Abstract
The paper seeks to determine whether there is a relationship between gender, age and level of education in patient anxiety from MRI scans. This is however done by conducting interviews on patients at King Abdul Aziz Medical City in Riyadh. The main causes of anxiety were seen to be the physical surrounding of the examination room, curiosity, beliefs, and the idea of having their brains scanned.
However, with communication, a little distraction and reassurance of their safety, the patients relaxed. Despite being among the major innovation made in the medical sector, people have still come to terms with the idea of how the procedure works. However, it is through the provision of adequate information that people are more informed, and understand the details of the MRI scanning.
Statement of problem
A study to assess the relationship between gender, age and level of education in patients undergoing Magnetic Resonance Imaging in King Abdul Aziz Medical City in Riyadh.
Introduction
Magnetic resonance imaging (MRI) is an imaging technique used by medical specialists to scan interior body organs and tissues. It is a diagnostic tool that screens the body by using radio waves and magnetic fields, transferring the images to a computer for thorough screening.
This is currently the best diagnostic technique offered in medical institutions as it offers more detailed results, and better imaging compared to other methods. Unlike other methods, there is no exposure to x-rays, making the method even safer.
During the examination, the patient usually lies on a table that is slide in a cylindrical container where the diagnoses are performed. Due to the nature of the procedure, the patient can stay in the cylinder for up to an hour depending on the criticality of the examination. In order to receive quality imaging from the scanner, the patient is usually expected to stay calm so as to allow critical imaging.
As calming as the environment may be, the MRI scanner normally produces disturbing noises such as clicks, loud bangs and knock, which most of the times scares patients (Shannon, 2002). It is for this reason that most patients develop anxiety from MRI scan.
However, studies have shown that music can be used to distract patient from the disturbing noises produced by the scanner, calming them down throughout the procedure. A technique that was first invented for mentally challenged individuals is now a solution to a problem that faces most patients (Stephens, Pait & Sheehan, 2003).
Literature review
Advancement in technology both in diagnosis and treatment has proved to manage diseases effectively. The Magnetic Resonance Imaging is among the most important medical innovations made over the century.
The MRI scanner was developed by Mr. Raymond Vahan Damadian, the founder of FONAR Co-operation. This technology has proven to be critically useful in cardiovascular, musculoskeletal, neurological (brain), and oncology imaging.
A number of researches revealed individuals are fearful of the equipment in relation to the loud acoustic noise delivered during imaging creating difficulties in communication. There have also been a range of complaints relating to a lack of information regarding the duration of the scanning and the temperature within the scan.
Patients also anticipate pain, discomfort, loss of sense of control and anxiety related symptoms of panic experiences while being scanned.
MRI can be problematic psychologically; respiration and swallowing may be increased in apprehensive patients, and motion artefacts arising from such increased movement result in images of no diagnostic value (Stern, 2010). Severe anxiety would result in cancellation of the procedure rescheduling that would increase costs and delaying evaluation (Morris & Liberman, 2005).
Studies have shown that 25% of the normal population entails patients that suffer moderate and severe anxiety while undergoing MRI scans (Stern, 2010). For this, MRI scanning has been looked at various perspectives, trying to figure out the best way to handle patients without agitating them. By looking at the scanning environment, it is clear why most patients are never at ease.
To begin with, one is slide in a container where there is only one outlet. This is usually scary to patients as some of them get frightened picturing a situation whereby the only opening is blocked, and one is locked in the chamber.
The temperature of the chamber is usually well moderated and oxygenated in order to make the patient feel as comfortable as possible. However, some say that this is what scares them because they cannot imagine the system failing and getting suffocated in the chamber.
The other thing is to examine the psychology of the patient before, and after the scan. With everyone saying how horrible it is to be in the scanning chamber, first timers are usually frightened of the experience. The best way is to take them through the process explaining the details of the procedure, ensuring that they understand that their safety is your concern.
This way, they are relaxed, making the procedure a success. To enhance this, some institutions have tried using attractive stencils and calming colors in the waiting and scanning room so as to calm down patients. Calming music has also proven to be relaxing and helps in avoiding triggering anxieties (Zlatkin, 2003).
Children, pregnant women and mentally challenged people are usually considered exceptions, and can be medicated in order to ensure that they stay calm throughout the examination.
There is the Neuro-Linguistic Programming (NLP), an approach that is meant to assure the patient that their safety is highly considered. It is basically all about communication but with a four-principled formula.
