The effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction of patients undergoing cardiac catheterisation

Non-pharmacological strategies to reduce stress and anxiety in endovascular procedures: A scoping review

AIM

This study aimed to identify and map the production of knowledge on non-pharmacological strategies to reduce stress and anxiety in patients undergoing endovascular procedures.

DESIGN

Scoping review.

METHODS

The review was performed using the PRISMA-ScR guidelines. The searches were conducted in Scopus, PubMed, Web of Science, Wiley Online Library, BVS/BIREME, Lilacs, Gale Academic OneFile, SciELO, Cochrane Library, CAPES Catalog of Dissertations and Theses, Oswaldo Cruz Foundation Portal of Theses and Dissertations, and Theses and Dissertations from Latin America.

RESULTS

Twenty-two articles were selected. The articles were published from 2001 to 2022, mostly in Iran, and there was a predominance of randomized clinical trials. The Spielberger State-Trait Anxiety Inventory was the most used instrument. The findings indicated that music therapy, educational guidelines or videos on the procedure, massage, psychological preparation and aromatherapy were the main non-pharmacological therapies used to reduce anxiety and stress in patients undergoing vascular procedures.

Effectiveness of educational intervention with manual for anxiety and stress reduction: controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of the educational intervention through an informative manual in reducing anxiety, stress, and changes in vital signs in patients awaiting cardiac catheterization.

METHODS

Parallel, randomized, controlled, blind clinical trial. The study excluded patients waiting for cardiac catheterization; those who received the information manual were randomized to the intervention group, and those who received routine information from the unit went to the control group. The study used the State Anxiety Inventory and Perceived Stress Scale and the ANOVA test to analyze the outcomes between the groups. Clinical Trials NCT03369873.

RESULTS

There was no change concerning time, first and second moment (anxiety, P=0.225; and stress, P=0.696), interaction (anxiety, P=0.183; and stress, P=0.444), or groups, control, and intervention (anxiety, P=0.341; and stress, p=0.624).

CONCLUSION

Although the educational intervention performed did not have an impact on the reduction of anxiety and stress, this type of intervention should be maintained for greater comfort and safety of patients and family members.

Stress Management in Pre- and Postoperative Care Amongst Practitioners and Patients in Cardiac Catheterization Laboratory: A Study Protocol

Background

As the number of cardiac diseases continuously increases within the last years in modern society, so does cardiac treatment, especially cardiac catheterization. The procedure of a cardiac catheterization is challenging for both patients and practitioners. Several potential stressors of psychological or physical nature can occur during the procedure. The objective of the study is to develop and implement a stress management intervention for both practitioners and patients that aims to reduce the psychological and physical strain of a cardiac catheterization.

Methods

The clinical study (DRKS00026624) includes two randomized controlled intervention trials with parallel groups, for patients with elective cardiac catheterization and practitioners at the catheterization lab, in two clinic sites of the Ernst-von-Bergmann clinic network in Brandenburg, Germany. Both groups received different interventions for stress management. The intervention for patients comprises a psychoeducational video with different stress management technics and additional a standardized medical information about the cardiac catheterization examination. The control condition includes the in hospitals practiced medical patient education before the examination (usual care). Primary and secondary outcomes are measured by physiological parameters and validated questionnaires, the day before (M1) and after (M2) the cardiac catheterization and at a postal follow-up 6 months later (M3). It is expected that people with standardized information and psychoeducation show reduced complications during cardiac catheterization procedures, better pre- and post-operative wellbeing, regeneration, mood and lower stress levels over time. The intervention for practitioners includes a Mindfulness-based stress reduction program (MBSR) over 8 weeks supervised by an experienced MBSR practitioner directly at the clinic site and an operative guideline. It is expected that practitioners with intervention show improved perceived and chronic stress, occupational health, physical and mental function, higher effort-reward balance, regeneration and quality of life. Primary and secondary outcomes are measured by physiological parameters (heart rate variability, saliva cortisol) and validated questionnaires and will be assessed before (M1) and after (M2) the MBSR intervention and at a postal follow-up 6 months later (M3). Physiological biomarkers in practitioners will be assessed before (M1) and after intervention (M2) on two work days and a two days off. Intervention effects in both groups (practitioners and patients) will be evaluated separately using multivariate variance analysis.

