Pre-Procedural Patient Anxiety in Dermatologic Procedures: A Cross-Sectional Study of Dermatologists

As many as 73% of patients scheduled to undergo surgery have substantial preoperative anxiety [1]. Significant preoperative anxiety has also been reported in fast track and day-care patients [2]. Dermatologists perform a number of procedures ranging from skin biopsies to Mohs micrographic surgery. Patients may experience anxiety prior to such procedures, termed pre-procedural or preoperative anxiety. Patient anxiety prior to dermatologic surgery may be influenced by factors such as the sight of blood, perception of pain during the surgery, and potential complications of surgery. Given the role of preoperative anxiety in affecting tolerance of the procedure, intra- and postoperative complications, and overall satisfaction, further research is warranted to determine how best to reduce preprocedural anxiety in dermatologic procedures.

The Need for Patient Centered Education Among Patients Newly Diagnosed With a Pituitary Tumor

Objectives Brain tumors, including pituitary adenomas (PA), cause anxiety and distress, with a high unmet need for information correlating with increased anxiety. Condition-specific education may alleviate anxiety. We explored patients’ experience around diagnosis of a PA and piloted a patient education intervention to address peri-diagnostic anxiety in adults diagnosed with PA Methods Anxiety, patient satisfaction, patient knowledge, and need for information were measured prior to, immediately after, and 1 month following the appointment in this multi-methods study. A phone interview to explore patient diagnostic and intervention experiences was analyzed using qualitative methods. Results 17 patients participated in the study; 15 completed the interview. Baseline need for information was high. Disease specific anxiety decreased, and patient knowledge and satisfaction significantly increased significantly after the visit. Interview analysis identified 3 main themes: (1) Importance of communication; (2) Need for information; and (3) Impact of the diagnosis on patient experience. Conclusions For patients with newly diagnosed PA, the diagnostic experience is associated with high levels of anxiety. Patients expressed a need for information. Information delivery reduced anxiety and had a positive impact on patient satisfaction. Practice implications The study findings suggest a need for a streamlined diagnostic process with readily accessible information.

A99 OPTIMIZING COLONOSCOPY PROCEDURES AND REDUCING PATIENT ANXIETY THROUGH RECENTLY DEVELOPED ONLINE INFORMATION RESOURCES

Background Invasive medical procedures such as colonoscopies are known to cause psychological distress and anxiety. Patient anxiety leads to reduce patient compliance for colonoscopy and increased adverse effects. Patient education prior to colonoscopy has previously been shown to have positive effects on outcomes and experience. Based on patient and provider input, we have developed easy to read written materials and easy to follow video materials, which other patients have rated highly. These, along with other materials, are embedded on Mycolonoscopy.ca. Mycolonoscopy.ca is a website that provides online information access for patients regarding preparation and peri-procedural expectations. Information about accessing the website is provided with appointment materials (which includes information about split-dose versus one day bowel preparation, giving patients the option between the two) mailed to all patients undergoing outpatient colonoscopy in Winnipeg. Aims (1) To evaluate the current use of mycolonoscopy.ca among patients undergoing colonoscopy (2) To determine whether there is an association between visitation to the website and patient outcomes such as reduction in procedural anxiety, bowel preparation tolerance/compliance, and bowel preparation score. Methods A paper-based survey was given out to patients at their colonoscopy appointments. Univariate and multivariate logistic regression analyses was performed to determine the factors associated with website visitation and association with procedural anxiety, bowel preparation compliance and bowel preparation scores. Results A total of 593 participants were given the surveys, of which 506 were completed. 17.4% of participants had visited the website prior to their colonoscopy. Visitors to mycolonoscopy.ca and those that had heard of the website were more likely to consume a split-dose bowel preparation (63.9% and 68.2% respectively) compared with non-visitors (52.5%) (p=0.0062). Individuals who consumed split-dose bowel preparation had a median Boston bowel preparation score of 9, compared with a score of 7 for individuals who used other forms of preparation (p<0.0001). 31.3% of website visitors were very or extremely worried about their colonoscopy compared with 17.9% of non-visitors. 76.6% of individuals agreed or strongly agreed that visiting the website helped them prepare for their colonoscopy and 69.7% who visited the website agreed or strongly agreed that it helped to reduce their stress/anxiety for the procedure as well. Conclusions Our study suggests that use of an informative online platform such as mycolonoscopy.ca can help to improve patient education prior to colonoscopy, reduce anxiety and stress surrounding the procedure, and improve bowel preparation compliance and bowel cleansing score. Funding Agencies CAG