Building a rapport with the patient is extremely vital and can be developed by positively empowering them on the procedure, but at the same time distracting them with other experiences that may take their mind off the subject. With people having different ways of processing information, there are various approaches that can be used to ease them up.
For example, there are those that need calming music, some a certain aromas and others a friend to accompany them in the examining room. However, there are those that prefer staying alert throughout the process experiencing the usual noises, which assures them that the machines are working properly.
With the high number of patients suffering from anxiety during MRI scans, it has become habitual for everyone else to be frightened of these procedures. For this, the use of testimonials from people who have successfully undergone the process without any hitches may be helpful in calming their nerves.
Professionalism from the staff also goes a long way in ensuring that one is calm as the key to this is to gain patient’s trust and making them feel comfortable (Guzzetta, 1998).
It has been proven that MRI scan poses no risk to anyone; in fact, it is considered the safest diagnostic technique. The procedure is painless and apart from the fact that it doesn’t involve x-rays, the positioning of the patient during the examination is usually made comfortable (Fatemi & Clayton, 2008).
Due to the magnetic energy used in the procedure, one is expected to remove any jewellery, and metals than could be pulled towards the scanner. For this, the procedure is unsuitable for people who have metal implants. For instance, the procedure is never safe for someone with a heart pacemaker.
In order to avoid situations that patients are injured because of insufficient information on how the MRI scan works, there is the need to determine the association of MRI scan anxiety and;
- Level of knowledge
- Gender
- Age
Methodology
A randomized prospective study was conducted among patients who underwent the MRI scan, out of 106 patients 55 patients received oral instruction and 51 patients received information pamphlet. Anxiety was measured just before colonoscopy by using STAI scale.
Out of the 106 participants 40 patients were men while women covered the rest of the populace. 90 percent of women and 30 percent of men participants suffered anxiety from the MRI scan. The age groups of the patients were; <20, 20-30 years, 31-50, and 51-70. 50 percent and 30 percent of patients who suffered anxiety were from the <20 and 20-30 years age groups consecutively.
In terms of the level of education, 67 percent of the patients were high school graduates, 21 percent were still in school and the remaining 11 percent had more than a college degree.
The younger patients were seen to be anxious due to their greenness in medical institution, which contributed to their anxiety. Also, the more the educated the patients were the less they suffered from anxiety; therefore, it was obvious that the level of education contributed in the reduction of the anxiety.
While the female were seen to hold the highest number of those that suffered anxiety, this can be explained by the nature of women whereby their emotions are easily triggered compared to those of men. The study revealed that the information pamphlet was more effective in reducing anxiety than the oral information.
To sum up, the anxiety experienced by patients from the MRI scan was evidently based on gender, age and level of education.
Data Collection Method
After obtaining administrative permission, the samples will be identified as per inclusion and exclusion criteria using purposive sampling technique. The samples will be randomly allocated into the experimental group by lot method. Initial rapport will be established, the purpose of the study will be explained to the subjects, and informed consent will be obtained.
The demographic data will be collected and knowledge and anxiety will be assessed by using standard questionnaire and STAI anxiety scale. The knowledge and pre procedural anxiety levels will be assessed by the investigator just before shifting the patient for Magnetic resonance imaging.
Findings
After the assessment of the results from the interview, it was evident that patients suffered anxiety from the MRI scan. Though the number of patients who suffered anxiety varied based on gender, age, and level of education, it clearly showed that the majority of the patients suffered moderate anxiety. As indicated on the analysis table, the study proved that patients were afraid of the procedure, which contributed to their anxiety.
Magnetic resonance imaging is a (MRI) is a non-invasive diagnostic procedure; it is considered painless, but between 25% and 37% of patients undergoing MRI experience moderate to high levels of anxiety and 1.5% to 6.5% terminate their scan prematurely.
Besides patient discomfort it is known that patients who experience anxiety move more during scanning than do calm patients, and this may have an effect on image quality (Dougherty, Rauch & Rosenbaum, 2004).
A study was done to assess the subjective experiences of patients undergoing MRI, using a questionnaire before and after imaging. Patients who experienced problems like fear, discontinuation of procedure during MRI had pre-imaging anxiety level similar to that of pre operative anxiety (Tasman et al., 2011).
