Ultrasound Guided Breast Biopsy Patient Education Video and Patient Anxiety

Katherine Patterson, M.D.Division Chief of Breast Imaging at Indiana University

Director of Breast Imaging at St. Margaret's Hospital Guild Diagnostic Breast Center at Eskenazi Health

Elise Miller, M.D.PGY-4, Radiology Resident

Indiana University

Jaimie Howell, M.D.Northwest Radiology

Disclosures

The authors have no financial interest or other relationship with a commercial organization that may have an interest in the content of the educational activity.

Purpose

• To determine the effects of an educational video about ultrasound guided breast biopsy on patient anxiety

• This project aims to improve clinical practiceStandardize informationCover all aspects of the biopsy so many patient

questions can be answeredAvailable on YouTube.com for patients to watch

again

Methods 7 Minute Video Filmed on an iPad

To make the biopsy look real, a few grapes were placed into a pork roast, thus imitating a breast mass under ultrasound imaging

The film was edited using Adobe Premiere Elements 14

Voiceover narration was used for better audio quality and to easily create both English and Spanish versions of the video

Staff radiologist played role of physicianTwo technologists played the roles of technologist and patient

Film Highlights- What is a biopsy and why is it necessary?

- What is ultrasound and what are the advantages of this technique?

- What is a radiologist and a breast technologist?

- Procedural details: step-by-step from patient positioning to what the biopsy needle sounds like

- Marker placement and what a marker is- Post-biopsy mammogram

- When to remove bandage and Steri-Strips- When to shower

- Lifting restrictions- Risks of the procedure

- Reasons to seek medical attention after procedure

Educate

Inform

Instruct

Film Screenshots

Methods

Patients scheduled for US guided breast

biopsy (random assignment)

Control Group- No video

- Verbal physician consult only

Experimental Group- Watched video

- Verbal physician consult as well

Methods• All participants filled out a State-Trait Anxiety

Inventory (STAI) both on the day that biopsy was recommended and when they returned for the biopsy appointment

• The STAI measures a patient’s “state” anxiety, or temporary anxiety, compared to her “trait” anxiety, or baseline anxiety

• Items are rated on a 4 point scale (e.g., from “almost never” to “almost always”)

• Higher scores correlate with higher anxiety

Results:Demographics

Results:State Trait Anxiety Inventory

Experimental Group(watched video)

N = 31

Average Anxiety Score = 44

Control Group(no video)

N = 27

Average Anxiety Score = 42

Between the experimental and control groups, there was no significant difference in state or trait anxiety between:

• Spanish speaking (N=13) and English speaking patients (N=45)

• Patients younger than 45-years-old (N=24) or older than 45-years-old (N=30)

• Patients with an educational level beyond high school (N=24) or high school diploma and below (N=30)

• Internal comparison of anxiety levels also did not significantly differ between the first and second surveys in either group.

Discussion No significant difference

in overall anxiety levels between the video and no video groups or in the subset comparisons based on language, age, or education level.

Patient comments from the video group, however, were overwhelmingly positive.

Sample of Patient Comments:

“Felt more comfortable”

“Very informative on the procedure”

“It was very informative. It explained the process in so much detail. Watching the people/pictures really goes beyond a voice/explanation”“Very helpful, it put your mind at ease”

“It was very interesting”

“Very helpful because I didn't understand how it was done or what it actually was”“The info presented was very helpful”

Brief Literature Review

Phillippe, F., et al. Effects of video information in patients undergoing coronary angiography. Arch Mal Coeur Vaiss 99(2): 95-101. Feb 2006.

• 200 patients• 100 watched video, 100 received verbal physician

consult• Patients who watched the video were significantly less

anxious and had lower heart rate• Procedure tolerability was higher in video group• Satisfaction of information for informed consent process

was higher in the video group

“Effects of video information in patients undergoing coronary

angiography”

• 67 patients• 33 watched the movie

• Level of anxiety was measured with a state-trait anxiety questionnaire

• Patient understanding and satisfaction with the information was also measured

• Results: Increased understanding and satisfaction, no effect on anxiety level

“Patient information for liver biopsy: impact of a

video movie”

Obled, S., et al. Patient information for liver biopsy: impact of a video movie. Gastroenterol Clin Biol 32(3): 274-278. Mar 2007.

Limitations

Fatigue- 40 STAI questions- Plus demographic

questions- 10 typed pages

Education Level- STAI 6th grade reading level

- 36% patients without high school

diploma

Small Sample Size- Difficult to recruit for

long survey- Technical errors (no

follow up survey given to some patients)

ConclusionsWhy is this important?

- Patient-focused care is one of the key components of the American College of Radiology’s “Imaging 3.0” initiative

- While anxiety levels were unaffected in our study, patient comments about the video were overwhelmingly positive

- Non-English speaking patients may derive the most benefit as multilingual standardized videos can save time and ensure communication consistency

- Educational videos may be one way for radiologists to empower patients through education and improve patient experience

Correspondence

Katherine Patterson, M.D. khwalker@iupui.edu

Elise Miller, M.D. milleeli@iupui.edu

Jaimie Howell, M.D. howelljaimie@gmail.com

bit.do/engmammoeske

US Guided Biopsy Video – English

bit.do/spanmammoeske

US Guided Biopsy Video – Spanish