Patients typically feel anxiety about undergoing an MRI, and new research finds that this stress impacts patients' experience during the scan, and it can also impact the imaging workflow.
Published in the Journal of the American College of Radiology, the study examined the psychological and physiological response of patients undergoing an MRI and how these response levels relate, the role of different potentially influencing factors, and the relation to procedural outcomes. The authors determined that patients who reported stress and anxiety were significantly more likely to need a repeat scan and to have a longer exam time (2022; https://doi.org/10.1016/j.jacr.2021.11.020).
The team of researchers included data from 96 patients, assessing the psychological or physiological response before and after MRI. The authors issued questionnaires on anxiety, strain, agitation, and mood, as well as salivary [alpha]-amylase and cortisol. They collected data on potentially influencing factors and outcomes of the clinical workflow.
Most of the patients in the study tolerated their MRI exam well, but about one-third experienced moderate-to-severe anxiety. What's more, two patients even chose to prematurely end their scan.
"A worse psychological state was related to a stronger response of cortisol, but not [salivary [alpha]-amylase], suggesting that physiological stress in patients is induced by experiences of uncontrollability and uncertainty rather than the physical characteristics of the examination," the authors wrote.
Overall, the researchers observed significant improvements of all psychological measures from pre- to post-MRI, but not of the physiological stress markers. The psychological response correlated with levels of cortisol, but not [alpha]-amylase. "The valence of previous MRI experience was particularly predictive of the patients' reaction," the authors wrote, adding that "stress and anxiety in patients significantly predicted the probability of scan repetitions."
The findings imply that various factors contribute to how patients respond to MRI, and the stress and anxiety that patients experience can in turn affect clinical workflow. As such, the authors urge that these factors "should be considered in the medical treatment to provide both a positive patient experience and smooth clinical workflows."
A significant body of research exists on the topic of patients' experience with MRI, noted lead study author Janika Madl, MSc, Chair of Health Psychology at Friedrich-Alexander-University Erlangen-Nuremberg. "Yet, stress and anxiety are still a common phenomenon [among patients undergoing MRI scans]."
This anxiety suggests that "we have not been able to address the issue adequately," she noted. "On the other hand, many patients are able to undergo MRI almost relaxedly. Therefore, we aimed to find out what patients experience the most stress and anxiety [with] respect to MRI, to make sure we can address their particular needs in the future while not bothering those who don't need additional support. By including two levels of patient experience-subjective and physiological-we hoped to paint a clearer picture of the patients' reaction."
As far as the finding that patients who report stress and anxiety were much more likely to need a scan to be repeated and take longer to undergo MRI, "it has been proposed repeatedly that patients who are very anxious tend to lie less still in the MRI scanner and move more," Madl said. Excessive movement "may provoke motion artifacts and the need for repeated scans, which prolongs procedural times," adding that research has been inconsistent regarding this hypothesis. "Our results point to the fact that this notion might indeed be valid."
The findings could also affect how radiology teams approach MRI exams, in terms of ensuring a positive and relatively stress-free patient experience, as well as a smooth clinical workflow.
"The reasons why patients experience stress and anxiety when facing MRI are very diverse, ranging from fear of the MRI scanner itself to fear of what the examination might reveal. Accordingly, patients differ immensely in their needs," Madl said. "There has been great research on the effect of team training and changing the way the health care staff interacts with patients. Many other researchers have explored a vast range of possible interventions, such as additional information, sensory stimulation, video distraction, and music."
Until now, however, psychological preparation, possibly combined with enhanced information, "seems to have the most promising results for adults. For children, modeling interventions or mock MRI seems to be promising, too," she said, noting that the authors are currently working on additional manuscripts evaluating different interventions for MRI patient preparation when taking into account different patient needs.
"In my opinion, tailoring health care not only on a medical-procedural level, but also on a psychosocial level is key to meeting patients' needs and improving patient experience," Madl concluded.
Mark McGraw is a contributing writer.