The effectiveness of interventions to reduce anxiety, claustrophobia, sedation and non-completion rates of patients undergoing high technology medical imaging

Abstract

<h4>Background</h4>Advanced, high technology medical imaging, such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT), have seen significant increases in their use. A number of interventions have been developed with the aim of reducing anxiety, fear and claustrophobia prior to and during imaging.<h4>Objective</h4>To determine the effectiveness of interventions aiming to improve the patient experience of high technology medical imaging.<h4>Inclusion criteria</h4>Any patients who have undergone high technology (MRI, CT, PET, Nuclear medicine and SPECT) imaging in a medical imaging department. Interventional scans were not considered for inclusion.Considered interventions were: MRI scanner designs, quieter machines, information, psychological support, anxiety reduction protocols, mock MRI, team training, prone scanning, audiovisual (AV) systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets.Experimental and observational studies were included in the review.Primary patient outcomes:Secondary patient outcome measures included: SEARCH STRATEGY: A comprehensive, three-step search strategy conducted during August to October 2011 aimed to find both published and unpublished English language studies across 14 major databases. No time restrictions.<h4>Methodological quality</h4>Retrieved papers were assessed by two independent reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).<h4>Data collection</h4>Data was extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI.<h4>Data synthesis</h4>Quantitative data was, where possible pooled in statistical meta-analysis using JBI-MAStARI. All results were subject to double data entry.<h4>Results</h4>Thirty-eight studies met the inclusion criteria and were considered to be of suitable methodological quality. The quality of the studies varied; however, all the studies included had at a minimum a comparison group. Of the final 38 studies, 29 assessed interventions for MRI, 8 Nuclear Medicine procedures, and one in CT. Meta-analysis was performed for two interventions; additional information and an AV system.Significantly fewer children (10-18 years) required sedation prior to a MRI scan when given an audiovisual intervention (n=1785) OR 0.42% (CI 0.25 - 0.70), compared with the control group. Open MRI, newer MRI scanners, quieter machines, information in combination with psychological support or an anxiety reduction protocol, mock MRI, team training, prone scanning, AV systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets were all found to have some positive effect on at least one outcome, whilst the findings for additional information were mixed.<h4>Conclusions</h4>This review identified 38 studies that assessed interventions to reduce anxiety, claustrophobia, sedation and non-completions and improve satisfaction for patients undergoing medical imaging. The majority of the interventions studied had some positive effect on at least one outcome.Healthcare professionals need to be aware of the potential for patients undergoing medical imaging to experience anxiety, fear and claustrophobia during scanning. A number of interventions can be selected and tailored to the patient group.There is still a significant amount of research required to establish the effectiveness for a number of interventions aimed to reduce anxiety, fear and claustrophobia in medical imaging, particularly in CT.