Improving information for nuclear medicine department outpatients

A scoping review of person-centred care strategies used in diagnostic Nuclear Medicine

INTRODUCTION

Person-centred care (PCC) emphasises the need for the health care professional to prioritise individual patient needs, thereby fostering a collaborative and emphatic environment that empowers patients to actively participate in their own care. This article will explore the purpose of PCC in Nuclear Medicine (NM), while discussing strategies that may be used to implement PCC during diagnostic NM examinations performed on adult patients.

METHODS

The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was performed on PubMed, Embase and Cinhal in June 2023 and included studies in English, Spanish, Portuguese and Italian. The research equation combined keywords and Medical Subject Heading terms (MeSH) related to person-centred care (PCC), for all types of nuclear medicine diagnostic examinations performed. Three independent review authors screened all abstracts and titles, and all eligible full-text publications were included in this scoping review.

RESULTS

Fifty-three articles, published between 1993 and 2022, met the inclusion criteria for this scoping review. Seven articles were published in 2015 while 56.6 % of all included studies were performed in Europe. Most studies (n = 39/53) focused on the patients only, with the identified patient benefits being: improve patient experience (67.9 %), increase patient comfort (13.2 %), increase patient knowledge (5.7 %), reduction of patient anxiety (9.4 %) and reduction of waiting/scan time (3.8 %).

CONCLUSION

The scoping review identified a lack of research investigating the use of person-centred care strategies in NM. Future research will focus on using an international survey to explore this topic in nuclear medicine departments overseas.

IMPLICATIONS FOR PRACTICE

By applying PCC principles, the NM professional can improve the patient care pathway and increase patient satisfaction, leading to enhanced clinical outcomes.

Survey on the knowledge of Portuguese society about Nuclear Medicine: A snapshot of the reality in the beginning of the decade

BACKGROUND

Nuclear Medicine has grown exponentially over the years, since it is useful in the early diagnosis and treatment of several pathologies. However, this field appears to be not widely recognized at the public level.

METHODS

An exploratory/descriptive cross-sectional study using a national survey assessed the Portuguese population's knowledge of Nuclear Medicine. A total of 211 questionnaires were collected and analyzed. The study population is made up of Portuguese adult citizens.

RESULTS

The study revealed a lack of knowledge about Nuclear Medicine. Some respondents were aware of this field, however a significant number have low or no knowledge at all. Most individuals are not aware about the Nuclear Medicine Departments in their home districts.

DISCUSSION/CONCLUSION

This project found limited knowledge within the Portuguese population about ionizing radiation in medical procedures, and mainly in Nuclear Medicine. Data highlighted the need to implement awareness campaigns to disseminate knowledge on this field. Health professionals should be aware about the lack of knowledge on this field by patients and public.

The effectiveness of interventions to reduce anxiety, claustrophobia, sedation and non-completion rates of patients undergoing high technology medical imaging

BACKGROUND

Advanced, high technology medical imaging, such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT), have seen significant increases in their use. A number of interventions have been developed with the aim of reducing anxiety, fear and claustrophobia prior to and during imaging.

OBJECTIVE

To determine the effectiveness of interventions aiming to improve the patient experience of high technology medical imaging.

INCLUSION CRITERIA

Any patients who have undergone high technology (MRI, CT, PET, Nuclear medicine and SPECT) imaging in a medical imaging department. Interventional scans were not considered for inclusion.Considered interventions were: MRI scanner designs, quieter machines, information, psychological support, anxiety reduction protocols, mock MRI, team training, prone scanning, audiovisual (AV) systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets.Experimental and observational studies were included in the review.Primary patient outcomes:Secondary patient outcome measures included: SEARCH STRATEGY: A comprehensive, three-step search strategy conducted during August to October 2011 aimed to find both published and unpublished English language studies across 14 major databases. No time restrictions.

METHODOLOGICAL QUALITY

Retrieved papers were assessed by two independent reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

DATA COLLECTION

Data was extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI.

DATA SYNTHESIS

Quantitative data was, where possible pooled in statistical meta-analysis using JBI-MAStARI. All results were subject to double data entry.

RESULTS

Thirty-eight studies met the inclusion criteria and were considered to be of suitable methodological quality. The quality of the studies varied; however, all the studies included had at a minimum a comparison group. Of the final 38 studies, 29 assessed interventions for MRI, 8 Nuclear Medicine procedures, and one in CT. Meta-analysis was performed for two interventions; additional information and an AV system.Significantly fewer children (10-18 years) required sedation prior to a MRI scan when given an audiovisual intervention (n=1785) OR 0.42% (CI 0.25 - 0.70), compared with the control group. Open MRI, newer MRI scanners, quieter machines, information in combination with psychological support or an anxiety reduction protocol, mock MRI, team training, prone scanning, AV systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets were all found to have some positive effect on at least one outcome, whilst the findings for additional information were mixed.

CONCLUSIONS

This review identified 38 studies that assessed interventions to reduce anxiety, claustrophobia, sedation and non-completions and improve satisfaction for patients undergoing medical imaging. The majority of the interventions studied had some positive effect on at least one outcome.Healthcare professionals need to be aware of the potential for patients undergoing medical imaging to experience anxiety, fear and claustrophobia during scanning. A number of interventions can be selected and tailored to the patient group.There is still a significant amount of research required to establish the effectiveness for a number of interventions aimed to reduce anxiety, fear and claustrophobia in medical imaging, particularly in CT.

Preparing children for day case nuclear medicine procedures

OBJECTIVES

To audit standards developed for children undergoing nuclear medicine procedures involving day case attendance on the renal unit.

METHODS

A prospective audit was undertaken of 210 children (113 males) undergoing day case nuclear medicine procedures in a teaching hospital department catering for adult and paediatric patients. An audit sheet was completed by both ward and nuclear medicine staff at the time of the procedure over an 18-month period.

RESULTS

The majority of families were given relevant information about the procedures and adequate notice before the scan date. Most patients were offered surface analgesia for the venepuncture and play preparation before the procedure. Fifty-eight per cent of patients were successfully cannulated at the first attempt and 88% after three attempts. Only 4% of children were sedated. The median delay between the scheduled and actual scan time was 15 min, with 71% of children being scanned within the standard of a 0-20-min delay. Most delays were due to logistic problems within the department (43%). Cannulation problems (35%) and patient-related factors (22%) accounted for further delays.

CONCLUSIONS

The audit of these locally agreed standards has resulted in changes in practice, including nurse training for cannulation and better scheduling within the nuclear medicine department. We believe that play preparation is an essential component for all potentially painful procedures, with few patients requiring sedation. The standards could be used for comparative audits between units.