Patient Anxiety

Question 1

Medical procedures are inherently threatening as they involve huge amount of UNCERTAINTY

Answer 1

surgery
chemo
genetic testing
diagnostic tests (endoscopy, colonoscopy)

Question 2

what are the two different types of stress

Answer 2

• procedural stress

- outcome stress

Question 3

What are patients anxious about?

Answer 3

• Anaesthesia/being unconscious
• Fear of waking during surgery
• Pain (e.g., post-operative)
• Life-threatening procedures

Question 4

Patients who experience high anxiety pre-operatively are more likely to:

Answer 4

• Experience more pain post-operatively
• Use more analgesic
• Stay in the hospital longer
• Experience more complications
• Anxiety and depression after surgery

Question 5

Psychological influences on surgical recovery

Answer 5

1. communication
2. adherence
3. pain management

Question 6

communication

Answer 6

Anxious patients are less likely to understand the info they are told

Question 7

adherence

Answer 7

Patients with > anxiety are < likely to be compliant with:

• Coughing & breathing exercises (help reduce the likelihood of pneumonia)
• Getting out of bed and moving around (help reduce phlebitis & enhance wound healing)

Question 8

pain management

Answer 8

Pre-surgery anxiety and stress can influence the type and amount of anaesthetic.

Question 9

what is the main way to help patient anxiety

Answer 9

increase their sense of control:

− Procedural information
− Sensory information
− Behavioural instruction
− Cognitive coping
− Other techniques [modelling, emotion focussed or psycho- therapeutic discussion, relaxation, hypnosis]

Question 10

Benefits of psychological preparation: historical interest

Answer 10

Egbert et al. (1964):− the patients receiving this intervention:
given lots of info

− were discharged from hospital on average 2.7 days earlier
− required half as much pain medication as patients receiving usual care.

Question 11

Evidence for benefits of psychological preparation according to primary outcome - post op pain

Answer 11

psychological preparation may reduce post

operative pain in the 1st month after surgery.

Question 12

Evidence for benefits of psychological preparation: according to primary outcome - behavioural recovery

Answer 12

psychological preparation, particularly behavioural instruction, may improve recovery outcomes.

Question 13

Evidence for benefits of psychological preparation: according to secondary outcome
- impact on negative effect

Answer 13

some evidence of benefits of psychological interventions

on post-operative -ve affect

Question 14

Evidence for benefits of psychological preparation: according to secondary outcome
- impact on length of stay

Answer 14

psychological preparation led to a reduction in mean

length of stay of around half a day.

Question 15

Evidence for benefits of psychological preparation according to intervention - procedural info

Answer 15

• Beneficial for ‘length of stay’.
• Beneficial for ‘-ve affect’ (but not significant if interventions included procedural info only)
• No evidence on post- operative pain

Question 16

Evidence for benefits of psychological preparation according to intervention - sensory information

Answer 16

• No intervention had sensory info only - always combined with another component.
• Beneficial for ‘length of stay’
• Beneficial for ‘-ve affect’
• No clear evidence for ‘post- operative pain’

Question 17

Evidence for benefits of psychological preparation according to intervention - behavioural instruction

Answer 17

• Beneficial for ‘length of stay’
• Greatest potential for ‘behavioural recovery’ outcomes
• No evidence for ‘post- operative pain’ or ‘-ve affect’

Question 18

Evidence for benefits of psychological preparation according to intervention - cognitive interventions

Answer 18

• Small number of studies
• No clear evidence on any
outcome

Question 19

Evidence for benefits of psychological preparation according to intervention - relaxation techniques

Answer 19

• Beneficial effect on ‘post- operative pain’

* Beneficial effect on ‘-ve affect’ but not when only relaxation techniques in the intervention

Question 20

Evidence for benefits of psychological preparation according to intervention - hypnosis and emotion focussed interventions

Answer 20

Hypnosis
• Few studies included in meta- analysis
Emotion focused interventions
• Small number of studies.
• Potential for benefit for ‘post- operative pain’ but not if included on its own

Question 21

Room w/ post-op pt

Same/diff surg

Answer 21

less anxious

released more quickly

Question 22

• Behavioural instructions for endoscopy

Answer 22

teaching how to breathe and swallow to facilitate throat anaesthetization and tube passage

 Sensory information  distress
 Combination of coping information + behavioural instructions
 distress AND  the time required for tube passage

Question 23

Preparation for non-surgical procedures

Answer 23

• relaxation training
• information provision
• systemic desensitisation

Question 24

monitors

Answer 24

details info

Question 25

blunders

Answer 25

low info