Determinants of anxiety and depression in patients with cubital tunnel syndrome

Background The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features. Methods From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. Results The proportions of depression and anxiety were 17.9% (n = 44) and 14.2% (n = 35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. Conclusions In patients with CuTS, the proportions of depression and anxiety were 17.9% and 14.2%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.

Determinants of Anxiety and Depression in Patients with Cubital Tunnel Syndrome

Background:: The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features.Methods: From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. Results: The proportions of depression and anxiety were 17.8% (n=44) and 14.2% (n=35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. Conclusions: In patients with CuTS, the proportions of depression and anxiety were 18% and 14%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.

Factors associated with anxiety in pre-lower gastrointestinal endoscopy in inflammatory bowel disease patients: a systematic literature review

Background Inflammatory bowel disease (IBD) affects more than 300 000 people in the UK alone. These patients will frequently require gastrointestinal (GI) endoscopic assessment and surveillance of their disease, which can cause pre-procedure anxiety. A better understanding of procedure-related anxiety can help develop measures to reduce it and improve patient experience. Aims A systematic literature review was conducted to identify the factors that are associated with pre-lower gastrointestinal endoscopy anxiety in inflammatory bowel disease (IBD) patients. Methods Electronic databases were searched for studies that evaluated anxiety with GI endoscopic procedures in IBD patients. Studies were independently reviewed by an author, extracting data and assessing quality. The main outcomes were the prevalence of pre-procedure anxiety, patient concerns, tolerance and interventions in IBD patients. Results In total, 77 studies were identified for inclusion. No studies specifically explored the prevalence and severity of anxiety in IBD patients. The studies that investigated pre-procedure anxiety identified that high levels were seen pre-procedure, with areas of anxiety-related concerns including bowel preparation, potential discomfort and the stigma of embarrassment. Conclusions Many patients undergoing GI endoscopic procedures experience anxiety. Improving the ways in which pre-procedure information is delivered can help in reducing this anxiety. However, the prevalence and severity of and best method of intervention for this anxiety in IBD patients are unclear, providing areas for further research.

The efficacy of music as a non-pharmacological intervention in the endoscopy setting: a literature review

Background: Music has been demonstrated to have therapeutic effects for relaxation and pain management in various healthcare settings. However, this practice has not been adopted in the UK in the endoscopy environment. Music as an intervention could potentially lower pain thresholds, promote anxiolysis, reduce sedation and enhance the patient experience. Aims: The study aimed to identify, analyse and discuss existing knowledge on the topic of music medicine as an intervention in the endoscopy setting and to expose gaps in previous research and form recommendations for future research. Methods: Iterative searching of electronic databases, hand searches and grey literature searches were employed, following inclusion/exclusion criteria to identify relevant studies. Studies were then thematically analysed and themes identified. Findings: The search identified 11 relevant studies, with emergent themes of anxiety, patient satisfaction, sedation/analgesia, choice of music and procedure times. Conclusions: This literature review showed that music is a safe therapeutic intervention. It has the potential to act as an anxiolytic, reducing amounts of sedation or even replacing sedation in some cases. Patient satisfaction and experience can be enhanced, reducing DNA rates and encouraging greater uptake of repeat procedures.