consult Clin Psychol
Interventions tested:
- Extra info: Video of procedure post-surgical
- Standard prep i.e. nurses discussing 2 pamphlets re procedures
- Extra info + coping prep (behavioural instructions)
Result:
2= least effective
No 3 more effective
Experiment to investigate Social Support and Distress from Surgery
Kulik, JA & Mahler, HI. (1989) Personality & Social Psychology Bulletin 15, 183-193
4 intervention investigated::
- Room with another PRE-op procedure. SAME surgery
- Room with POST-op procedure. SAME surgery
- Room with another PRE-op procedure. DIFFERENT surgery
- Rose with a POST-op procedure. DIFFERENT surgery.
Result: Room with POST-op procedure + Same/diff surgery --> Released more quickly Less anxious post-op More ambulatory post-op
Anxiety and non-surgical procedures?
- Non-surgical treatments can be just as anxiety-provoking and distressing for patients
- The techniques used for surgery patients can also be beneficial to prepare patients for non- surgical procedures
How to prepare for an endoscopy to reduce anxiety/distress?
- Procedural and sensory information: Describing endoscopy procedure and sensations to expect
- Behavioural instructions (teaching how to breathe and swallow to facilitate throat anaesthetization and tube passage)
- Sensory information reduced distress
- Combination of coping information and behavioural instructions reduced distress AND reduced the time required for tube passage
