How to reduce patient anxiety before a urodynamics test?

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How to reduce patient anxiety before a
urodynamics test?

• By Brighter Health Network (BHN)
• www.BHNCo.com

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About Brighter Health Network (BHN)

• BHN is a leading provider of mobile medical
  diagnostics including Urodynamics, Anorectal
  Manometry, UroCuff Testing, and more
• Over 300 clinics across the country trust BHN to
  provide them with urodynamics testing services
• BHN services urology, UroGyn, and ObGyn practices
  of all sizes and interacts with them daily, which
  served as the basis for this presentation.
• Visit www.BHNCo.com for more info.
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• If you are interested in urodynamics outsourcing
  visit this link and sign up to get a brochure and
  pricing http//www.bhnco.com/Urodynamics/Urodynam
  ics-Testing-Services-slideshare.html

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Overview

• Urodynamic Testing
• Urodynamic testing and anxiety
• Why Anxiety?
• How well do patients tolerate urodynamic tests?
• Studies on interventions to decrease pain
  anxiety before a urodynamics test
• Resulting Suggestions

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Urodynamic Testing

• A group of procedures that evaluation how well
  the bladder, sphincters, and urethra are storing
  and releasing urine. Most urodynamic tests focus
  on the bladders ability to hold urine and empty
  steadily and completely. Urodynamic tests can
  also show whether the bladder is having
  involuntary contractions that cause urine
  leakage.
• Urodynamic tests may be recommended if symptoms
  suggest problems with the lower urinary tract.
  Lower urinary tract symptoms (LUTS) include
• urine leakage
• frequent urination
• painful urination
• sudden, strong urges to urinate
• problems starting a urine stream
• problems emptying the bladder completely
• recurrent urinary tract infections
• (Source https//www.niddk.nih.gov/health-i
  nformation/health-topics/diagnostic-tests/urodynam
  ic-testing/Pages/Urodynamic20Testing.aspx)

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Urodynamic Testing

• Urodynamic tests range from simple observation to
  precise measurements using sophisticated
  instruments.
• For simple observation, a health care provider
  may record the length of time it takes a person
  to produce a urinary stream, note the volume of
  urine produced, and record the ability or
  inability to stop the urine flow in midstream.
• For precise measurements, advanced urodynamics
  equipment is used to accurately capture
  physiological measurements of the bladder filling
  and emptying. Pressure monitors record the
  pressures inside the bladder, and sensors record
  muscle and nerve activity.
• The health care provider will decide the type of
  urodynamic test based on the persons health
  information, physical exam, and LUTS. The
  urodynamic test results help diagnose the cause
  and nature of a lower urinary tract problem.
• (Source https//www.niddk.nih.gov/health-inf
  ormation/health-topics/diagnostic-tests/urodynamic
  -testing/Pages/Urodynamic20Testing.aspx)

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Urodynamics testing and anxiety

• While urodynamics testing is perceived by
  clinicians as minimally invasive, patients may
  experience anxiety related to urodynamics testing
  associated with uncertainty about
  catheterization, the need to urinate in a test
  situation, and potential embarrassment or
  discomfort associated with other aspects of
  testing. 
• Adult patients tend to report that urodynamics
  testing causes modest psychosocial anxiety and
  physical discomfort
• (Source Urol Nurs. 201131(2)71-77.)

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Why Anxiety ?

• Anxiety was due to fear of the unknown and
  embarrassment at the intimate nature of the
  procedure and lack of privacy.
• The interpersonal and communication skills of the
  health care professional are central in
  alleviating these negative feelings.
• The establishment of a friendly relationship
  based on equality and mutual respect and trust
  was important in preventing anxiety and
  embarrassment.
• (Source JAN 32 (6) December 2000 
  13561363)

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How well do patients tolerate urodynamic tests?

