Anxiety during stressful medical procedures Flashcards
What is Anxiety ?
- Unpleasant feeling or emotion
- Range of physiological, emotional, cognitive symptoms
Associated with;
- threatening situations
- thoughts of threatening situations
How may a patient perceive a medical procedure?
Medical procedures are inherently threatening as they involve huge amount of uncertainty
Different procedures will cause different types of stress
Patients experience;
- Function of procedure
- Procedural stress
- Outcome stress
What things are patients anxious about ?
What are patients anxious about?
- Anaesthesia/being unconscious
- Fear of waking during surgery
- Pain (e.g., post-operative)
- Life-threatening procedures
- Post-operative outcome
- Possibility of disfigurement
- Threat of severe illness
- Outcome of test results
- Unfamiliarity of surroundings
- The ward environment
- Surrounded by machines
- Physical restriction
- Loss of independence
- Being away from home (children, job, other obligations)
What kind of anxiety and pattern of anxiety do surgical patients present with ?
- Most surgical patients experience high anxiety when they are admitted to the hospital
- Anxiety remains quite high before and after the operation
Greater fear and distress before surgery = worse recovery
What are patients who experience high anxiety preoperatively more likely to experience?
Patients who experience high anxiety preoperatively more likely to;
- Experience more pain post-operatively
- Use more analgesic
- Stay in the hospital longer
- Experience more complications
- Anxiety and depression after surgery
What are the Psychological influences on surgical recovery ?
Communication;
- Anxious patients are less likely to understand the info they are told
Adherence;
- Patients with higher anxiety are less likely to be compliant with;
- Coughing and breathing exercises (help reduce the likelihood of pneumonia)
- Getting out of bed and moving around (help reduce phlebitis & enhance wound healing)
Pain management;
- Pre-surgery anxiety and stress can influence the type and amount of anaesthetic
What are some effective approaches to help patients ?
Effective approaches to help patients;
Key is to increase patient sense of control!
Give them;
- Procedural information
- Sensory information
- Behavioural instruction
- Cognitive coping (thoughts + beliefs)
- Other techniques (modelling, emotion focussed or psycho-therapeutic discussion, relaxation, hypnosis)
Provide context of sensory info increases patient control and what can anticipate
What are the benefits of psychological preparation ?
Classic study by Egbert et al 1964
Patients received additional procedural info (before, during after surgery)
- Patients were discharged from hospital on average 2.7 days earlier
- Required half as much pain medication as patients receiving usual care
What did the Cochrane Library study show on the evidence for the benefits of Psychological preparation ?
Primary outcome;
Impact on post operative pain;
- Psychological preparation may reduce operative pain in the 1st month after surgery
Impact on behavioural recovery;
- Psychological preparation particularly behavioural instruction may improve recovery outcomes
Secondary outcome;
Impact on negative effect;
- Some evidence of benefits of psychological interventions on post-operative negative affect
Impact on length of stay;
- Psychological preparation reduced mean length of stay of around half a day
How did Procedural Information affect patients in the Cochrane meta-analysis?
Procedural information;
- Beneficial for ‘length of stay’
- Beneficial for negative affect (but not significant if interventions included procedural info only)
- No evidence on post-operative pain
How did Sensory Information affect patients in the Cochrane meta-analysis?
Sensory information;
- No intervention has sensory info only - always combined with another component
- Beneficial for ‘length of stay’
- Beneficial for negative affect
- No clean evidence for ‘post operative pain’
How did Behavioural Instruction affect patients in the Cochrane meta-analysis?
Behavioural instruction;
- Beneficial for ‘length of stay’
- Greatest potential for ‘behavioural recovery’ outcomes
- No evidence for ‘post-operative pain’ or negative affect
How did Cognitive Interventions affect patients in the Cochrane meta-analysis?
Cognitive interventions;
- Small number of studies
- No clear evidence or outcome
How did Relaxation Techniques affect patients in the Cochrane meta-analysis?
Relaxation techniques;
- Beneficial effect on ‘post-operative pain’
- Beneficial effect on negative affect but not when only relaxation techniques in the intervention
How did Hypnosis affect patients in the Cochrane meta-analysis?
Hypnosis;
- Few studies included meta-analysis
What kinds of preparation can we give for non-surgical procedures ?
Preparation can we give for non-surgical procedures;
- Relaxation training
- Systematic desensitisation
- Information provision
