Barriers and pathways to informed consent for ionising radiation imaging examinations: A qualitative study.

INTRODUCTION: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive and authoritative integration into clinical practice, and lack of direction has caused many health care professionals to be unsure of an appropriate consent methodology. Consent practices have been undertaken inconsistently and sometimes poorly. This research sought to investigate what barriers exist to meaningful informed consent, and what pathways are suggested to overcome these barriers. These views are then discussed in the context of practical health care consent practices. METHODS: A semi-structured interview explored the views of radiographers and radiologists on the practice of disclosing the ionising radiation risk of a clinical medical imaging examination. Qualitative data was analysed using a nominal method of quantitative transformation. Responses were reviewed, and a set of definitive themes constructed. Participants considered the influences, logistics and barriers to the informed consent process. Participants were then asked what pathways might be developed that would improve the process. RESULTS: Twenty-one (21) radiographer participants and nine (9) radiologists were interviewed. The barriers to consent identified issues of time constraints, lack of a unified message, and patient presentations. Pathways suggested included limiting the scope of the consent practice, sharing the consent responsibility, and formulation of definitive consent guidelines. CONCLUSION: A unified, definitive series of guidelines for informed consent for ionising radiation examinations would alleviate many of the identified barriers. Having the consent process consistently begin with the referring doctor would facilitate more meaningful consent.

Scan-associated distress in lung cancer: Quantifying the impact of "scanxiety".

OBJECTIVES: Diagnostic imaging may be a major source of cancer-related distress, a condition known as "scanxiety". Scant scholarly work has been performed to evaluate scan-associated distress in cancer. We sought to characterize risk factors for scan-associated distress among patients with Non-Small Cell Lung Cancer (NSCLC), and to evaluate the impact of scan-associated distress on quality of life. MATERIALS AND METHODS: We conducted a cross-sectional survey study of patients with recurrent/metastatic NSCLC treated at an academic medical center. Clinical and demographic variables were obtained through chart abstraction and patient self-report. We used a modified version of the Impact of Event Scale 6 (IES-6) to specifically assess distress associated with scans, and quality of life was measured using the Functional Assessment of Cancer Therapy - Lung (FACT-L). RESULTS: Among 103 participants (survey response rate 76.3%), median age was 67, 61.2% were women, and 82.5% were white. At the study visit, 72.8% of subjects discussed a recent scan, and 83% reported some scan-associated distress. Scan-associated distress was not associated with whether the patient had a recent scan, progressive disease or time from diagnosis. Scan-associated distress was associated with impaired quality of life (p=0.004); each unit increase in IES-6 corresponded to an approximately one-unit decrease in FACT-L score. CONCLUSION: Scan-associated distress is a common problem among patients with NSCLC, and is associated with impaired quality of life. Scan-associated distress severity was not associated with time since diagnosis or whether a recent scan was discussed at the study visit, which implies scan-associated distress may be a persistent problem.

The Fukushima nuclear accident temporarily increased patients reluctance for nuclear medicine investigations.

Only mentioning the word "nuclear" already creates anxiety and distress. We attempted to assess the impact of the media hype about the Fukushima event on patients admitted in nuclear medicine units to undergo diagnostic investigations. The number of patients denying scintigraphic studies over half a year after the Fukushima accident was compared with the same period of the 2 previous years 2009 and 2010. Data were separately analyzed into thyroid vs. other organ scintigraphies. Physicians' referrals to nuclear medicine showed no decline. Patients undergoing various organ scintigraphies asked questions related to the accident but only few of them denied the investigation. Questioning and denial for nuclear medicine tests were more frequent in females as compared to males and especially in child-bearing females. Among patients referred in the initial post-event phase for thyroid function tests, more than 10% denied thyroid scintigraphy and 2.75% questioned this test. Again, questioning and denial was higher with females, especially in child-bearing age. In conclusion, this study showed that nuclear accidents and perhaps irresponsible media reports may affect behaviour of patients referred for nuclear medicine studies and in particular for thyroid scintigraphy even if these accidents had no radioactive effect to them.

[Evaluation of the anxiety state in patients receiving radioiodine treatment or who undergo a sentinel lymph node examination in the Nuclear Medicine Department]. / Valoración del estado de ansiedad de los pacientes que reciben un tratamiento con radioyodo o son sometidos a una exploración de ganglio centinela en el servicio de Medicina Nuclear.

