Discussion
In this randomized single-blind placebo-controlled trial the effects of
a standardized MRI information booklet on anxiety and satisfaction with
information among adult outpatients undergoing their first MRI
examination was investigated. There were no differences in anxiety
between the intervention and control groups before or during scanning,
but those who received the placebo booklet had a significantly higher
risk of experiencing severe anxiety immediately prior to MRI. The
results also showed that pre-scanning information is considered
important, and that those who received MRI specific written information
before their examination were more satisfied than those who received
general information.
The effects of written patient information on elevating patient anxiety
associated with MRI have been investigated before using the STAI
questionnaire 16, 32. One study found significantly
decreased anxiety during MRI among patients who received an information
booklet in comparison with those who did not 16.
However, the written information in that study was supplemented by other
interventions such as a pre-scan counselling, which makes it uncertain
to what extent the outcomes can be attributed to the written informationper se . Another study failed to demonstrate any reduction in
MRI-associated anxiety from provision of an information booklet alone32. This may have been due to providing written MRI
information to both study groups and only supplemental information to
the experimental group 32. However, the present study
demonstrates that those who received the placebo booklet had a higher
risk of experiencing high pre-scan anxiety compared to those who
received specific MRI information. This association was independent and
beyond those of high baseline anxiety levels, pre-scan visits to the MRI
and the presence of relatives during scanning. Furthermore, factors such
as cause of referral, use of sedatives and gender, which all have been
found associated with MRI anxiety in previous studies9, 19, 32, did not contribute to high anxiety levels
once the written information was taken into account. These findings are
strengthened by the randomized placebo-controlled design, which differs
from previous quasi-experimental studies of the effects of written
information on MRI associated anxiety 16, 32.
The comparison within the groups regarding patient perceived anxiety
prior to and during the MRI showed significant differences for both
groups. This may be due to a feeling of relief after the examination.
That is, although STAI-SA intended to assess anxiety during the
examination, it cannot be ruled out that responses may have been
influenced by perceptions at the time when the inventory was answered.
Furthermore, attendance and oral information by the staff (which was
provided after the STAI-SB was responded to) may also have had an
anxiety reducing effect 4-5, 39. For example, it has
been found that support from the staff have a significant impact on
patients‘ experiences of an MRI and the staff/patient interaction may
facilitate self-control and coping during the examination4.
The intervention group was more satisfied with the information compared
to the control group, which is contrary to previous results in MRI32. This could be explained that our study provided a
booklet that was developed in interaction with people who had undergone
an MRI, which probably enhances the relevance and comprehension of the
information 31.
A placebo booklet was applied, which is considered a strength of the
study. Nevertheless, there is also a risk to use placebo considering
that the attention provided by the placebo booklet may have affected
their experiences of MRI, even though it did not include any information
about the examination. However, it has been argued that these effects
are negligible in interventions of patient education that are applied
over a short period of time 40. Indeed, the Nordic
Cochrane Centre concluded that in general there is no evidence that
placebo interventions have clinical effect with an exception of possible
influence on experiences of pain and nausea 41.
One aspect that always should be considered in relation to any
intervention is its cost-effectiveness. That is, whether the extra cost
associated with printing and distributing an MRI information booklet is
compensated by its effects. To the best of our knowledge, there is no
such evidence available regarding written information prior to MRI.
However, it appears reasonable to consider the relatively small costs to
be acceptable in view of the results presented here, particularly since
previous studies have suggested that this type of intervention also may
reduce motion artefacts 32, 42. Nevertheless, future
studies should consider cost-effectiveness in addition to motion
artefacts and MRI associated anxiety and wellbeing 43.
Conclusion
This placebo-controlled single-blind randomized trial examined the
effects of standardized written information to people undergoing their
first MRI examination. The results showed that such information reduces
the risk of experiencing high pre-scanning anxiety levels, that patients
find it important to receive information before the examination, and
that it increases the satisfaction with the information as compared to
general information.
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