Psychological Preparation for Medical Procedures

Question 1

Give some examples of stressful medical procedures.

Answer 1

-Uncomfortable procedures
-Ones concerning specific pat groups e.g., cancer pats
-Ones where general anaesthetic is used
-Spinal surgery
-Oncology
-Gynaecology - IVF, C-section, hysterectomy
-ICU

Question 2

Why do people need to be psychologically prepared for treatment?

Answer 2

-May perceive surgery as threat = inc anxiety
-High pre-op anxity = link to higher post-op complications - pain & longer recovery
–> may mean longer in hospital = more anxiety & depression

Question 3

What are the 2 forms of anxiety (in general) regarding a medical procedure?

Answer 3

-Anxiety about procedure (procedural stress) = pre-op
-Anxiety about outcome (outcome stress) = post-op

Question 4

What is anxiety - brief definition?

Answer 4

An emotional response to stress

Question 5

What may a patient’s anxiety of a medical procedure be about (pre-op)?

Answer 5

-Feeling exposed/embarrassed/loss of dignity
-Incision, opening flesh, knives, needles
-Losing consciousness, losing control
-Reliance on others/not in control
-Fear not waking up
-Fear of being aware but unable to communicate

Question 6

Summarise the anxiety about a medical procedure (pre-op).

Answer 6

Before event - link to loss of control & unpredictability

Question 7

What may a patient’s anxiety about the outcome of a medical procedure be regarding (post-op)?

Answer 7

-Diagnosis & prognosis
-Pain/loss of sensation
-Loss of mobility/function
-Disfigurement
-Surgical/anaesthetic harm
-Post-op infection
-What is happening at home/work

Question 8

What are levels of anxiety experienced by the patient, dependent upon?

Answer 8

-Purpose of investigation/surgery – is it exploratory – establish diagnosis (exclude cancer), or more complex such as removing organ, or restoring function in hip replacement

–> SO IS THE PROCEDURE elective or emergency procedure!!!

Question 9

What is anxiety - longer definition?

Answer 9

= sense of apprehension/doom, accompanied by physiological reactions, involving an uncertain or unspecified threat (Sarafino, 2006)
(may be legitimate fear)

Question 10

What are the 2 types of anxiety?

Answer 10

-Cognitive (psychological) anxiety
-Somatic anxiety

Question 11

What is cognitive anxiety?

Answer 11

= -ve thoughts, worry, rumination (having constant repetitive thoughts about something)

Question 12

What is somatic anxiety?

Answer 12

Autonomic (NS?) arousal - shows physical symptoms of anxiety:
-inc HR
-inc BP
-muscle tension
-sweating
-nausea
-trembling
-dry mouth
-dizziness

Question 13

Where are there 80% anxiety rates for patients - what groups?

Answer 13

Patient’s awaiting high-risk surgery = psych reactions

Question 14

What does increased pre-op anxiety (about procedure) causing a psychological & somatic response, -vely affect?

Answer 14

-Anaesthesia
-Post-op care & treatment
-Rehabilitation
= risk factors for mortality after surgery

Question 15

What are the 2 categories of behaviour in due to anxiety?

Answer 15

-Adaptive - ritualistic behs
-Maladaptive - coping behs

Question 16

What are state & trait anxiety?

Answer 16

-State = anxiety in response to situation
-Trait = anxiety a person is predisposed to - in their natural temperament (e.g., can say is the env allows this then trait anxiety will be shown)

Question 17

What are some risk factors to pre-op STATE anxiety?

Answer 17

-Cancer history (as will be more nervous)
-Smoking (often a coping strategy for anxiety though)
-Psychiatric disorders
-ve future perception
-Moderate-intense depressive symptoms
-High trait-anxiety (predisposition)
-Moderate to intense pain
-Medium surgery
-Female (but to males just not report anxiety?)
-Over 12 years education = independent risk factors for pre-op state-anxiety
-Prev surgery reduced risk for pre-op anxiety

Question 18

Why is gender a risk factor of pre-op state anxiety?

Answer 18

-Cult diffs = gender diffs in willingness to acknowledge distress - also influenced by sex-limited procedures
-Females experience more anxiety than males
-But poor understanding of this - studies often just look @ 1 gender

Question 19

How does cognitive anxiety involve?

Answer 19

-Attention bias to threatening info - whilst ruminating in thoughts
1 - more likely to pick up on non-harmful sensations/things
2 = misinterpretation of these
3 = incs physical symptoms
e.g., misinterpret post-op pain as complication - worsens pain - as are more tense

Question 20

Characteristic features of people with trait anxiety?

Answer 20

-Often those w/ high trait anx = not shown to be more anx due to med procedures
-Often highest pre-op (for people w/ high & low trait anx)
-MUST CONSIDER SIT FACTORS e.g., time measured, past exp

Question 21

What are some consequences of high anxiety?

Answer 21

-Phobias, panic attacks = maladaptive, & unable to process info
-Inc pain perception (due to heightened awareness/att bias)
+ve correlation of pre-op anx & post-op pain!!!
-Link to poorer recovery outcomes
-Pre-op anx can affect post-op pain, anaesthesia & analgesia requirement
-Anx can inc post-op morbidity & mortality!
-Effects imm syst & wound healing - delay

Question 22

How are patients helped to prepare for surgery?

Answer 22

Support coping by:
-Give info
-Beh instruction
-Cog approaches
-Relaxation/hypnosis/imagery
-Focussed discussion
-Modelling (demonstrate on model e.g., for kids - on toy)

Question 23

What are the aims when helping patients prepare for medical procedures?

Answer 23

Inc feelings (informational, cog & behavioural) of control & reduce anxiety

Question 24

What is information giving, effectiveness, dependent on?

