Original articleClinical practice managementImaging-Guided Core-Needle Breast Biopsy: Impact of Meditation and Music Interventions on Patient Anxiety, Pain, and Fatigue
Introduction
Stereotactic- and ultrasound-guided core-needle breast biopsy (CNBB) are minimally invasive methods of diagnosing suspicious breast lesions and have many advantages compared with surgical biopsies. CNBBs performed in outpatient settings decrease procedure costs [1], minimize delays, and limit use of intravenous sedation and pain medication used to treat pain and anxiety, which are commonly reported 2, 3, 4, 5, 6, 7. Patient anxiety may negatively affect patient adherence to follow-up mammography recommendations 8, 9 and is cited as a potential harm of screening mammography, influencing the US Preventive Services Task Force to reduce the recommended frequency of mammography screening [10].
Higher patient anxiety is associated with greater CNBB pain [11]; therefore, interventions to reduce anxiety during CNBB may decrease pain as well. Effective pain and anxiety management not only improve patient comfort, but also are vital to CNBB success. Pain and anxiety can result in patient movement, which lowers the diagnostic yield of procedures, particularly during stereotactic biopsies. In addition, pain may influence adherence to future mammography screening recommendations 11, 12 and potentially affect practice revenues. A proposed CMS reimbursement plan, which adjusts payments based on patient satisfaction, includes measures of pain and doctor-patient communication in its patient-satisfaction survey [13].
Fatigue refers to the physically taxing nature of medical procedures. Patients may experience mental or physical exhaustion, weakness, reduced capacity for initiating activity, concentration difficulty, and emotional instability 14, 15, 16. Although fatigue commonly affects patients undergoing breast cancer treatment 15, 16, the impact of fatigue related to CNBB has not been investigated.
Studies investigating interventions, such as oral anxiolytics, relaxing music, and hypnosis, designed to reduce anxiety and other negative experiences during outpatient biopsies show varying benefits 7, 17, 18, 19, 20. Potential limitations of anxiolytics during outpatient CNBB include need for an adult to drive the patient home after sedation, and possible adverse effects from the medication. Hypnosis seems to be effective but requires formal training of medical personnel in administration of the interactive intervention, which could add to initial costs [7]. One alternative that avoids these issues is use of an audio-recorded, meditation-based intervention. Studies show that meditation-based interventions lead to positive psychological and physical health outcomes, such as decreased anxiety, pain, and fatigue 21, 22, 23, 24.
This pilot study evaluated the impact of an audio-recorded, guided meditation, on patient anxiety, pain, and fatigue during CNBB, compared with a music intervention and a standard-care control group. The meditation intervention tested in this study uses an adaptation of loving-kindness meditation (LKM), focusing on developing positive emotions (eg, compassion) toward oneself and others while releasing negative emotions 25, 26. Hutcherson et al [27] demonstrated that a seven-minute LKM protocol increased positive emotions, suggesting that a brief LKM intervention could be effective during the CNBB timeframe. A secondary aim is to evaluate effects of LKM on radiologist-patient communication, as better communication during CNBB is associated with lower patient anxiety [3] and may have a role in reducing pain [11].
Section snippets
Participants
From September 2012 through December 2013, a total of 203 women undergoing ultrasound- or stereotactic-guided CNBB were invited to participate in this prospective, HIPAA-compliant, randomized controlled trial approved by institutional review board. Inclusion criteria were that patients: (1) be women ≥21 years old; (2) present for CNBB; (3) be able to speak and read English; (4) provide written informed consent (Fig. 1). A total of 138 women completed informed consent (participation rate: 68%);
Sample Description and Prebiopsy Group Comparability
Table 1 displays participant characteristics. Bivariate analyses testing for group differences prebiopsy found that women in the LKM group tended to be older (mean [M] = 56.10 [standard deviation {SD} = 13.04] years) than those in the music group (M = 52.93 [SD = 11.08] years) and the standard-care group (M = 49.85 [SD = 12.78] years; F (2,118) = 2.60, P = .08]). The women in the LKM group were significantly more likely to be white than were those in the music and standard-care groups (82.9%
Discussion
This study examined the impact of an audio-recorded, guided LKM on patient anxiety, pain, and fatigue during CNBB, compared with the music and standard-care control groups. Although average self-reported anxiety decreased in all groups after CNBB, anxiety reduction was significantly greater in the LKM and music groups compared with the standard-care control group. Self-reported fatigue increased in the standard-care control group, but decreased overall in the LKM and music groups. Patients in
Conclusions
Loving-kindness meditation and music interventions during CNBB are efficacious for reducing patient anxiety, and do not interfere with radiologist-patient communication; and LKM resulted in lower levels of biopsy pain. These interventions seem to be safe, inexpensive, and easy to incorporate into clinical practice; further study is warranted to determine whether incorporating them into clinical practice affects adherence to subsequent treatments and recommendations.
Take-Home Points
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Inexpensive, easy-to-implement, guided LKM and music interventions reduced patient anxiety and fatigue compared with a standard-care control group during imaging-guided CNBB.
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No differences in radiologist-patient communication were found among study groups (P = .36).
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The LKM intervention resulted in lower biopsy pain during CNBB (P = .03), compared with the music group.
Acknowledgements
The authors acknowledge Dee Campbell, MSEE, and Mary Brantley, MA, LMFT for their assistance with this research.
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This study was supported in part by seed funding from the Department of Radiology at Duke University Medical Center.
The authors have no conflicts of interest related to the material discussed in this article.