Discussion

This study evaluates the effectiveness of two stress management intervention programs for patients and practitioners within cardiac catheter laboratory. Study will disclose strains during a cardiac catheterization affecting both patients and practitioners. For practitioners it may contribute to improved working conditions and occupational safety, preservation of earning capacity, avoidance of participation restrictions and loss of performance. In both groups less anxiety, stress and complications before and during the procedures can be expected. The study may add knowledge how to eliminate stressful exposures and to contribute to more (psychological) security, less output losses and exhaustion during work. The evolved stress management guidelines, training manuals and the standardized patient education should be transferred into clinical routines.

Efetividade da intervenção educativa com manual para redução da ansiedade e estresse: ensaio clínico controlado

RESUMO Objetivo: Avaliar a efetividade da intervenção educativa mediante manual informativo na redução da ansiedade, estresse e alterações dos sinais vitais em pacientes que aguardavam o cateterismo cardíaco. Métodos: Ensaio clínico paralelo, randômico, controlado, cego. Incluíram-se pacientes que aguardavam o cateterismo cardíaco; os que receberam o manual informativo foram randomizados para o grupo-intervenção; e os que receberam informações rotineiras da unidade, para o grupo controle. Utilizaram-se Inventário de Ansiedade-Estado e Escala de Estresse Percebido. Realizou-se teste ANOVA para análise dos desfechos entre os grupos. Clinical Trials NCT03369873. Resultados: Não houve alteração em relação ao tempo, primeiro e segundo momento (ansiedade, p=0,225; e estresse, p=0,696), interação (ansiedade, p=0,183; e estresse, p=0,444) ou grupos, controle e intervenção (ansiedade, p=0,341; e estresse, p=0,624). Conclusão: Embora a intervenção educativa realizada não tenha apresentado impacto na redução da ansiedade e estresse, esse tipo de intervenção deve ser mantido, para maior conforto e segurança dos pacientes e familiares.

The effects of a multimedia education on self-efficacy and self-esteem among patients with acute coronary syndrome: A clinical randomized trial

Background:

Acute Coronary Syndrome (ACS) is the first leading cause of death in the industrial world. It is associated with low self-esteem and self-efficacy. Given that patient education is a key role of nurses, this study sought to evaluate the effects of multimedia education on self-efficacy and self-esteem among patients with ACS.

Materials and Methods:

This randomized clinical trial was conducted in 2017 on 60 patients recruited from the two coronary care units of Hajar and Kashani hospitals, Shahrekord, Iran. Participants were randomly allocated to an intervention and a control group. The study intervention was a multimedia educational program. Data were collected before and 1 and 2 months after the intervention onset using a demographic questionnaire, the Cardiac Self-Efficacy Scale, and Coopersmith Self-Esteem Inventory. Data analyses were performed using repeated measures analysis of variance, t-test, Chi-square test, and Fisher's exact test.

Results:

The mean score of self-efficacy in the intervention group (F₂ = 119.26, p < 0.001) and in the control group (F₂ = 74.21, p < 0.001) significantly increased across the three measurement time points. The mean score of self-esteem in the intervention group significantly increased across the three measurement time points (F₂ = 101.19, p < 0.001), while it remained significantly unchanged in the control group (F₂ = 2.56, p = 0.086).

Conclusions:

Multimedia education is effective in significantly improving self-efficacy and self-esteem among patients with ACS. Therefore, nurses can use this strategy to improve these patients’ self-efficacy and self-esteem.

Role of an e-Health Intervention in Holistic Healthcare: A Quasiexperiment in Patients Undergoing Cardiac Catheterization in Taiwan

Background

The use of electronic health (e-health) resources is emerging as an alternative method to improve the secondary prevention of coronary artery disease (CAD). The aim of this study was to describe the influence of an e-health application in holistic healthcare for patients with CAD.

Methods

A quasiexperiment with nonequivalent groups design recruited outpatients with a high risk of CAD admitted for cardiac catheterization. They were divided into two groups. Before the procedure, the control group received traditional patient education, and the intervention group watched videos on Internet-based social media. EQ-5D and FACIT–Sp-12 questionnaires were used as outcome measures of interest, and they were administered before and after the procedure and at the first return visit to the outpatient clinic after discharge. The effect of each intervention was tested using a linear mixed effects model. In addition, the 90-day readmission rate was also studied.

Results

A total of 300 patients were divided into intervention and control groups (150 patients in each group). The interaction effect of EQ-5D was not statistically significant; however, improvements in FACIT–Sp-12 were greater in the intervention group from baseline to before discharge (regression coefficient (B) = 1.70, p < 0.001) and from baseline to postdischarge first outpatient visit (B = 1.81, p < 0.001). Moreover, the 90-day readmission rate was significantly lower in the intervention group (14% vs. 18.7%; p=0.016, log-rank test).

