Original article
Clinical practice management
Raised Anxiety Levels Among Outpatients Preparing to Undergo a Medical Imaging Procedure: Prevalence and Correlates

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Abstract

Purpose

To examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure; their attribution of procedural-related anxiety or worry; and sociodemographic, health, and procedural characteristics associated with raised state anxiety levels.

Materials and Methods

This prospective cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in Australia, with institutional board approval. Adult outpatients undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy) completed a preprocedural survey. Anxiety was measured by the short-form state scale of the six-item State-Trait Anxiety Inventory (STAI: Y-6). The number and percentage of participants who reported raised anxiety levels (defined as a STAI: Y-6 score ≥ 33.16) and their attribution of procedural-related anxiety or worry were calculated. Characteristics associated with raised anxiety were examined using multiple logistic regression analysis.

Results

Of the 548 (86%) patients who consented to participate, 488 (77%) completed all STAI: Y-6 items. Half of the participants (n = 240; 49%) experienced raised anxiety, and of these, 48% (n = 114) reported feeling most anxious or worried about the possible results. Female gender, imaging modality, medical condition, first time having the procedure, and lower patient-perceived health status were statistically significantly associated with raised anxiety levels.

Conclusion

Raised anxiety is common before medical imaging procedures and is mostly attributed to the possible results. Providing increased psychological preparation, particularly to patients with circulatory conditions or neoplasms or those that do not know their medical condition, may help reduce preprocedural anxiety among these subgroups.

Introduction

More than three billion medical procedures involving ionizing radiation are performed worldwide each year [1], and over 15 million medical imaging procedures are performed in Australia [2]. Patients experience imaging procedures in diverse ways [3], and for some there is a level of burden including anxiety, fear, and claustrophobia associated with some imaging modalities [3]. Patient distress may have negative implications for the health care system via imaging appointment cancellations or no-shows, increased use of sedatives, longer procedural times, or the need for repeated procedures 4, 5. In one study, 72% of radiographers reported that anxiety was an issue for patients before undergoing MRI, and 19.3% reported that anxiety disrupted scanning on a regular basis [6]. Although conflicting findings have been reported, image quality may be inversely proportional to patient anxiety [7].

Some studies have examined medical imaging-related anxiety. However, most of this research has focused on MRI 1, 6, 8, 9, 10, PET/CT 11, 12, interventional radiology 5, 13, or procedures relating to breast cancer diagnosis 14, 15, 16, which limits the generalizability of findings. Some studies report estimates of anxiety using poorly defined and inconsistent State-Trait Anxiety Inventory (STAI) score cut points, making it difficult to compare and contrast findings between studies 5, 7, and other studies report mean anxiety scores only 4, 12, 15, 17. Additionally, some studies have not accounted for participants’ prior experience of the procedure 7, 9 or attempted to ascertain what patients are most anxious about in relation to the procedure (eg, fear of the procedure versus the findings). Collectively, these issues limit our understanding of the prevalence of raised anxiety in medical imaging populations.

Evidence-based methods of reducing anxiety exist, including the provision of preparatory information and psychological approaches 5, 11, 18. However, it is not clear which patients are at higher risk of experiencing preprocedural anxiety and should be targeted for such interventions by health care providers. Determining the extent to which raised anxiety is experienced by patients presenting for a range of imaging modalities and medical conditions and the subgroup of patients most at risk of raised anxiety could assist in the planning and delivery of health care.

To address these gaps in knowledge, we undertook this study to examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy), their attribution of procedural-related anxiety or worry, and the sociodemographic, health, and procedural characteristics associated with raised state anxiety levels.

Section snippets

Study Description

This article presents the anxiety-related findings from a larger study that assessed patients’ perceived preparation for medical interventions. A cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in regional Australia. Patients aged ≥18 years and undergoing an elective medical imaging procedure, including CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy, were eligible to participate. Patients unable to provide informed consent

Sample

A total of 801 patients were assessed for study eligibility, of which 636 were identified as being eligible. Reasons for ineligibility included aged under 18 (n = 118), inability to provide informed consent independently or considered physically or mentally incapable of participating by clinic staff (n = 32), not undergoing the procedure as an outpatient (n = 6), had already participated in the study (n = 5), or inadequate English (n = 4). There was no significant difference in gender between

Discussion

This is the first Australian study and one of few internationally [7] to examine the prevalence and correlates of preprocedural anxiety across a diverse range of imaging modalities and medical conditions. Our findings revealed that raised anxiety is common, with almost half of patients experiencing raised anxiety preprocedure. Patient gender, medical condition, perceived health status, no prior procedural experience, and imaging modality were statistically significantly associated with raised

Take-Home Points

  • This is the first study to examine the prevalence and correlates of preprocedural anxiety across a diverse range of medical imaging modalities and medical conditions.

  • Raised anxiety is common; almost half of patients experienced raised anxiety before their imaging procedure, and of those, 48% reported they felt most anxious or worried about the possible findings or results.

  • Health and procedural characteristics (particularly medical condition and overall health rating) were more strongly

Acknowledgments

We thank the participating clinic for research support, the study participants, and Jean Ball and Chris Oldmeadow for statistical assistance.

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    This research was supported by a grant from the Priority Research Centre for Health Behaviour, University of Newcastle and infrastructure funding from the University of Newcastle and Hunter Medical Research Institute (HMRI). Ms Kristy Forshaw is supported by an Australian Government Research Training Program Scholarship. Dr Allison Boyes is supported by Early Career Fellowships from the National Health and Medical Research Council (APP1073317) and Cancer Institute New South Wales (13/ECF/1-37). A/Prof Mariko Carey is supported by a National Health and Medical Research Council Translating Research into Practice (TRIP) Fellowship (APP1073031). The authors have no conflicts of interest related to the material discussed in this article.

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