RSNA: In interventional radiology, mood affects outcomes

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CHICAGO—Interventional radiologists ought to be mindful of pre-procedure patient mood, as a negative state of mind heading in can kindle the self-fulfilling prophecy of a negative outcome.

The research behind the recommendation was presented Thursday at the annual meeting of the RSNA.

Nadja Kadom, MD, of Emory University and Children’s Healthcare of Atlanta, and colleagues looked at 230 patients (120 women and 110 men, mean age 55) who underwent percutaneous peripheral vascular and renal interventions in a randomized sequence.

Before undergoing the procedure, the patients completed the Positive Affect Negative Affect Schedule (PANAS), assigning a numeric value from 1 (“Very slightly/Not at all”) to 5 (“Extremely”) on 10 adjectives describing positive affect and 10 for negative affect.

The adjectives for negative affect were distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery and afraid.

The adjectives for positive affect were interested, excited, strong, enthusiastic, proud, alert, inspired, determined, attentive and active.

The researchers split summary scores for the two affects into high and low over their medians, then correlated with absence or presence of adverse events using logistic regression.

They found that patients with high negative affect had significantly more adverse events—including prolonged hypoxia, hypertensive or hypotensive episodes, prolonged bradycardia and postoperative bleeding—than those with low negative affect (22 percent vs. 12 percent; odds ratio 0.48).

Interestingly, the degree of positive affect had no significant impact on adverse event rates.

“Our study shows that mood matters,” co-author Elvira V. Lang, MD, PhD, of Harvard Medical School, said in prepared remarks. “You don’t need to have a chipper, cheery attitude prior to your procedure. You just have to overcome negative emotions and get to a neutral level.”

The authors also noted that a negative mood can be contagious—and interventional radiologists are not immune.

“This is a real issue,” Lang said. “The procedure room is a two-way street in which the patient can affect the healthcare professional and vice versa. Any time the team must manage an adverse event, it takes attention away from the procedure.”

Lang recommended training for procedure-room workers in coping strategies as well as in techniques to help patients reverse negative thought processes.