The effect of information and behavioural training on endoscopy patients' clinical outcomes

Use of virtual reality in patient education program to reduce anxiety in upper gastrointestinal endoscopy: A randomized controlled trial

Background and Aim

Virtual reality (VR) provides an immersive image-viewing experience that has recently been expanding its use in clinical medicine. We aimed to examine a patient education program by VR to reduce anxiety in patients undergoing esophagogastroduodenoscopy (EGD).

Methods

We conducted a randomized controlled trial and consecutively enrolled patients who had an indication for unsedated EGD with topical anesthesia. Patients were randomly assigned to use Oculus GO with three-dimensionally specific software content (a stand-alone VR headset) for patient education or standard patient education using oral information (the control group) before EGD. The primary outcome was the variation in anxiety scores before and after patient education programs.

Results

A total of 107 patients underwent EGD and received a VR (n = 58) and control (n = 49) patient education program. The mean anxiety score before starting the patient education program was 41.4 9.6 in the VR group and 41.9 7.7 in the control group. The mean anxiety score after the patient education program was 37.1 10.8 in the VR group and 38.9 8.07 in the control group (P-value = 0.354). The anxiety score in the VR group decreased more than in the control group but was not significant. The recall questionnaire scores were higher in the VR group (4.70.4) than the control group (3.91, P-value 0.001).

Conclusion

A virtual reality-assisted patient education program before EGD did not significantly reduce anxiety but may provide more memory and understanding about the procedure to patients who underwent unsedated EGD.

The Effect of Home Care Training on Anxiety and Vital Signs Levels in Coronary Artery Bypass Grafting Patients: A Randomized Clinical Trial

PURPOSE

Patients after coronary artery bypass grafting (CABG) require special care at home, and not being aware of this need before surgery can result in anxiety. This study aimed to determine the effect of home care training on the level of anxiety and vital signs in CABG patients.

DESIGN

The study was a randomized clinical trial study.

METHODS

The study included 80 patients undergoing CABG surgery in January 2020. Samples were selected by convenience sampling and were randomly divided into intervention and control groups. The control group received only routine training, whereas the intervention group received two additional training sessions on home care. Data were collected using the Spielberger situational anxiety questionnaire and a checklist of vital signs, and then analyzed using descriptive and inferential statistics.

FINDINGS

Results showed that before the intervention, the mean anxiety scores, heart rate, respiratory rate, temperature, and systolic and diastolic blood pressure between the two groups were not significantly different (P > .05). However, after the intervention, the mean anxiety score, heart rate, respiratory rate, and systolic and diastolic blood pressure in the intervention group was significantly (P < .05) lower than the control group, but the mean temperature of the two groups showed no significant difference (P > .05).

CONCLUSIONS

Home care training before surgery reduces anxiety and improves vital signs. The use of home care training before surgery is recommended for this patient population.

Procedural Anxiety, Pain Catastrophizing, and Procedure-Related Pain during EGD and Colonoscopy

OBJECTIVES

Although sedatives and analgesic drugs defuse anxiety and relieve pain, digestive endoscopy still is uncomfortable and painful for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. The present study evaluated the relations between procedural anxiety, catastrophizing thoughts, and pain, using a prospective design and multimodal assessments of pain.

METHODS

A total of 118 consecutive patients were assessed for procedural anxiety before endoscopy. During endoscopy, a doctor rated the patients' pain behavior. Before discharge, the patients retrospectively rated endoscopy pain and related catastrophizing thoughts.

RESULTS

Notwithstanding sedation, our study revealed large between-subject variability in pain. Catastrophizing thoughts mediated the relation between procedure-related pain observed by the doctor and pain intensity reported by the patient. Catastrophizing thoughts also mediated the effect of procedural anxiety. Our study showed that anxiety exacerbates endoscopy pain when the patient engages in ruminative thinking and feels unable to cope with unpleasant bodily sensations.

CONCLUSIONS

This study shows that catastrophizing thoughts account for between-subject differences in endoscopy pain. Rumination and helplessness but not magnification explain how procedural anxiety may evolve in a painful endoscopy experience. To the extent that one can address catastrophizing thoughts, endoscopy pain can be mitigated, especially for patients who are difficult to sedate.

Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation

Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.

The effect of presence of family members on the anxiety level of candidates for esophagogastroduodenoscopy: A randomized controlled trial

Background: Anxiety and its control is a public health problem worldwide. This study was conducted to determine the effect of family members' presence on the anxiety level of patients who were candidates for esophagogastroduodenoscopy (EGD). Methods: This randomized controlled trial study was performed in Shahid Chamran hospital in city of Saveh in IR Iran. In this study, 96 patients who were candidates for EGD and met the inclusion criteria were assigned into control and intervention groups by simple random sampling method. The demographic questionnaire and Spiel Berger's State and Trait Anxiety Questionnaire (STAI) were used to measure anxiety. Results: No significant difference was found between the 2 groups in the mean level of anxiety before intervention (p= 0.13). After intervention, the level of anxiety decreased significantly in the intervention group (p= 0.001). However, the mean level of anxiety was not significant in the control group after intervention (p= 0.09). Conclusion: The results of the present study showed that the presence of family members during endoscopy may reduce the patient's anxiety level, and thus it is recommended as a non-pharmaceutical, beneficial, and safe intervention.

Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy

Although sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients’ pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure.

Effect of Information of Patients' Coping Style on Pregastroscopy Anxiety

Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.

Impact of anxiety on sedative medication dosage in patients undergoing esophagogastroduodenoscopy

Introduction

Esophagogastroduodenoscopy (EGD) is a diagnostic method used in the investigation of upper gastrointestinal system diseases. A high level of anxiety of patients who undergo EGD increases the duration of the procedure and the sedation and analgesic requirements. Sedation is used to increase patient comfort and tolerance by reducing the anxiety and pain associated with endoscopic procedures.

Aim

In this study, the effect of anxiety scores on medication doses was investigated in patients who underwent EGD under sedation.

Material and methods

A psychiatrist, an endoscopist and an anesthesiologist conducted a prospective observational study blindly to investigate the effect of pre-procedural (before EGD) anxiety level on medication doses for sedation. Patients were divided into two groups, with and without additional medication doses.

Results

The study included 210 consecutive patients who underwent EGD under sedation. The average STAI-S score was 40.28 and the average STAI-T score was 40.18. There was no relationship between anxiety scores and gender (p = 0.058, p = 0.869). Statistically significant results were obtained for anxiety scores with additional sedation dosing (p < 0.05). It was observed that an additional dose of medication was affected by age, body mass index and anxiety scores (p < 0.005). Patients who were young, had a low body mass index and had high anxiety scores had significantly higher additional dose requirements.

Conclusions

The medications used for sedation during EGD may be inadequate or an additional dose of medication may be needed for patients who have higher anxiety scores, younger age, and lower body mass index.

Effects of written plus oral information vs. oral information alone on precolonoscopy anxiety

AIMS AND OBJECTIVES

To determine the effect of written plus oral information vs. oral information alone on precolonoscopy anxiety.

BACKGROUND

Information provision has been considered to reduce precolonoscopy anxiety. However, the best means to provide information before colonoscopy has not yet been determined as there is inconsistency in the outcomes of the clinical trials.

DESIGN

A two-group, pretest, post-test, prospective, quasi-experimental design with non-random assignment.

METHODS

Participants were assigned to group 1 or 2 in the study. In the enrolment all the participants completed the questionnaires to collect personal characteristics data and assessed subjects' anxiety level by the Chinese version of the State Scale of State-Trait Anxiety Inventory as baseline data. After that, subjects in group 1 received written plus oral information before colonoscopy, while those in group 2 received oral information before colonoscopy. On the day for colonoscopy all subjects completed the Chinese version of the State Scale of State-Trait Anxiety Inventory again.

RESULTS

There was no difference in state anxiety and personal characteristic between the two groups at enrolment. After the intervention, although the state anxiety scores were dropped, there were no statistical significant differences between two groups or within groups 1 and 2.

CONCLUSIONS

Information provision before colonoscopy did not reduce the anxiety level in patients directly before colonoscopy.