Answer 24

-Type & level of info
-Anxiety level & pat coping style

Question 25

Give the 4 general types of intervention to help patients prepare for a medical procedure.

Answer 25

-Give objective info: sequ of events, equipment used, & timing of experiences (procedural information)
-Describe sensations before: accompany & follow procedure (sensory information) - e.g., ‘sharp scratch’ - ‘you will feel…’
-Teach coping methods to lower pain (coping information)
-Show other people undergoing same procedure without complications (modelling) - e.g., child w/ toy

Question 26

Why is information giving so important in helping patient’s prepare for a medical procedure?

Answer 26

-Reduces fear of unknown & pat knows what to expect e.g., so don’t perceive post-op pain as a complication
As most pats have little understanding of what are undergoing even if have given consent!
–> level of info, pat coping style - affect anx
(BUT more anxious = comprehend less info)
-Who should give this info, when & how?

Question 27

What are the 2 types of information?

Answer 27

-Procedural info
-Sensory info
= prepare pats for these so know what to expect = dec post-op anx

Question 28

What is involved in procedural info?

Answer 28

-Timetable of events
-People involved
-Rooms used
-Sequ of events & procedures

Question 29

What is involved in sensory info?

Answer 29

-Nature, site & duration of pain
-‘It’s normal to feel thirsty’
-Nausea
-Specific to procedure e.g., “hot flash”

Question 30

When is giving procedural info most effective?

Answer 30

= When pats are info seekers (not info avoiders)
-But is overall less effective than giving sensory info

Question 31

Why is sensory info more effective than procedural info?

Answer 31

= reduces anxiety more!
-encourages pat to think of themselves & how they feel
-Give pat’s info as & when needed - no time to ruminate over
-Tell people how something will feel

(but some studies showed doesn’t reduce anx)

Question 32

What is sensory info often combined with to be most effective & why?

Answer 32

Coping instructions - as coping (physiological/bio & psychological) encourages pats to take active role in procedure - serves a purpose rather than just stating info alone

Question 33

What is coping?

Answer 33

Physical behs - to minimise possible complications after surgery (e.g., leg exercises, walking, methods for turning in bed)

Question 34

How does coping affect patient preparation for medical procedures?

Answer 34

-Can reduce need for pain relief & sedatives pre & post-op
-Improve breathing & coughing
-Teach breathing, leg & foot exercises = fewer days in hospital
-Beh rehearsal & relaxation training for stressful procedures e.g., catheterisation

RELAXATION = big component

Question 35

What are the 2 types of patients in regard to receiving information about a procedure?

Answer 35

-Info seekers = want to know info about procedure - will help them reduce their anxiety
-Info avoiders = don’t want to know info about procedure - won’t help them reduce their anxiety

Question 36

What are some trends seen in info seekers?

Answer 36

Seekers = less anxiety & pain when given sensory info (compared to avoiders given no sensory info)

Question 37

What are the 2 types of coping styles patients are & link to the 2 types info needs of patient?

Answer 37

-Blunters = info avoiders = avoidant
*low info group = lower pulse
*high info group = higher pulse

-Monitors = info seekers = attention/vigilant
*low info group = higher pulse
*high info group = lower pulse

(based upon measuring pulse rate - pre & post info & post investigation)

Question 38

What must be matched when giving info to patients to help prepare for medical procedure?

Answer 38

-Match amount/level of info & type of info - based upon pat’s coping style –> to be effective @ reducing anxiety

Question 39

Summarise the anxiety levels of blunters & monitors?

Answer 39

-Blunters = less anxiety to low info - low amounts of info decs anxiety BUT lost of info ncs anxiety (overwhelms!) –> = repressors
-Monitors = less anxiety to high info - show higher anxiety levels than blunters before info giving! - as are v. attentive & vigilant so respond well to lots of info but poorly to low amounts of info –> = sensitisers

Question 40

What are the types of relaxation - as a coping strategy to prepare patient’s for medical procedures?

Answer 40

-Progressive muscular relaxation
-Meditation
-Biofeedback
-Guided imagery
-Relaxation tapes

Question 41

What are the +ve effects of relaxation?

Answer 41

-Reduce anxiety
-Counter physical consequences of anxiety
-Incs feeling of physical control
-Psychological & physical benefits

Question 42

What do cognitive-behavioural interventions involve - as an intervention to help prepare patients for medical procedures (i.e., to lower anxiety)?

Answer 42

-Identify problem thoughts causing anxiety
-Demonstrating link between thoughts & feelings
-Look @ evidence for problem thoughts
-Replacing w/ more reality based thoughts = reappraisal of sit in more +ve way

Question 43

How effective are cognitive-behavioural interventions?

Answer 43

-Compared cognitive intervention group with routine care controls
= no diff in reported pain but faster mobility & reduced pain medication

Question 44

What does modelling involve - as an intervention to lower anxiety & so prepare patients for medical procedures?

Answer 44

-Often used w/ children - demonstrate procedure on toy
= alternative way to provide procedural & sensory info

Question 45

Compare repressors & sensitisers in terms of modelling.

Answer 45

Repressors needed to view film more times than sensitisers to break through defensive barrier

Question 46

Do psychological preparations for medical procedures work?

Answer 46

Better prepared patients have better post-operative outcomes!!!

-Less likely report post-op pain
-Beh recovery = more likely
-ve affects = fewer
-Length of hospital stay = shorter
-Get back to everyday activities faster

–> all impact whether develop comorbidities

Question 47

What is the link between pre-op anxiety & post-op outcomes?

Answer 47

High pre-operative anxiety is predictive of poor post-operative outcome