Preparing for medical procedures Flashcards
(10 cards)
Intro
- hospitalisation presents unique stressor, anxiety highly prevalent in in-patients
- subset of stressors: frustration, fear of unknown, overwhelmed, pain, inability to sleep (Palmer et al., 2021)
- moderate levels of anxiety theorised as optimal (Janis, 1958) but anxiety before surgery is particularly high internationally (Caumo et al., 2001)
- reducing pre-op anxiety may benefit post-op outcomes
Information interventions
- most research focused on this - info provision conventionally considered good but ignores coping styles
Video info intervention (Jlala et al., 2010) - given film before hand or knee/ankle surgery
- film group less anxious pre-op and both groups less anxious post-op but film group more so
- limitations - did not test knowledge retained from video, video anesthesia specific not surgery itself, population may be skewed to those receptive to video, those said video may make them more anxious didn’t participate
- strength - efficient intervention and economically viable
Role of coping style
- Miller et al (1987) - behavioural style scale - monitors or blunters
- info interventions have been more effective when tailored to coping style (Miller & Mangan, 1983; Kola et al., 2013)
Kola et al (2013) - one of first to account for coping style effects on stress outcomes - stress reduction enhanced when info provision matched coping style
- self-report anxiety failed to show group differences but may be different if asked during procedure
- low info group blocked sights and sounds of clinic environment so may have enhanced both coping styles
- high monitors decreased BP in low info, may struggle to disengage from threat cues so may benefit from distraction as well
- future research needed to disentangle confounding effects of relaxation
Anxiety in children
- history of distressing medical procedures linked to negative adult outcomes (Noel et al., 2015)
Child-centred communication may help (Davison et al., 2023) - place child front and centre, build rapport, allow child to tell own story, reply in plain english, have open discussion about possible tests, treatments and risks, encourage child to comment and state preferences
- but evaluation often focuses on clinician/parental feedback not child’s views (Marshman et al., 2007)
Interventions in children
Video for pediatric anxiety with anorectal manometry reduced distress and anxiety but physiological arousal was mixed (Lamparyk et al., 2019)
- assessed via self-report, parent-report, physiological arousal measurements and observational scale of distress
- HRM requires alert and cooperative child so reducing distress important
- training parent in effective coping skills also effective
- but didn’t account for coping styles
Birnie et al (2018) - systematic review
- distraction, hypnosis, combined CBT and breathing can reduce needle related pain, distress or both
- children may benefit more from distraction than info
- hypnosis had largest effect
- but quality of trials and overall evidence low and intervention delivery varied a lot
- failure to manage pain and distress during needle procedures can lead to needle fears in adulthood and vaccine hesitancy
Dental anxiety in children
- significant problem globally (Grisolia et al., 2021)
Shammasi et al., 2018 - formal measurement of anxiety is low in practice - use judgement not scale even though many available
- brief scale should be recommended as adjunct to judgement
- anxious children more likely to report pain during dental procedures
- scales can highlight anxious patients, inform management, act as vehicle for child to communicate worries
- poor use may be lack of knowledge/understanding, lack of teaching, questioning validity/reliability, concern it makes child more anxious, lack of time
- study was in real-life setting but only one hospital
- dentists overwhelmingly treat in monitoring style (Buchanan & Niven, 2003)
Interventions for surgery (general)
- stress linked to slower wound healing (Maple, 2015)
- interventions should focus on reducing negative emotions, worry about surgery and perceptions of stress
Interventions for surgery (review)
Powel et al (2016)
- psychological prep may benefit post-op pain, behavioural recovery, negative affect and length of stay
- unlikely to have harmful effects
- strength of evidence insufficient for firm conclusions but high prevalence of surgery means small effect size still important
- only applicable to elective procedures with general anesthesia in adults
- only looked at earliest outcome measure from each study - not long-term effects
- didn’t look at coping styles
Interventions for oncology surgery
Hanalis-Miller et al (2022)
- scoping review of interventions for oncology surgery
- current research lacks systematic methods and provides varying results, hard to reach conclusions
- oncological surgeries elicit higher pre-op stress due to additional fears around cancer, awaiting and undergoing surgery induces stress-inflammatory responses which can contribute to cancer growth - priority for future research
- pre-op psychological interventions may be beneficial
- COVID-19 raised stress in most populations, especially those coping with illness - taken into account in future research
- psych intervention lacked capacity to improve physical/inflammatory response - may use in conjunction with medical interventions
- these studies intervened in pre-op period, may benefit more across whole period - future research
Buchanan (2017)
- anxious children use maladaptive coping strategies so anxiety is maintained
- need to be taught behavioural/cognitive strategies
- TSD (tell-show-do) recommended, evidence it reduces anxiety (Carson & Freeman, 1998)
- monitor-blunter dental scale (MBDS) - blunting more prevalent in children but dentists use monitoring techniques
MBCT-D (Buchanan & Campbell, 2016) - brief for clinical use - when used found children more likely blunters, children and clinicians found it helpful, but only pilot study
- can’t just use this, need to discuss treatment with patient (use tool WITH not ON)
