Anxiety during stressful medical procedures Flashcards
What is anxiety ?
Unpleasant feeling or emotion (involving physiological, cognitive, and emotional symptoms) associated with:
-Threatening situations
OR
-Thoughts of threatening situations
Why do medical procedures result in anxiety ?
Medical (both surgical, and non-surgical) procedures are inherently threatening as they involve much uncertainty, including:
- Surgery, chemo, raditherapy
- Diagnostic tests (e.g. endoscopy)
- Predictive tests (e.g. genetic testing)
Identify different kinds of stresses associated with medical procedures.
Different procedures (e.g. diagnostic/therapeutic/both) result in different stresses
- Procedural stress (e.g. will it be painful etc.)
- Outcome stress (is this going to cure me etc.)
Identify what patients get anxious about during medical procedures.
- 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)
Describe the evolution of anxiety before, during, and after the procedure.
- Most surgical patients experience high anxiety when they are admitted to the hospital
- Anxiety remains quite high before and after the operation
Identify which post-operative outcomes pre-operative anxiety is associated with.
Pre-operative anxiety affects outcomes of recovery:
- More pain post-op
- More analgesic usage
- Longer hospital stay
- More complications
- Anxiety and depression after surgery
Pre-op anxiety may also affect:
- Communication (anxious patients are less likely to understand the info they are told)
- Adherence (less likely to be compliant with cough and breathing exercises which help reduce likelihood of pneumonia, and with getting out of bed and moving around which helps reduce phlebitis and enhances wound healing)
- Pain management (may influence type and amount of anesthetic used)
Identify the methods that can be used to help patients prepare for medical procedures (and thereby help reduce anxiety).
BY INCREASING SENSE OF CONTROL
- Procedural information
- Behavioral instruction
- Cognitive coping
- Sensory information
- Modelling
- Counselling (e.g. emotion focused of psychotherapeutic discussion, can be one to one or with other patients)
- Relaxation
- Hypnosis
Explain what ‘procedural information’ consists of, as a way to reduce anxiety and help patients prepare.
- Giving patients information about the procedures they will undergo.
- This involves patients being informed:
- When the procedure will happen and where they will be. E.g., they might be told about the possibility of a catheter and waking up in the recovery room.
Explain what ‘sensory information’ consists of, as a way to reduce anxiety and help patients prepare.
- Giving patients information about the sensations they will experience.
- E.g. they might be told that premedication will not necessarily make them drowsy; how it will feel when the anaesthetics are given.
What do you tell the patients before you put the needle in?
It will feel like a scratch
Identify an example of behavioral instruction (as a way to reduce anxiety and help patients prepare).
Teaching techniques such as breathing, coughing exercises, and relaxation or how to turn over in bed.
Explain what is meant by cognitive coping, as a way to reduce anxiety and help patients prepare. Give examples.
- Encouraging more adaptive/helpful thoughts (‘cognitions’)
- E.G. Teaching methods of reinterpreting apparent threats in a more positive light, using distraction or other techniques that has been previously useful in anxiety-provoking situations and using these before and after the surgery.
Explain what is meant by modelling, as a way to reduce anxiety and help patients prepare. Give examples.
(e.g., showing videos of similar patients).
Particularly used with children. Contains a lot of procedural information.
Identify benefits of psychological preparation before a medical procedure.
- Earlier discharge (decreased length of stay)
- Less pain medications
- Less post-op pain (potentially)
- Earlier behavioural recovery (e.g. physical activity, ADLs)
- Improved post-op negative affect
Describe the evidence for the benefits of psychological preparation before a medical procedure on post-op pain (including conclusion, limitations, quality of study).
Impact on post operative pain:
• Conclusion: psychological preparation may reduce post operative pain in the 1st month after surgery (BUT behavioural instruction does not impact post-operative pain).
• Limitations: High degree of heterogeneity in terms of types of surgery and intervention content.
• Quality of studies: low
Describe the evidence for the benefits of psychological preparation before a medical procedure on behavioural recovery (including number of studies, conclusion, limitations, quality of study).
Impact on behavioural recovery (e.g. physical activity, ADLs):
• Conclusion: promising findings that psychological preparation, particularly behavioural instruction, may improve these outcomes.
• Limitations: Outcome measures are diverse so hard to make comparisons.
• Quality of studies: very low
Describe the evidence for the benefits of psychological preparation before a medical procedure on negative affect (including number of studies, conclusion, limitations, quality of study).
Impact on negative affect:
• Conclusion: some evidence of benefits of psychological interventions on post-operative negative affect. No evidence one technique did better than others. Individual characteristics such as pre-operative fear may affect the way that psychological interventions impact on post- operative outcomes.
• Limitations: Heterogeneity and small effect size
• Quality of evidence: low
Describe the evidence for the benefits of psychological preparation before a medical procedure on length of stay (including number of studies, conclusion, limitations, quality of study).
Impact on length of stay:
• Conclusion:psychological preparation led to a reduction in mean length of stay of around half a day.
–> represents important savings for healthcare.
• Limitation: Variations in the studies
• Quality of studies: Low
Which of these does procedural information affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
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
Which of these does sensory information affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
SENSORY INFORMATION
• No intervention had sensory info only – always combined with another component.
• Beneficial for ‘length of stay’.
• Beneficial for ‘negative affect’
• No clear evidence for ‘post- operative pain’
Which of these do behavioural instructions affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
BEHAVIOURAL INSTRUCTIONS
- Beneficial for ‘length of stay’.
- Greatest potential for ‘behavioural recovery’ outcomes
- No evidence for ‘post- operative pain’ or ‘negative affect’
Which of these do cognitive interventions affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
COGNITIVE INTERVENTIONS
• Small number of studies.
• No clear evidence on any outcome
Which of these do relaxation techniques affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
RELAXATION
• Beneficial effect on ‘post- operative pain’
• Beneficial effect on ‘negative affect’ but not when it’s only relaxation techniques in the intervention.
Which of these does hypnosis affect:
- Length of stay
- Negative affect
- Post-op pain
- Behavioural recovery
HYPNOSIS
• Hardly in studies included in meta-analysis.
