Interventions may reduce patient distress during bone marrow biopsy
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Patients undergoing bone marrow biopsy would respond favorably to interventions intended to improve their experience, according to study results presented at TCT Meetings Digital Experience.
Listening to music, watching online videos or using guided meditation ranked among the options most patients felt would help minimize distress associated with the procedure, results showed.
“We cannot change the fact that a patient has to get this procedure, but we can improve upon how they experience it,” researcher Michelle Lasota, BSN, RN, registered nurse in the department of oncology at Sidney Kimmel Cancer Center at Jefferson University Hospital, said during a presentation.
Patients with hematologic malignancies often undergo bone marrow biopsies.
“They have become so routine to us, we never really take a step back and think about what it means to patients and how it impacts them,” researcher Anne Delengowski, RN, MSN, AOCN, director of oncology nursing education at Thomas Jefferson University, said during a presentation. “We presume to know the procedure is a source of anxiety and pain for patients, and we sought to look at how we could improve the patient experience.”
Prior studies showed noninvasive, nonpharmacologic interventions — such as changes to the room environment and use of music, guided imagery or virtual reality — may help reduce patient stress in various settings.
Lasota, Delengowski and colleagues surveyed patients to determine whether these or other strategies may benefit patients undergoing bone marrow biopsy.
Twenty-five patients completed anonymous surveys on the day of bone marrow biopsy, providing responses to Likert-type questions and questions that allowed for free-text responses.
All patients had undergone bone marrow biopsy at Jefferson within the prior 2 years. The majority were aged 55 years or older (n = 15), male (n = 18), white (n = 19) and had been diagnosed with leukemia (n = 15).
The survey asked questions about patients’ experience, the room environment, their interactions with staff and the pain they experienced, as well as what interventions they would prefer.
Researchers used a 10-point distress scale (0 to 10) to assess patients’ distress levels on the day of their procedures.
Average distress scores increased with time since prior biopsy. Patients whose most recent bone marrow biopsy was more than 1 year earlier reported feeling the highest level of stress on their procedure day (distress score = 8); patients whose most recent biopsy was less than 1 month earlier reported considerably less distress on their procedure day (distress score = 2). Researchers hypothesized this finding was due to increased fear of relapse among patients with longer time between biopsies.
When researchers asked patients about the most distressing aspects of bone marrow biopsies, the most frequent responses were pain (51%), thinking about the results (46%) and thinking about the process of the procedure (42%).
When researchers asked patients what strategies would improve the time they spent waiting for their provider, the most common responses were listening to music (59%), watching online videos (35%) and using guided meditation (26.3%).
When researchers asked patients what strategies would improve the experience during bone marrow biopsies, the most frequent responses were listening to music (72.7%), watching videos (36.8%) and using guided meditation (30%). Approximately one-quarter (26.3%) of patients expressed interest in trying virtual reality, and 12% indicated changes to the décor in the procedure room would help.
“Although there were strong variations in what patients thought they would like to try, there was never really a ‘hard no’ for any of these perceived interventions,” Lasota said. “All patients who participated in the study acknowledged this procedure does cause them pain and anxiety and they would be willing to try these things to find out which is the best option for them.”
Researchers acknowledged potential limitations to their findings, including the small sample size, patients’ limited knowledge of or experience with suggested interventions, the fact participants completed the survey immediately prior to undergoing bone marrow biopsy, and the potential that patients’ self-reported strong relationships with their advanced practice providers may have altered their perceptions of pain or other aspects of the biopsy experience.
“We have to do a better job holistically of educating on distractions and interventions to improve pain and anxiety with both patients and the staff,” Delengowski said. “These measures are cost-effective and can be easily implemented.”
In the next phase of this study, researchers intend to pilot several of the interventions in clinical areas and assess which ones lead to the greatest objective improvement in patient distress and reductions in pain or anxiety.
They also hope to incorporate biometrics to record physiologic responses, including blood pressure, heart rate and respiratory rate.
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Delengowski A, et al. Abstract 108. Presented at: The 2021 TCT Meetings Digital Experience (virtual meeting); Feb. 8-12, 2021.
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