Basically, lack of enough information, discouraging beliefs, and the screening environment develops the relentless to pre mature scanning. With the study completed, it is obvious that patient anxiety of MRI scan is not associated in any way with age, gender or level of education. However, the level of education may matter in terms of the information one has on the examination.
Our study reviewed, out of 40 patients undergoing MRI 95% of the patients completed the procedure and 37% reported moderate to severe anxiety (Burghart & Finn, 2011). People are never patient with the procedure, and for this, they decline further screening before complete examinations. Hospital setting itself makes the person anxious (Dougherty, Rauch & Rosenbaum, 2004).
Discussions
Having identified that patient anxiety from MRI scan is a problem that people in Riyadh are faced, implementation of strategic plans to control this is the way to go.
However, patient anxiety from MRI scans is not an issue that is based on gender, age or level of education, but with awareness. For this, the level of education may seem to weigh a little, but the fact that anyone can be informed of the details of the procedure makes the level not an exception.
As seen, curiosity and beliefs are the major cause that triggers these anxieties because of being misinformed. Therefore, by giving people the right information, there is the possibility of turning around the situation, making better perceptions of the procedure.
Even though the study showed that most of the women seemed to be the victims of the MRI scan anxiety, it does not mean that gender is factor that defines the outcome of the procedure; it only happens that women tend to be nervous than men not just in this procedure, but also in other ventures.
Also, when it comes to age, it can be tricky is the patient is an infant or just a baby that is incontrollable. In this case, there is special medication used to help them relax, and stay calm throughout the screening so as to get quality results.
To sum up, anxieties associated in MRI scans are in no way linked to age, gender or level of education; it is the psychology of the patient, and the environment on which the procedure is performed that controls the feelings and outcome of the results.
Conclusion and Recommendation
Having identified the factors that facilitate MRI scan anxiety, coming up with solution to curb this problem is not difficult. As seen, it would be nicer, and a whole lot comfortable if the MRI scanner is placed in the center of a room, and has an exit that assure the patient that they can be removed if anything goes wrong.
Also, lying for up to an hour can be agitating, and therefore, the machines should be made to accommodate other positions such as sitting, and standing. With positions such as sitting, patients can be distracted by exciting visual contents such as movies, or television. It is all about patient psychology and control of the surrounding, making it pleasant.
References
Burghart, G., & Finn, C. A. (2011). Handbook of MRI scanning. St. Louis, Mo: Mosby.
Dougherty, D. D., Rauch, S. L., & Rosenbaum, J. F. (2004). Essentials of neuroimaging for clinical practice. Washington, DC: American Psychiatric Pub.
Fatemi, S. H., & Clayton, P. J. (2008). The medical basis of psychiatry. Totowa, NJ: Humana Press.
Guzzetta, C. E. (1998). Essential readings in holistic nursing. Gaithersburg, Md: Aspen Publishers.
Morris, E., & Liberman, L. (2005). Breast MRI: Diagnosis and intervention. New York: Springer.
Shannon, S. M. (2002). Handbook of complementary and alternative therapies in mental health. San Diego: Academic Press.
Stephens, J. T., Pait, T. G., & Sheehan, J. (2003). Golf forever: The spine and more : a health guide to playing the game. Las Vegas, Nev: Stephens Press.
Stern, T. A. (2010). Massachusetts General Hospital handbook of general hospital psychiatry. Philadelphia: Saunders/Elsevier.
Tasman, A., Kay,. J., Lieberman, J. A., First, M. B., & Maj, M. (2011). Psychiatry. Hoboken: John Wiley & Sons.
Zlatkin, M. B. (2003). MRI of the shoulder. Philadelphia: Lippincott Williams & Wilkins.
Appendices – Questionnaire
- What is your: Name? Age? Gender?
- Is this your first time to perform the MRI scan?
- What do you know about the procedure?
- Do you know of people who have performed the procedure and what do they say?
- What do you feel about this diagnostic method (also state your expectation)?
- What was the experience like?
- Was the support of the staff helping?
- Do you feel any distortion/abnormality?
- Were your expectations met?
- Would you go for another MRI scan?
- What would you recommend?
Age
Chi-square = 9.77; df = 8, p = 0.2815, Cramer’s V = 0.1073
Gender
Chi-square = 32.58; df = 4, p = <.0001, Cramer’s V = 0.196
Level of education
Chi-square = 5.72; df = 6, p = 0.4553, Cramer’s V = 0.0821