Conclusions

e-health intervention with easily accessible Internet-based social media is a promising model to meet the holistic needs of patients with CAD in the modern era.

Anxiety reduction after pre-procedure meetings in patients with CHD

BACKGROUND

Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.

METHODS

Prospective study of patients ≥18 and parents of patients <18 scheduled for clinically indicated catheterisations. Patients completed online surveys before and after meeting with the interventional cardiologist, who was blinded to study participation. Both the pre- and post-meeting surveys measured anxiety using the State-Trait Anxiety Inventory. In addition, the post-meeting survey evaluated the subjective value (from 1 to 4) of individual educational tools: physician discussion, cardiac diagrams, echocardiograms, prior imaging, angiograms and three-dimensionally printed cardiac models. Data were compared using paired t-tests.

RESULTS

Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety.

CONCLUSION

In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.

A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety

OBJECTIVES

The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used.

KEY FINDINGS

The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio-visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio-visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation.

CONCLUSION

Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment.

IMPLICATIONS FOR PRACTICE

Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.

Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review

BACKGROUND

Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process.

OBJECTIVE

To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population.

METHODS

We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO International Clinical Trials Registry Platform, EMBASE and LILACS.

RESULTS

We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation.

CONCLUSIONS

We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time progresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Visually enhanced education and immunization perceptions in low-income parents

OBJECTIVE

Despite immunizations being an effective health promotion intervention, about 28% of children are not up-to-date on the combined seven-vaccine series by 35 months of age in the United States. Identifying innovative techniques to increase immunization literacy is crucial to the health and well-being of children.

DESIGN AND SAMPLE

Based on the theory of multimedia learning, this study examined whether the use of visually enhanced education (VEE) positively impacted parental perception of immunization effectiveness, perceived knowledge of disease, comfort with immunization decision making, and satisfaction with the provider. Forty parents of infants 4-14 days old that could read English.

INTERVENTION

Parents completed a questionnaire with 12 items in four categories during the initial visit (4-14 days old) before VEE and at the second visit (17-37 days later) after the second VEE session had been completed.

RESULTS

A paired sample t test revealed a significant increase in two of the four categories (i.e., perceived knowledge of the disease [t(37) = 8.73, p = .000] and satisfaction with the provider [t(37) = 2.68, p = .011]. Cohen's effect size value suggested high practical significance in one of the four categories (i.e., perceived knowledge of disease d = 1.31, d = 1.42, d = 1.18, d = 1.05, d = 1.12). Cronbach's alpha for the 12 items was 0.852.

CONCLUSIONS

VEE may be an innovative technique for improving parental immunization health literacy and increasing parent-professional communication about immunizations.

The Use of an Informational Video to Improve Patient Satisfaction, Preparedness, Mood, and Empowerment

Background

Massage therapy is commonly used in Canada for the treatment of a wide range of health concerns. Massage therapy is changing to meet the health care needs of Canadians. Rapid changes to the profession may create a gap between patient expectations of massage therapy treatment based on historic views of the profession and their experience in today’s practice. This gap could lead to patient confusion, dissatisfaction, or other negative outcomes.

Purpose

This study sought to understand whether patient satisfaction, preparedness, mood, and patient empowerment are improved when new patients who attend a student massage therapy clinic watch an informational video, compared to those who receive the standard paper information sheet.

Participants

The study used a convenience sample of new patients who presented for their first massage therapy appointment to the Humber College Student Massage Therapy Clinic. Participants were randomized either to the intervention group (video and paper information) or the comparison group (paper information only). The outcomes of interest in this study were patient preparedness, satisfaction, mood, and empowerment. Data were collected using two questionnaires, one before treatment and one after.

Results

A total of 108 patients participated in the study (55 comparison group; 53 intervention group). Demographic and clinical characteristics were comparable between the two groups. A statistically significant difference was seen between the two groups when comparing their responses to the pre-appointment statement: “I know what will happen in my initial massage therapy appointment” (p < .001). There was no statistically significant difference seen when comparing the responses of the related post-appointment statement (p = .63).

Conclusion

This study found that an informational video improved perceived knowledge as patients entered the massage therapy treatment, but did not have a significant effect on satisfaction, mood, or patient empowerment. Other student clinics should consider the addition of an informational video to their procedures to increase patient knowledge of what to expect.