360°-ohjausympäristön vaikutus sepelvaltimoiden tietokonetomografiatutkimukseen tulevien potilaiden ahdistukseen

Abstract The aim of the study was to investigate the effect of a 360° virtual counselling environment (360°VCE) on reducing people's anxiety levels and improving computed tomography angiography (CCTA) process time. The anxiety during CCTA can reduce patient safety, the quality of the imaging experience, and the image quality, as well as increase the radiation dose. In the intervention planning phase (phase I) the systematic review identified and synthesized the effectiveness of digital counseling environments (n=26) at reducing anxiety, depression, and adherence to treatment among patients who are chronically ill. In phase II the 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. A qualitative study was then conducted to describe patients' (n=10), radiographers' (n=10) and radiography students’ (n=10) experiences of the developed 360°VCE for the CCTA. In the pilot study the 360°VCE relieved patients’ fear, increased knowledge and senses of patient safety and self-efficacy. In phase III the effect of a 360°VCE on patient anxiety and CCTA process time were evaluated in a randomised controlled trial. A total of 86 CCTA patients were randomly assigned to intervention (n=41) and control (n=45) groups. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome was CCTA process time. Pre-scan anxiety was lower among patients in the 360°VCE group right before CCTA in comparison to patients in the control group (p=0.015). The change in the state anxiety was -7.34 (95% CI -9.83 to -4.86, p<0.001) for the intervention and -0.98 (95% CI -1.73 to -0.22, p=0.012) for the control group. Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.Tiivistelmä Ahdistus sepelvaltimoiden tietokonetomografiatutkimuksessa (TT) voi heikentää potilasturvallisuutta, potilaan kuvantamiskokemuksen laatua, kuvanlaatua sekä lisätä potilaan säteilyannosta. Tämän tutkimuksen tarkoituksena oli kehittää ja kuvailla 360°-ohjausympäristöä sekä arvioida sen vaikuttavuutta sepelvaltimoiden TT-tutkimukseen tulevien potilaiden ahdistukseen ja tutkimuksen läpimenoaikaan. Tavoitteena oli tuottaa uutta tietoa 360°-ohjausympäristöjen kehittämiseksi kuvantamistutkimuksiin tuleville potilaille. Tutkimuksessa oli kolme vaihetta: ohjausympäristön kehittäminen, pilotointi ja vaikuttavuuden arviointi. Vaiheessa I systemaattisella kirjallisuuskatsauksella syntetisoitiin aiempi tutkimustieto pitkäaikaissairaiden digitaalisten ohjausympäristöjen (n=26) vaikuttavuudesta. Tietoa hyödynnettiin intervention kehittämisessä. Vaiheessa II kehitettiin 360°-ohjausympäristö ja kuvailtiin laadullisella pilottitutkimuksella potilaiden (n=10), röntgenhoitajien (n=10) ja röntgenhoitajaopiskelijoiden (n=10) kokemuksia siitä. Aineisto kerättiin teemahaastatteluilla ja analysoitiin sisällönanalyysillä. Vaiheessa III arvioitiin 360°-ohjausympäristön vaikuttavuutta sepelvaltimoiden TT-tutkimukseen tulevien potilaiden ahdistukseen ja tutkimuksen läpimenoaikaan. Potilaat satunnaistettiin koe- (n=41) ja kontrolliryhmiin (n=45): koeryhmä käytti ennen sairaalaan tuloa 360°-ohjausympäristöä nykykäytännön mukaisen (kirjallisen ja suullisen) ohjauksen lisäksi. Kontrolliryhmä sai nykykäytännön mukaisen ohjauksen. Aineisto kerättiin ennen ja jälkeen intervention ahdistusta mittaavalla STAI-mittarilla sekä TT-tutkimuksen läpimenoajan osalta potilastietojärjestelmästä. Aineisto analysoitiin tilastollisesti. Katsaus osoitti, että pitkäaikaissairaille kehitetyt digitaaliset ohjausympäristöt ovat tehokkaampia tai yhtä tehokkaita kuin tavanomaiset ohjausmenetelmät, kuten suullinen ohjaus. Pilottitutkimuksessa potilaat kokivat 360°-ohjausympäristön vähentävän pelkoja sekä lisäävän tietoa ja turvallisuuden ja suoriutumisen tunteita. RCT-tutkimuksen tulosten mukaan 360°-ohjausympäristö vähensi potilaiden ahdistusta ennen TT-tutkimusta (p=0,015). Naisten ahdistus oli miehiä korkeampaa. Noin 63 %:lla potilaista tutkimusta edeltävä ahdistus oli lievää ja noin 37 %:lla ahdistus kohtalaista tai vaikeaa. Ryhmien välillä ei ollut eroja tutkimuksen läpimenoajassa. Tulosten perusteella suositellaan 360°-ohjausympäristöjen kehittämisen jatkamista ja laajentamista eri potilasryhmille, eri kuvantamistutkimuksiin sekä sovellettavaksi ammattilaisten ja opiskelijoiden perehdytykseen

Effectiveness of digital counseling environments on anxiety, depression, and adherence to treatment among patients who are chronically ill:systematic review

Abstract Background: Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective: This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods: Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results: Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions: This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling

Effectiveness of digital counseling before pediatric diagnostic imaging

Abstract Purpose: To review and synthesize the available evidence on the effectiveness of preparatory digital counseling for children undergoing diagnostic imaging and their parents in terms of patient-related and imaging outcomes. Methods: Relevant studies were identified by searching databases and gray literature resources. References from full-text articles identified in the initial search were searched manually to identify additional relevant studies. The reviewed literature included studies on children and adolescents aged 3 to 21 years, their parents, or both, who participated in digital counseling interventions before medical imaging examinations. Literature selection and quality appraisal were conducted by 2 independent reviewers. Data were extracted using standardized tools and synthesized using the narrative synthesis approach. This review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Five randomized controlled trials and quasi-experimental studies were included in this review. Digital counseling was provided via multiple approaches with interactive elements. Digital counseling was reported to be effective at reducing anxiety and increasing knowledge and satisfaction among children and their parents. It also appeared to reduce the need for general anesthesia and to improve the success of imaging procedures based on image quality and number of repeated images required. Digital counseling also appeared to increase children’s confidence and help them remain still during the imaging process. Discussion: The increased knowledge from digital counseling can strengthen senses of security and self-efficacy, which are important for successful medical imaging examinations, especially in children. The digital counseling applications used in the included studies are location-independent, and children and their parents can use them as often as they want, which might help ensure the provision of sufficient counseling before procedures. Conclusions: Digital counseling seems to be an effective method for preparing children for diagnostic imaging and a useful tool for facilitating successful medical imaging examinations of children. Because of the small number of original studies in this area, further research is needed to confirm the effectiveness of digital counseling in children’s diagnostic imaging

Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time:a randomised controlled trial

Abstract Introduction: This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients’ anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups. Methods: A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination. Results: Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. Conclusions: Access to 360°VCE can reduce patients’ pre-CCTA anxiety levels. Implications for practice: The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure