Patients who feel scared, distressed or hostile before undergoing an interventional radiology procedure may experience a poor outcome, according to research presented at the Radiological Society of North American Annual Meeting in Chicago on Dec. 3, 2015.
Nadja Kadom, MD, acting associate professor of radiology, Emory University School of Medicine, and colleagues at the Boston Medical Center, where Kadom was on the faculty prior to coming to Emory, studied 230 patients who underwent image-guided vascular or kidney interventional radiology procedures in Boston, Mass. Before their interventions, they completed the Positive Affect Negative Affect Schedule (PANAS), a questionnaire to assess their mood, which contained 20 adjectives —10 related to positive affect (PA) and 10 related to negative affect (NA).
“NA or negative mood has been found to be associated with undesirable health outcomes such as hypertension, bradycardia (a slow heart rate) and prolonged hypoxia (reduced supply of oxygen),” says Kadom. “We wanted to look at patients undergoing radiological procedures and see whether a negative mood could play a role in negative events occurring.”
On the mood evaluation, negative adjectives included: distressed, upset, scared, hostile, irritable, plus others; while positive adjectives included: interested, excited, proud, inspired, determined and more. Using a five-point rating scale, the study participants (120 women and 110 men) were asked to indicate how they felt in general – on average – based on these terms, not necessarily just before their procedure began.
Kadom and colleagues grouped the patients based on high and low scores for negative affect and high and low scores for positive affect. Higher scores indicated more overall NA or PA affect.
“We were surprised to find that between the high negative numbers and the low negative numbers, there was a difference in outcomes,” says Kadom. “Patients with high NA had significantly more adverse events than those with low NA,” (22% vs. 12%). “There was no significant difference in adverse outcomes for high versus low PA,” (18% vs. 15%).
The researchers determined that NA was associated with increased heart rate and blood pressure, as well as decreased cardiovascular reactivity. Participants in this study with high NA scores had an increased risk of prolonged hypoxia, hypertensive or hypotensive episodes, prolonged bradycardia and post-operative bleeding.
The effect of high NA was independent of high or low PA. Since NA and PA represent different aspects of mood, they can exist independently of each other. As an example, it is possible that a patient is scared (NA) of undergoing a procedure, and at the same time, is excited (PA) about getting minimally invasive treatment instead of undergoing surgery.
“By using a short questionnaire before an interventional radiology procedure, this study tells us that we may be able to identify patients at risk of having adverse events or poor outcomes in advance of that procedure,” says Kadom. “Our team should then be able to distract negative thinking of patients by talking to them, and by guiding a patient’s thoughts, for example encouraging them to imagine their last great vacation, or assisting in self-guided hypnosis.”
The study was made up of participants ranging in age from 18 to 92 years old, with a mean age of 55.