Information, social support and anxiety before gastrointestinal endoscopy
ABSTRACT To examine Lazarus and Folkman's (1984) stress theory regarding the effects of the stress mediators information and perceived social support on anxiety (as the stress response) regarding gastrointestinal (GI) endoscopy (as the stressor) in male and female patients of various age groups.
Structured interviews were conducted with 113 hospital out-patients about to undergo GI endoscopy. Participants indicated their perceptions of how much support and how much clear and useful information they had received from both their general practitioner (GP) and a patient information leaflet developed in collaboration with health psychologists as well as their perceptions of how much social support they had obtained from other patients, family and friends. Anxiety was measured with a population-specific trait and state adaptation of the Hospital anxiety and depression scale (HADS-A).
Psychometric exploration of the HADS-A revealed a single general anxiety factor. The reliability of this factor was high, with Cronbach's alpha=0.91. The majority of the sample experienced high anxiety levels. Gender, but not age, differences emerged, showing females to be more anxious than males, F(1, 84)=5.68, p<.05. A regression model built on stress theory was tested, with anxiety as the dependent variable and 11 predictor variables. The model was significant with R(2)=0.452, F(11, 47)=3.522 and p=0.001.
The clarity, but not the amount, of information and social support from important others, but not GPs, were both mediating the stress experience of the patients by reducing their perceived anxiety.
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ABSTRACT: Providing a procedure report to patients after endoscopy is inconsistently practiced by clinicians. To evaluate the effect of providing a procedure report to patients after an outpatient endoscopy. Demographic data, including age, sex, race, and endoscopic procedures. Assessments one week after the procedure included anxiety, satisfaction, recall of endoscopic findings and recommendations, and compliance. A prospective, randomized, single-center, investigator-blinded study. Anxiety was measured by using the Beck Anxiety Inventory; satisfaction was measured with a modified American Society for Gastrointestinal Endoscopy survey, which was validated as part of this study, and recall and compliance was measured by a patient interview, during which responses were compared with the original endoscopy report. Single university outpatient endoscopy laboratory. Between June and September 2005, 115 patients were randomized, and 83 completed this protocol. The two groups were equally matched, except the intervention group (received report) was older (54.4 vs 50.7 years; P = .037). Receipt of an endoscopy report reduced postprocedure anxiety (P = .001) and improved recall of findings and recommendations (P = .001 for both). Satisfaction was very high for all patients and was unaffected by receipt of a report. Patients older than 60 years had significantly lower satisfaction scores by approximately 6 points (P = .004). Some subcategories of compliance were significantly better in the intervention group, but there was no effect on the number of patients who complied with all recommendations. Small number of patients. The receipt of an endoscopy report at discharge reduces postprocedure anxiety, improves recall of findings and recommendations, and may increase compliance. This inexpensive and safe practice should be routinely adopted.Gastrointestinal Endoscopy 02/2008; 67(1):103-11. DOI:10.1016/j.gie.2007.08.035 · 5.37 Impact Factor
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ABSTRACT: The experience of unpleasant blood donation reactions (e.g., dizziness, nausea, and fainting) has been linked to negative attitudes about donation and decreased likelihood of repeat donation. Consequently, interventions to reduce the adverse effects of blood donation are important and likely to increase donor retention. Based on laboratory studies suggesting that social support attenuates both physical and psychological responses to stress, the present study hypothesized that the presence of a supportive person during the donation process may help reduce reactions. A final sample of 65 men and women with fewer than three prior donations was randomly assigned to either donate blood as usual or donate with a supportive research assistant. Donors in the support condition were accompanied throughout the donation process by a female research assistant who provided encouragement, made reassuring remarks, and engaged in small talk. Donors in both conditions completed a series of questions to assess anxiety, experience of prefaint reactions, and willingness to provide a future donation. Compared to standard donation controls, donors in the social support condition reported fewer prefaint reactions (F(1,61) = 9.15, p = 0.004, eta(2)= 0.13) and greater likelihood of donating again within the next year (Z =-1.70, p < 0.05, one-tailed). Relatively novice donors report reduced reactions to blood donation when accompanied by a supportive individual, suggesting that social support may be a simple strategy to enhance the donation experience and possibly increase donor retention.Transfusion 02/2009; 49(5):843-50. DOI:10.1111/j.1537-2995.2008.02057.x · 3.23 Impact Factor
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ABSTRACT: The effect of patient education on bowel preparation for colonoscopy has not been well studied. An improvement in patient understanding of the rationale for bowel preparation before colonoscopy might enhance adherence to the prescribed bowel regimen and improve bowel preparation quality. To measure the effect of a simple educational intervention on the quality of bowel preparation during colonoscopy. Prospective, single-center, endoscopist-blinded, randomized, controlled trial. Tertiary-care center. This study involved outpatients directly referred for screening colonoscopy. Inclusion of a visual aid depicting both clean and dirty colons in addition to standard written colonoscopy instructions. The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included the need for repeat colonoscopy because of inadequate bowel preparation, insertion and withdrawal time, polyps detected, and patient tolerance of bowel preparation and colonoscopy. We analyzed 492 patients given a visual aid and 477 controls. The percentage of colonoscopies with a BBPS score≥5 was similar in both groups (91% visual aid vs 89% control, P=.43). The odds ratio for having a BBPS≥5 in the visual aid group was 1.24 (95% CI, 0.83-1.87) compared with controls. Other secondary outcomes were similar between groups. Single-center study. A simple card with photographs and text explaining the rationale for bowel preparation did not change the quality of bowel preparation in patients directly referred for screening colonoscopy. Future educational studies may need to include more interactive or intensive methods. (Clinical trial registration number: NCT00643682.).Gastrointestinal endoscopy 02/2011; 73(2):307-14. DOI:10.1016/j.gie.2010.10.013 · 5.37 Impact Factor