Children's Hospital at Montefiore West Hempstead, NY
Introduction: Invasive medical procedures such as endoscopy are a significant source of anxiety for patients. Published data show that higher levels of pre-endoscopy anxiety are associated with worse clinical outcomes. Studies in adults have shown that pre-endoscopy interventions such as educational videos or brochures are associated with decreased pre-endoscopy anxiety. Similar literature in pediatrics is limited. We sought to evaluate whether an educational video effectively reduces pre-endoscopy anxiety in a pediatric cohort of patients and to identify the most common concerns surrounding endoscopy.
Methods: This is a prospective randomized controlled trial of patients ages 8-21 years requiring gastrointestinal endoscopy with their parents participating when appropriate. The intervention group was shown an educational video created by the study investigators. Subjects were asked to report anxiety using a Numerical Rating Scale (NRS) and the State-Trait Anxiety Inventory (STAI, STAI-C). They also reported their anxiety levels surrounding specific components of the procedure.
Results: 160 subjects have been recruited and the study remains open. 82 (51%) and 78 (49%) subjects were randomized to the intervention and control group, respectively. Most subjects identified as Hispanic (26%) or African American (15%) and 28% had Medicaid. 35% of subjects had a history of prior endoscopy. Baseline anxiety trait was not significantly different between control and intervention groups. NRS and STAI/STAI-C scores were comparable in intervention and control groups amongst all-comers. However, for the cohort of patients recruited prior to the day of endoscopy, NRS scores were lower in the intervention group (mean score of 3.4 vs 5.6, p=0.01). Subjects receiving the intervention prior to the day of endoscopy had lower STAI-C state scores than those receiving the intervention the day of endoscopy. Regarding concerns surrounding endoscopy, patients and parents were most worried that some disease might be found, followed by the need for anesthesia.
Discussion: Our results suggest that an educational intervention may attenuate pre-endoscopy anxiety, but that this may be contingent on the timing of delivery. Our results also highlight the factors surrounding endoscopy that are most anxiety-provoking for patients and parents, providing valuable information which may help further define topics that should be addressed not only by educational interventions but also in physician-patient discussions regarding endoscopy.