• urodynamic investigations are generally well
  tolerated, there is a significant minority of
  patients who find the test embarrassing, painful
  and distressing.
• Overall distress from the procedure was less in
  older patients and in those who had been referred
  from a specialist clinic. Distress was higher
  when difficulties were encountered during the
  investigation and in patients who had
  investigations other than a standard
  cystometrogram.
• Patients (and particularly female patients) were
  likely to find the test less distressing when
  they felt they had been given adequate
  information about the test.
• (Source Br J Obstet Gynaecol
  106,851-856)

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Study I - Interventions to decrease pain
anxiety before a urodynamics test (Neurourol.
Urodynam. 35805808, 2016)

• Aims
• To find out if information leaflets reduce
  anxiety levels before urodynamic studies (UDS).
• Methods
• One hundred and four patients (age 60??15
  years) who were referred for multichannel UDS
  were prospectively recruited and randomized into
  2 groups
• (1) received a leaflet containing detailed
  information regarding the examination
• (2) did not receive a leaflet.
• Results
• Demographics and clinical and psychological
  co-morbidities were similar between the groups.
  The psychological distress score was
  significantly lower in group 1 (13.1??2.9 vs.
  24.8??5.8, P?lt?0.001), whereas there was no
  difference in the positive well being score.
• Conclusions
• We recommend providing patients with an
  information leaflet on UDS since it significantly
  reduces anxiety levels. 

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Study II - Interventions to decrease pain
anxiety before a urodynamics test (Pioneer Med
Sci 2015 5(4)113-116)

• Aims
• To examine the influence of pre-examination
  intimation and counseling of patient with urinary
  incontinence on physical and psychological
  discomforts during urodynamic assessment.
• Methods
• One hundred fifty-two patients with urinary
  incontinence, who underwent urodynamic
  assessment, were studied prospectively. A
  questionnaire survey was used to study their
  awareness about the nature of the assessment,
  extent of physical discomfort, mental stress, and
  the pain level during the assessments and to
  determine if pre-examination counseling had any
  effect on the level of pain or distress.
• Results
• Most patients felt that the urodynamic
  examination was important, but noted lack of
  detailed information. Although the patients were
  anxious, most were not in distress. There was no
  correlation between prior information and the
  extent of pain or distress. However, older
  patients reported less pain during the procedure
  compared to the younger patients. The results
  also indicated that the patients were comfortable
  with familiar doctors, and that most preferred a
  female doctor.
• Conclusion 
• Our findings confirm the importance of
  pre-examination counseling in patients before
  undergoing urodynamic examination to minimize the
  symptoms of anxiety and shame, which may
  indirectly result in fewer artifacts and better
  interpretation of the results.

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Study III - Interventions to decrease pain
anxiety before a urodynamics test (Neurourol
Urodyn 2015 Jul 30)

• Aims
• To determine if music (at 60?beats/min) or
  watching a pre-procedure educational video
  decreases pain and anxiety in patients undergoing
  multichannel urodynamic testing compared to usual
  care.
• Methods
• Patients undergoing multichannel urodynamic
  testing at a health care center were randomized
  to one of three groups usual care (UC), music
  (M), in which music was played throughout the
  urodynamic test, or video (V), in which subjects
  watched an informational video on the procedure
  prior to undergoing the test.
• Results
• 98 subjects were included in this analysis. In
  the overall group, mean perceived pain on the
  pre-test VAS was significantly higher than the
  post-test VAS with pre-test mean (SD) 47(30) and
  post-test mean (SD) 26(23), P??0.0001. Overall
  the anxiety pre-test VAS was significantly
  greater than post-test VAS with pre-test mean
  (SD) 46.9(29) and post-test mean 17.9(18),
  P??0.0001. There were no differences in pain and
  anxiety scores between the two intervention
  groups and usual care. Patients who were
  randomized to usual care or the video arm felt
  more prepared for the test compared to patients
  who were randomized to the music arm, with
  (mean??SD) usual care (42??8), video (43??9),
  music (37??11), P??0.002.
• Conclusions
• Music and an educational video do not decrease
  pain or anxiety in subjects undergoing
  multichannel urodynamics compared to usual care.

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Resulting Suggestions

• Clinical experience suggests that two
  interventions may reduce anxiety prior to
  urodynamics evaluation individual counseling
  with patients and the use of educational
  brochures or online information explaining the
  study.
• (Source Urol Nurs. 201131(2)71-77.)
• Well-trained staff is the key to the success of
  urodynamic testing. UDS (urodynamic studies) must
  be performed by well-trained and knowledgeable
  staff. It is not a simple test and involves
  skilled personnel who must be experts in the
  history-taking, catheterization, zeroing, and
  calibration right through to the software nuances
  and adjustments made while testing.
• It is recommended to ensure that the staff
  performing the test are well-trained,
  compassionate healthcare professionals. The
  patient will be most relaxed, cooperative, and
  tolerant when the patient is confident in the
  urodynamicists skill level.
• (Source Can Urol Assoc J 201610(5-6)

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