Effects of the Provision of Information on Anxiety in Patients during Outpatient Surgery: A Systematic Review

Ae-Ri Jung; In-Sook Lee

doi:10.16952/pns.2016.13.1.48

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Jung and Lee: Effects of the Provision of Information on Anxiety in Patients during Outpatient Surgery: A Systematic Review

Original Article

Perspectives in Nursing Science 2016;13(1):48-57.

Published online: 19 April 2016

DOI: https://doi.org/10.16952/pns.2016.13.1.48

Effects of the Provision of Information on Anxiety in Patients during Outpatient Surgery: A Systematic Review

Ae-Ri Jung^1,, In-Sook Lee²

¹RN, Samsung Medical Center, Seoul

²Professor, College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Jung, Ae-Ri College of Nursing, Seoul National University, 103 Daehack-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-3410-2484, Fax: +82-2-2632-3197, E-mail: eari83@hanmail.net

Received 2 March 2016 Revised 14 April 2016 Accepted 14 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to investigate the research methods, contents, and effects of providing information to alleviate patients’ anxiety during outpatient surgery. Methods: The PICOTS-SD (Participants, Interventions, Comparisons, Outcomes, Time, Setting, Study design) was used and 11 randomized controlled trials studies that met the inclusion and exclusion criteria were selected. For assessing the quality of the studies, the Cochrane Risk of Bias tool was used. Results: In the 11 selected studies, intervention methods included verbal, written paper, video, and websites, and the outcome variable was anxiety. Regarding the effectiveness of providing information on anxiety, the result of the present study was ambivalent. Conclusion: This study showed the current trends in providing information as an intervention. However, randomized controlled trials are further needed in Korea, to verify the effects of such an intervention on patients’ anxiety.

Keywords: Outpatient, Surgery, Anxiety, Information, Systematic review

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Figure 1.

PRISMA flow chart of studt selection.

Figure 2.

Assessment risk of bias in selected studies.

Table 1.

List of Reviewed Articles (N=11)

Year	Authors	Country	Title	Source
1999	Luck et al.¹⁹⁾	Australia	Effects of video information on precolonoscopy anxiety and knowledge: A randomised trial.	The Lancet
2004	Ng et al.²⁰⁾	HK	The effect of pre-operative information in relieving anxiety in oral surgery patients	Community Dent Oral Epidemiol
2005	Pager²¹⁾	Australia	Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery	Br J Ophthalmol
	Pearson et al.²²⁾	Australia	Interacting effects of preoperative information and patient choice in adaptation to colonoscopy	Disease of the Colon & Rectum
2008	Felley et al.²³⁾	Switzerland	Combined written and oral information prior to gastrointestinal endoscopy compared with oral information alone: A randomized trial	BioMed Central
2009	Ogden et al.²⁴⁾	UK	The impact of viewing a hysteroscopy on a screen on the patient's experience: a randomised trial	General Gynaecology
2010	Jlala et al.²⁵⁾	UK	Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia	British Journal of Anaesthesia
2012	Heikkinen²⁶⁾	Finland	Ambulatory orthopaedic surgery patients' emotions when using different patient education methods	Clinical Feature
2013	Tarhan et al.²⁷⁾	Turkey	The effect of video-based education on patient anxiety in men undergoing transrectal prostate biopsy	Urology
	Choi et al.²⁸⁾	korea	The Effects of Structured Preoperative Instruction on Anxiety and Self-care Compliance in Patients with Cataract Surgery	Korean Journal of Adult Nursing
2014	Kekecs et al.²⁹⁾	Hungary	Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial	Patient Education and Counseling

Table 2.

General Characteristics and Methodology of 11 Studies (N=11)

Variables	Categories	n (%)
Publication year	1995~1999	1 (9.1)
	2000~2004	3 (27.3)
	2005~2009	3 (27.3)
	2010~2015	4 (36.4)
Country	Europe	5 (45.5)
	Australia	3 (27.3)
	Asia	3 (27.3)
Research design	Randomized controlled trial	11 (100.0)
Gender of participants	Only men	1 (9.1)
	Only women	1 (9.1)
	Men and women	9 (81.8)
Mean age of participants	≤40	1 (9.1)
	41~50	2 (18.2)
	51~60	3 (27.3)
	＞60	5 (45.5)
Sample size of each group	≤100	2 (18.2)
	101~200	7 (63.6)
	≥201	2 (18.2)
Intervention setting	Outpatient	11 (100.0)
Intervention setting	Inpatient	0 (0.0)
Intervention unit	Individual	11 (100.0)
Intervention unit	Group	0 (0.0)

Table 3.

