Elsevier

The Lancet

Volume 354, Issue 9195, 11 December 1999, Pages 2032-2035
The Lancet

Articles
Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial

https://doi.org/10.1016/S0140-6736(98)10495-6Get rights and content

Summary

Background

The provision of information before medical or surgical procedures should improve knowledge and allay anxiety about the pending procedure. This trial aimed to assess the value of an information video in this process.

Methods

Patients scheduled to undergo colonoscopy were approached about 1 week before the procedure. All patients were given an information leaflet about colonoscopy, and completed a Spielberger state anxiety inventory (STAI) questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information video. Immediately before colonoscopy, all patients completed a second anxiety questionnaire and a knowledge questionnaire.

Findings

198 patients were screened. 31 declined to participate and 17 were unable to complete the forms. Of the remaining 150 patients, 72 were assigned the video, and 78 no video. The groups were similar with regard to age, sex, educational attainment, and initial anxiety score. Female patients had higher baseline anxiety than male patients (mean STAI 46·3 [95% CI 44·9–47·7] vs 36·9 [35·5–38·3]; difference 9·4 [7·8–12·2], p=0·0008). Patients who had not had a previous colonoscopy had higher baseline anxiety scores than those who had prior experience of the procedure (46·9 [45·4–8·5] vs 36·43 [34·7–37·9]; difference 10·6 [7·5–13·8], p=0·0008). Patients who watched the video were significantly less anxious before colonoscopy than those who did not The former also scored more highly in the knowledge questionnaire than the latter with regard to the purpose of the procedure, procedural details, and potential complications of colonoscopy.

Interpretation

An information video increases knowledge and decreases anxiety in patients preparing for colonoscopy.

Introduction

The provision of information before a medical or surgical procedure has two goals: to provide a mechanism by which patients can participate in treatment decisions with full understanding of the factors relevant to their proposed care,1 and to improve postoperative recovery2 and reduce situational anxiety.3 Achievement of these goals requires an understanding of the interaction between situational anxiety, memory, and retention of information. Moderate anxiety may improve memory by acting as a motivator, although severe anxiety is reported to decrease the retention of information.4 Variability between individuals' ways of coping with the stress of an impending procedure may also affect the achievement of the goals of preoperative information provision. Some patients will actively seek out more information (monitoring), whereas others will avoid information (blunting).5

The ideal medium for the provision of preoperative information is unclear. Traditionally, this information has been provided verbally by the clinician as a component of informed consent. Although the doctor-patient interaction must remain at the core of the information process, varying communication abilities on the part of the doctor may lead to the patient having an inadequate understanding of the proposed procedure. Several studies have investigated the use of leaflets to improve and standardise the information received by patients.6, 7 These studies have shown mixed results. Many patients do not read such forms, and many of those who do do not fully understand the information provided. Electronic media such as audiotape, videotape, and interactive laser-discs have the potential to overcome these deficiencies of information leaflets.

The aim of this trial was to investigate the impact of an information video, provided in addition to verbal and written information, on the knowledge and anxiety of patients scheduled to undergo colonoscopy.

Section snippets

Participants

All patients scheduled for colonoscopy in the Day Surgery Unit of Queen Elizabeth Hospital were considered for enrolment in the trial. Patients were excluded if, under normal circumstances, they would require a third party to complete the consent process (patients under 16 years of age, patients who did not adequately understand English, and those with mental impairment). Patients were approached about enrolment in the trial at the end of the preanaesthetic appointment, about 1 week before

Results

Between January and August, 1998, 198 patients were asked to join the trial. 48 patients were excluded from the trial: nine spoke insufficient English to understand the video, seven could not comprehend the purpose of the trial, and one could not read the self-evaluation questionnaire because of poor eyesight; 31 were not interested in participating in the trial. The remaining 150 patients were enrolled. 72 patients were assigned to the video group, and 78 patients to the no-video group. All

Discussion

A high degree of anxiety before a medical or surgical procedure can have adverse consequences. In addition to being unpleasant, there is evidence that it increases sympathetic outflow10 and causes a stress response with raised corticosteroid and catecholamine release.11 Requirements for anaesthetic agents may be increased.12 Kulik and Mahler showed that less anxious patients were more mobile postoperatively, and were discharged from hospital sooner after coronary-artery-bypass surgery.13

The

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