Anxiety during stressful medical procedures Flashcards
What is Anxiety ?
- Unpleasant feeling or emotion
- Range of physiological, emotional, cognitive symptoms
Associated with;
- threatening situations
- thoughts of threatening situations
How may a patient perceive a medical procedure?
Medical procedures are inherently threatening as they involve huge amount of uncertainty
Different procedures will cause different types of stress
Patients experience;
- Function of procedure
- Procedural stress
- Outcome stress
What things are patients anxious about ?
What are patients anxious about?
- 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
- The ward environment
- Surrounded by machines
- Physical restriction
- Loss of independence
- Being away from home (children, job, other obligations)
What kind of anxiety and pattern of anxiety do surgical patients present with ?
- Most surgical patients experience high anxiety when they are admitted to the hospital
- Anxiety remains quite high before and after the operation
Greater fear and distress before surgery = worse recovery
What are patients who experience high anxiety preoperatively more likely to experience?
Patients who experience high anxiety preoperatively more likely to;
- Experience more pain post-operatively
- Use more analgesic
- Stay in the hospital longer
- Experience more complications
- Anxiety and depression after surgery
What are the Psychological influences on surgical recovery ?
Communication;
- Anxious patients are less likely to understand the info they are told
Adherence;
- Patients with higher anxiety are less likely to be compliant with;
- Coughing and breathing exercises (help reduce the likelihood of pneumonia)
- Getting out of bed and moving around (help reduce phlebitis & enhance wound healing)
Pain management;
- Pre-surgery anxiety and stress can influence the type and amount of anaesthetic
What are some effective approaches to help patients ?
Effective approaches to help patients;
Key is to increase patient sense of control!
Give them;
- Procedural information
- Sensory information
- Behavioural instruction
- Cognitive coping (thoughts + beliefs)
- Other techniques (modelling, emotion focussed or psycho-therapeutic discussion, relaxation, hypnosis)
Provide context of sensory info increases patient control and what can anticipate
What are the benefits of psychological preparation ?
Classic study by Egbert et al 1964
Patients received additional procedural info (before, during after surgery)
- Patients were discharged from hospital on average 2.7 days earlier
- Required half as much pain medication as patients receiving usual care
What did the Cochrane Library study show on the evidence for the benefits of Psychological preparation ?
Primary outcome;
Impact on post operative pain;
- Psychological preparation may reduce operative pain in the 1st month after surgery
Impact on behavioural recovery;
- Psychological preparation particularly behavioural instruction may improve recovery outcomes
Secondary outcome;
Impact on negative effect;
- Some evidence of benefits of psychological interventions on post-operative negative affect
Impact on length of stay;
- Psychological preparation reduced mean length of stay of around half a day
How did Procedural Information affect patients in the Cochrane meta-analysis?
Procedural information;
- Beneficial for ‘length of stay’
- Beneficial for negative affect (but not significant if interventions included procedural info only)
- No evidence on post-operative pain
How did Sensory Information affect patients in the Cochrane meta-analysis?
Sensory information;
- No intervention has sensory info only - always combined with another component
- Beneficial for ‘length of stay’
- Beneficial for negative affect
- No clean evidence for ‘post operative pain’
How did Behavioural Instruction affect patients in the Cochrane meta-analysis?
Behavioural instruction;
- Beneficial for ‘length of stay’
- Greatest potential for ‘behavioural recovery’ outcomes
- No evidence for ‘post-operative pain’ or negative affect
How did Cognitive Interventions affect patients in the Cochrane meta-analysis?
Cognitive interventions;
- Small number of studies
- No clear evidence or outcome
How did Relaxation Techniques affect patients in the Cochrane meta-analysis?
Relaxation techniques;
- Beneficial effect on ‘post-operative pain’
- Beneficial effect on negative affect but not when only relaxation techniques in the intervention
How did Hypnosis affect patients in the Cochrane meta-analysis?
Hypnosis;
- Few studies included meta-analysis
How did Emotional Focus Interventions affect patients in the Cochrane meta-analysis?
Emotional focus interventions;
- Small number of studies
- Potential for benefit for ‘post operative pain’ but not known if included on its ownHow did Procedural Information affect patients?
What did the study on a patient being in a room with a post-operative patents with either the same or different surgery ?
Patients were;
- Less anxious post-op
- More ambulatory post-op (better walking)
- Discharged more quickly
Post op patients can well describe to pre-op patients, role models, etc
What kind of anxiety can patients have in non-surgical procedures?
- Non surgical treatments can be just as anxiety-provoking and distressing for patients
- Techniques used for surgery patients can also be beneficial to prepare patients for non-surgical procedures
What preparation for a patient waiting on an Endoscopy might be helpful?
Procedural and sensory information;
- Describing endoscopy procedure, sensations to expect
Behavioural instructions:
- Teaching how to breathe and swallow to facilitate throat anaesthetisation and tube passage
- Sensory information decreases distress
- Combination of coping information and behavioural instructions decrease distress and decrease the time for tube passage
What preparation for a patient with cancer might be helpful?
- Cancer patients experience drug induced side effects (e.g nausea, vomiting)
- With repeated chemotherapy treatments, cancer patients may also experience Anticipatory Nausea and Vomiting (ANV) before a chemotherapy treatment
- ANV may lead patients to discontinue treatment (worse long term outcomes)
What kinds of preparation can we give for non-surgical procedures ?
Preparation can we give for non-surgical procedures;
- Relaxation training
- Systematic desensitisation
- Information provision
What are the 2 individual different coping styles?
Based on personality;
Monitors;
- Copes by seeking out detailed info
Blunters;
- Copes by using avoidance to minimise the situation
Research shows that we should
Give bunters less info and give monitors high info (based upon personality type)
How do psychological preparation promote recovery ?
Two explanations (not mutually exclusive)
Psychological preparation decreases stress, leading to a decrease in sympathetic arousal, consequently improving patients immunological responses
- Preparations that alter patents coping may modulate immune and endocrine function
Preparations decrease frequency and extend of maladaptive behaviours that an unprepared patient can engage in
- E.g NOT doing the breathing exercises following surgery might increase the risk of pneumonia, resulting in a worsened outcome
