Radiology: Rad waiting rooms invoke stress for women

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Writing that there is no such thing as a “simple” diagnostic test, researchers reported that women waiting for breast biopsy, hepatic chemoembolization and uterine fibroid embolization procedures experienced high levels of stress in a study published in the July edition of Radiology. The breast biopsy cohort also experienced highly abnormal anxiety levels, the researchers continued, and both factors could impact departmental operations.

Waiting room distress can impact patients and radiology resources by taxing “departmental resources in terms of appointment cancellations, patients’ lack of cooperation, extended room times, increased medication use, prolonged recovery and inability to complete imaging procedures well or at all, with adverse impact on both image quality and reimbursement,” wrote Nicole Flory, PhD, of the department of radiology at Beth Israel Deaconess Medical-Harvard Medical School in Boston, and colleagues.

As a first step in evaluating patient stressors in the radiology department, Flory et al designed the study to compare distress levels among three groups of female patients waiting for different procedures:  breast biopsy, hepatic chemoembolization and fibroid embolization.

The researchers administered four standardized psychological questionnaires: the State Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Center for Epidemiologic Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) to 214 women between February 2002 and June 2006. The study population was comprised of 112 women awaiting breast biopsy, 102 awaiting fibroid embolization and 42 with known hepatic malignancy.

The primary differences in scores among the three groups occurred on the STAI assessment with breast biopsy patients showing significantly higher levels of anxiety with a mean STAI score of 48 compared with women awaiting hepatic chemoembolization or fibroid embolization, with mean scores of 26 and 24, respectively.

Other results showed high levels of subjective distress; all three groups had mean scores in the range of high clinical concern on the IES. Depressive scores measured by the CES-D hovered near, but below, the cutoff score of 16 traditionally interpreted as suggestive of clinically significant depression. These scores were 15 for biopsy patients, 14 for hepatic chemoembolization patients and 12 for fibroid embolization patients.

The mean PSS score of 18 for biopsy patients was significantly higher than those of hepatic chemoembolization patients at 15. However, the breast biopsy group’s mean score was not significantly different from the mean score of fibroid embolization patients, which was 16.

“[It] was surprising to find in our study that awaiting breast biopsy and diagnosis proved a greater stressor in terms of anxiety and perceived stress than did awaiting much riskier invasive treatment of known cancer. ...This finding suggests that the invasiveness of the procedure has less influence on patients’ distress than does uncertainty of outcome,” wrote Flory and colleagues.

The researchers emphasized the importance of attending to patients’ distress before and after procedures, noting the link between acute distress and hemodynamic instability, procedural complications and other adverse events.

Operational issues may be involved as well. “Patients with negative affect also tend to have longer procedural times than do others, and they request and receive more medication, which may result in an increased likelihood of adverse events.”

Flory and colleagues recommended that radiologists reconsider their on notions of “minor” procedures as patients’ perceptions may differ from physicians. Raising awareness of patients’ psychological states among physicians, they suggested, may be the first step in targeting resource use and may help providers better design and staff waiting areas, particularly for mammography.

The authors concluded, “Training medical personnel in how to communicate with these patients and how to assuage their distress promises not only to relieve patients’ distress but also to positively affect departmental resources.”