RELEVANCE TO CLINICAL PRACTICE

There was a trend that information had a positive effect on patients' state anxiety. Future information provision studies may need to add more interactive methods appropriately and take patients' gender, educational level and coping style into consideration.

The Effect of Preparatory Education Program on Discomfort and Retching of Examinees during Upper Gastrointestinal Endoscopy

Background

Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover, there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy.

Methods

A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information.

Results

The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028).

Conclusion

We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.

Information, social support and anxiety before gastrointestinal endoscopy

OBJECTIVES

To examine Lazarus and Folkman's (1984) stress theory regarding the effects of the stress mediators information and perceived social support on anxiety (as the stress response) regarding gastrointestinal (GI) endoscopy (as the stressor) in male and female patients of various age groups.

DESIGN

Non-experimental design.

METHODS

Structured interviews were conducted with 113 hospital out-patients about to undergo GI endoscopy. Participants indicated their perceptions of how much support and how much clear and useful information they had received from both their general practitioner (GP) and a patient information leaflet developed in collaboration with health psychologists as well as their perceptions of how much social support they had obtained from other patients, family and friends. Anxiety was measured with a population-specific trait and state adaptation of the Hospital anxiety and depression scale (HADS-A).

RESULTS

Psychometric exploration of the HADS-A revealed a single general anxiety factor. The reliability of this factor was high, with Cronbach's alpha=0.91. The majority of the sample experienced high anxiety levels. Gender, but not age, differences emerged, showing females to be more anxious than males, F(1, 84)=5.68, p<.05. A regression model built on stress theory was tested, with anxiety as the dependent variable and 11 predictor variables. The model was significant with R(2)=0.452, F(11, 47)=3.522 and p=0.001.

CONCLUSIONS

The clarity, but not the amount, of information and social support from important others, but not GPs, were both mediating the stress experience of the patients by reducing their perceived anxiety.

The effects of providing pre-gastrointestinal endoscopy written educational material on patients' anxiety: a randomised controlled trial

BACKGROUND

Endoscopy is a frequently applied operation in health institutions which may cause anxiety in patients.

OBJECTIVE

The objective of this study is to determine the effects of written educational material related to the endoscopy procedure on the anxiety level of the patient before gastrointestinal endoscopy.

DESIGN

A randomised controlled trial design with two groups: case and control groups.

PARTICIPANTS

140 patients assigned randomly who applied for gastrointestinal endoscopy.

METHODS

INTERVENTION

the control group in our study consisted of 70 people who were briefly informed by the relevant unit about pre-endoscopy preparation. The case group consisted of 70 people who were also given brief information about the pre-endoscopy preparation by the relevant unit. Only the case group were also given written educational material and told orally by the researcher about the content.

MEASUREMENTS

for the collection of the data, a questionnaire form and Spielberger's State-Trait Anxiety Inventory were used.

RESULTS

A significant difference in the average state anxiety scores was found between the case and the control group (p<0.05). An important difference was found in the average state anxiety scores between the case and the control group who had not undergone endoscopy before our study (p<0.05).

CONCLUSIONS

Use of written material including detailed information to inform the patient before endoscopy was useful in lessening their anxiety level. Health professionals should evaluate the anxiety level of patients before endoscopy and educational material should be given to them to read.

The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study

OBJECTIVE

The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time. The information provided was based on self-regulation theory, and patients could restrict themselves to reading the summary only.

METHODS

Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy (N=47), or to a control group not receiving the brochure (N=48).

RESULTS

The results show that all experimental subjects, except one, fully read the brochure. Those receiving the brochure experienced less anxiety before the gastroscopy and, afterwards, they reported greater satisfaction with the preparation for it. With regard to coping style there were some small moderating effects into the direction expected: low blunters (those not seeking distraction under impending threat) as compared to high blunters showed extra reduced anxiety after reading the brochure. They also tended to read the brochure more often. High monitors (those seeking information under impending threat) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors (tendency).

CONCLUSION

We conclude that providing patients with the developed brochure constitutes an efficient, beneficial intervention.

PRACTICE IMPLICATIONS

The brochure could easily be implemented in standard practice without the necessity to take the patient's coping style into account.