- Title
- An exploration of procedural anxiety in patients undergoing radiation therapy
- Creator
- Forbes, Erin
- Resource Type
- thesis
- Date
- 2023
- Description
- Professional Doctorate - Doctor of Philosophy (PhD)
- Description
- Radiation therapy (RT) is becoming an increasingly utilised treatment option for cancer. While safe and effective, some patients find the procedure of RT distressing (procedural anxiety). In addition to the distress felt by patients, procedural anxiety can be detrimental to treatment delivery, with implications for both patients and the healthcare department. Despite this, there are existing gaps in the literature regarding the rates and pattern of procedural anxiety in RT, the current management in clinical practice, the state of evidence for non-pharmacological management of procedural anxiety, and availability of feasible and acceptable non-pharmacological interventions. To address these evidence gaps, this thesis aims to: 1. Describe the rates, patterns and current clinical management of procedural anxiety in patients undergoing RT for cancer; 2. To systematically review the available evidence for non-pharmacological management of procedural anxiety in RT; 3. Explore the patient experience of procedural anxiety and patient perceptions of possible interventions to reduce anxiety; 4. Trial the novel use of a biofeedback intervention that can be delivered within the treatment room by radiation therapists. These four aims have been addressed in a series of studies that include: an observational longitudinal study of 101 patients with head and neck cancer (HNC) undergoing RT; a systematic review describing the results of nine studies trialling non-pharmacological interventions aiming to reduce procedural anxiety in RT; a qualitative study of five patients with HNC; and a pilot randomised controlled trial of a biofeedback intervention (Biofeedback Enabled CALM) aiming to reduce procedural anxiety. The studies in this thesis have contributed to addressing the aforementioned evidence gaps in a number of ways. Firstly, Paper One reported the current rates of procedural anxiety in a sample of 101 patients with HNC, and the identified four different patterns of anxiety from start of treatment to end of treatment. Additionally, anxiety management interventions used in clinical practice were reported for the first time. Secondly, the systematic review (Papers Two and Three) highlighted the limited evidence base for non-pharmacological interventions aiming to reduce procedural anxiety, with only nine studies meeting criteria for inclusion, with few high-quality studies and limited evidence for effective interventions to manage procedural anxiety. Thirdly, the qualitative study (Paper Four) revealed patient perceptions of possible improvements to care, which can be used to inform clinical practice or guide further research. Lastly, the pilot randomised controlled trial (Papers Five and Six) demonstrated the feasibility, acceptability and potential effectiveness of an intervention that has great potential for translation into practice. Overall, the studies in this thesis highlight the need for improved guidance for healthcare providers regarding the use of non-pharmacological interventions, including increased screening for procedural anxiety throughout treatment and development of effective non-pharmacological interventions. Further research considerations include: further research to effectively identify patient anxiety prior to treatment, more rigorous testing of interventions aiming to reduce procedural anxiety, formalised trajectory analysis and association with interventions received, and a large randomised controlled trial of the Biofeedback Enabled CALM intervention.
- Subject
- radiation therapy (RT); procedural anxiety; biofeedback intervention; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1506656
- Identifier
- uon:55913
- Rights
- Copyright 2023 Erin Forbes
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 437 KB | Adobe Acrobat PDF | View Details Download |