Effectiveness and Information of Intervention for Anxiety (N=11)

Authors	Participants			Intervention			Measurement and result
Authors	Exp.	Cont.	Methods	Information content	time	Anxiety tools	time	Outcome (Significant: +)
Luck¹⁹⁾	N=72 MA=59.5	N=78 MA=62	Video	10 m, a standard information leaflet + video(discuss the procedure, filmed procedure was in progress)	Pre-op.	STAI	Before information and on arrival at the unit	Anxiety+, knowledge+
Ng²⁰⁾	N=48 MA=37.6; N=48 MA=34.7; N=48 MA=35.2	N=48 MA=33.3	Verbal	Three experimental groups p – basic information + operative procedures R – basic information + expected recovery PR – basic information + both operative procedures and recovery	Pre-op.	DASS	1) Pre local anesthetics 2) Pre-op 3) 10, 20 and 30 min during op., 4) After last suture, 5) 10 min after op.	, Anxiety+(not significant only p group in high-trait anxiety)
Pager²¹⁾	N=73 MA=74.6	N=68 MA=72.9	Video	9m, Cataract surgery experience and the potential risks	Pre-op.	VAS	Before and after information, before discharge	Anxiety+, Discomfort, Risk, understanding+, satisfaction+
Pearson²²⁾	N=68 MA=59.8; N=50 MA=57.2	N=50 MA=59.7 N=49 MA=58.6	Video	10m, video + a standard information leaflet (the purpose of the procedure, preparing for a colonoscopy, procedure, potential complications, and the postoperative period)	Pre-op.	STAI	Before information and before procedure	Anxiety, Worry, knowledge+Sati sfaction
Felley²³⁾	N=339 MA=57	N=379 MA=58.7	Combined written and verbal	Written(benefits and risks of the procedure, treatment of complications, and possibility of receiving hypnotic drug during endoscopy and the related risks) + verbal (routine nonstandardized oral information)	Pre-op.	Global assessment of endoscopy	Before procedure and at the time of the procedure	Anxiety, Quality of information+
Ogden²⁴⁾	N=81 MA=45.5	N=76 MA=47.7	Viewing the screen	Seeing a hysteroscopy procedure on a screen	Pre-op.	POMS Anxiety depression, fatigue, vigour	y, r Before procedure and after procedure	Anxiety+, Pain+ (negative effect for the local anesthesia)
Jlala²⁵⁾	N=55 MA=58	N=55 MA=59	Video	9 min film(PNB), 7 min film(SA), Anesthesia information about the risks, benefits, alternatives, and regional anesthesia procedure.	Pre-op.	STAI, VAS	Before and after the film, Pre-op and post-op	Anxiety+
Heikkinen²⁶	N=72 MA=44.2	N=75 MA=43.5	Website	Spent time mean : 81m, internet-based patient education, 9 surgical topics (instructions for preparing for the operation, the schedule of events on the operation day, follow-up care, financial aspects, and frequently asked questions)	Pre-op.	Emotional questionnaire	1) Before education 2) After education 3) On the op. day but before op. 4) 1 day after the op. 5) 3 days post-op 6) 2 weeks post-op. 7) Four weeks post-op.	. 7 emotions: fear, worry, nervousness, impatience, depression, anxiety and uncertainty
Tarhan²⁷⁾	N=123 MA=64.12	2 N=123 MA=65.10	Video	6m 41s, definition of prostate cancer, the need for prostate biopsy to diagnose prostate cancer, patient preparation, positioning, transrectal probe, biopsy gun, and sound of the biopsy gun during procedure, possible discomfort, and complications.	Pre-op.	STAI	Pre-information STAI-S, STAI-T, Post-information STAI-S, VAS	Anxiety+, pain perception
Choi²⁸⁾	N=30 MA=68.13	N=30 MA=64.77	PPT. Leaflet verbal	20m, Individual Structured Preoperative Instruction (cataract surgery procedure, sensory information, deep breathing, use of eye drop, post op self –care regimen)	Pre-op.	STAI, NRS	Pre-op and post-op	Anxiety+, HR, BP, self-care compliance+
Kekecs²⁹⁾	N=34 MA=66.82	N=50 MA=70.76	CD	15m 27s, listen to the recording 4 times, information on the phases of the operation and recovery period using positive verbal suggestions with relaxation and imagery techniques.	Pre-op.	STAI, 7point Likert scale	1st. meeting, Pre-op, Surgery 1, 2, 3, End of surgery, After surgery, post-op visit	t Calmness+, cooperation +, HR, BP, wellbeing, sleep quality

Exp.=Experimental group; Cont.=Control group; N=No.; MA=Mean age; op.=operation; STAI=State-trait anxiety inventory; DASS=Depression anxiety stress scales; VAS=Visual analogue scale; POMS=Profile of mood states; PNB=Peripheral nerve block; SA=Spinal anesthesia; HR=Heart rate; BP=Blood pressure.

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