Post on 13-Apr-2017
Ultrasound Guided Breast Biopsy Patient Education Video and Patient Anxiety
Katherine Patterson, M.D.Division Chief of Breast Imaging at Indiana University
Director of Breast Imaging at St. Margaret's Hospital Guild Diagnostic Breast Center at Eskenazi Health
Elise Miller, M.D.PGY-4, Radiology Resident
Indiana University
Jaimie Howell, M.D.Northwest Radiology
Disclosures
The authors have no financial interest or other relationship with a commercial organization that may have an interest in the content of the educational activity.
Purpose
• To determine the effects of an educational video about ultrasound guided breast biopsy on patient anxiety
• This project aims to improve clinical practiceStandardize informationCover all aspects of the biopsy so many patient
questions can be answeredAvailable on YouTube.com for patients to watch
again
Methods 7 Minute Video Filmed on an iPad
To make the biopsy look real, a few grapes were placed into a pork roast, thus imitating a breast mass under ultrasound imaging
The film was edited using Adobe Premiere Elements 14
Voiceover narration was used for better audio quality and to easily create both English and Spanish versions of the video
Staff radiologist played role of physicianTwo technologists played the roles of technologist and patient
Film Highlights- What is a biopsy and why is it necessary?
- What is ultrasound and what are the advantages of this technique?
- What is a radiologist and a breast technologist?
- Procedural details: step-by-step from patient positioning to what the biopsy needle sounds like
- Marker placement and what a marker is- Post-biopsy mammogram
- When to remove bandage and Steri-Strips- When to shower
- Lifting restrictions- Risks of the procedure
- Reasons to seek medical attention after procedure
Educate
Inform
Instruct
Film Screenshots
Methods
Patients scheduled for US guided breast
biopsy (random assignment)
Control Group- No video
- Verbal physician consult only
Experimental Group- Watched video
- Verbal physician consult as well
Methods• All participants filled out a State-Trait Anxiety
Inventory (STAI) both on the day that biopsy was recommended and when they returned for the biopsy appointment
• The STAI measures a patient’s “state” anxiety, or temporary anxiety, compared to her “trait” anxiety, or baseline anxiety
• Items are rated on a 4 point scale (e.g., from “almost never” to “almost always”)
• Higher scores correlate with higher anxiety
Results:Demographics
Results:State Trait Anxiety Inventory
Experimental Group(watched video)
N = 31
Average Anxiety Score = 44
Control Group(no video)
N = 27
Average Anxiety Score = 42
Between the experimental and control groups, there was no significant difference in state or trait anxiety between:
• Spanish speaking (N=13) and English speaking patients (N=45)
• Patients younger than 45-years-old (N=24) or older than 45-years-old (N=30)
• Patients with an educational level beyond high school (N=24) or high school diploma and below (N=30)
• Internal comparison of anxiety levels also did not significantly differ between the first and second surveys in either group.
Discussion No significant difference
in overall anxiety levels between the video and no video groups or in the subset comparisons based on language, age, or education level.
Patient comments from the video group, however, were overwhelmingly positive.
Sample of Patient Comments:
“Felt more comfortable”
“Very informative on the procedure”
“It was very informative. It explained the process in so much detail. Watching the people/pictures really goes beyond a voice/explanation”“Very helpful, it put your mind at ease”
“It was very interesting”
“Very helpful because I didn't understand how it was done or what it actually was”“The info presented was very helpful”
Brief Literature Review
Phillippe, F., et al. Effects of video information in patients undergoing coronary angiography. Arch Mal Coeur Vaiss 99(2): 95-101. Feb 2006.
• 200 patients• 100 watched video, 100 received verbal physician
consult• Patients who watched the video were significantly less
anxious and had lower heart rate• Procedure tolerability was higher in video group• Satisfaction of information for informed consent process
was higher in the video group
“Effects of video information in patients undergoing coronary
angiography”
• 67 patients• 33 watched the movie
• Level of anxiety was measured with a state-trait anxiety questionnaire
• Patient understanding and satisfaction with the information was also measured
• Results: Increased understanding and satisfaction, no effect on anxiety level
“Patient information for liver biopsy: impact of a
video movie”
Obled, S., et al. Patient information for liver biopsy: impact of a video movie. Gastroenterol Clin Biol 32(3): 274-278. Mar 2007.
Limitations
Fatigue- 40 STAI questions- Plus demographic
questions- 10 typed pages
Education Level- STAI 6th grade reading level
- 36% patients without high school
diploma
Small Sample Size- Difficult to recruit for
long survey- Technical errors (no
follow up survey given to some patients)
ConclusionsWhy is this important?
- Patient-focused care is one of the key components of the American College of Radiology’s “Imaging 3.0” initiative
- While anxiety levels were unaffected in our study, patient comments about the video were overwhelmingly positive
- Non-English speaking patients may derive the most benefit as multilingual standardized videos can save time and ensure communication consistency
- Educational videos may be one way for radiologists to empower patients through education and improve patient experience
Correspondence
Katherine Patterson, M.D. khwalker@iupui.edu
Elise Miller, M.D. milleeli@iupui.edu
Jaimie Howell, M.D. howelljaimie@gmail.com
bit.do/engmammoeske
US Guided Biopsy Video – English
bit.do/spanmammoeske
US Guided Biopsy Video – Spanish