OBJECTIVE: To analyze the presence of anxiety in patients referred to a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: A total of 148 patients were included: 67 were referred for radioiodine therapy, 48 with hyperthyroidism (HT), 19 with differentiated thyroid carcinoma (DTC), and 81 were referred for detection and biopsy of the sentinel node in breast cancer (BC). The following documents were filled out: personal data, a state-trait anxiety inventory, a scale of pre-disposing factors causing anxiety and an information questionnaire. Anxiety-predisposing factors and the influence of the information on the presence of anxiety were studied. RESULTS: HT patients: 47% had anxiety in the moment of the visit that was not related to the level of information received. The factor that worried them the most was the radioiodine administration. Being the first visit to a NMD significantly influenced (p<0.05) on the presence of anxiety. DTC patients: 42% had anxiety in the moment of the visit not related to the level of information received. The factor that worried them the most was the illness itself. No factor had a significant influence on the presence of anxiety. BC patients: 53% had anxiety in the moment of the visit that was not related to the level of information received. What worried them the most were the results. Having anxiety and/or depression significantly influenced (p<0.05) the presence of anxiety. CONCLUSION: The quantity of information given before a procedure in a NMD does not influence on the presence of anxiety. Nevertheless, it is our duty to give the best possible information.

Estudo correlacional entre neuroimagem e a técnica de Rorschach em crianças com síndrome de Tourette / Correlational study between neuroimaging and the Rorschachïs inkblot test in children with Tourette syndrome

A pesquisa foca a Síndrome de Tourette (ST), tendo como instrumentos o Rorschach e a Cintilografia com objetivo de comparação e correlação entre os resultados dos instrumentos. A amostra teve 8 crianças com diagnóstico de ST (Gr1); o estudo contou com Gr2 (controle). Foi utilizado como método de comparação de diferença o t-Test, com nível de < 0,05. Nos resultados, confirmaram-se as hipóteses de maior índice indicador de liberação dos impulsos e das reações emocionais, de ansiedade, de carência afetiva e de necessidade de contato humano no Gr1. O estudo correlacional entre alterações neurofuncionais e os dados do Rorschach indicou correlações significativas (< 0,01) entre confusão de pensamento, tendência à fuga da realidade, capacidade de adaptação e bloqueio mental (Rorschach), e variáveis da neuroimagem. Estes achados parecem demonstrar que existem diferenças significativas de personalidade entre as crianças portadoras de ST e crianças não-portadoras, sendo possível realizar estudos de associação e correlação entre instrumentos psicológicos e médicos.(AU)

The research focuses on Tourette Syndrome (ST), having as instruments the Rorschach and the Cintilography for comparative and correlational study between the results of the instruments. The sample was comprised of 8 children diagnosed with ST (Gr1), the study had Gr2 (control). T-Test was used for comparison of difference, with level of < .05. The hypotheses of highest indicator of release of the impulses and the emotional reactions had been confirmed, as well highest anxiety, affective lack and necessity of human contact in the Gr1. The correlacional study (Pearson) between neurofunctionals alterations and data from the Rorschach indicated significant correlations (<.01) between confusion of thought, tendency to escape from reality, adaptability and mental block (Rorschach), and neuroimaging variables. These findings seem to demonstrate that there are significant differences in personality among children suffering from ST children and non-carriers, and that it is possible to carry through studies of association and correlation between psychological and medical instruments.(AU)

Estudo correlacional entre neuroimagem e a técnica de Rorschach em crianças com síndrome de Tourette / Correlational study between neuroimaging and the Rorschachïs inkblot test in children with Tourette syndrome

A pesquisa foca a Síndrome de Tourette (ST), tendo como instrumentos o Rorschach e a Cintilografia com objetivo de comparação e correlação entre os resultados dos instrumentos. A amostra teve 8 crianças com diagnóstico de ST (Gr1); o estudo contou com Gr2 (controle). Foi utilizado como método de comparação de diferença o t-Test, com nível de < 0,05. Nos resultados, confirmaram-se as hipóteses de maior índice indicador de liberação dos impulsos e das reações emocionais, de ansiedade, de carência afetiva e de necessidade de contato humano no Gr1. O estudo correlacional entre alterações neurofuncionais e os dados do Rorschach indicou correlações significativas (< 0,01) entre confusão de pensamento, tendência à fuga da realidade, capacidade de adaptação e bloqueio mental (Rorschach), e variáveis da neuroimagem. Estes achados parecem demonstrar que existem diferenças significativas de personalidade entre as crianças portadoras de ST e crianças não-portadoras, sendo possível realizar estudos de associação e correlação entre instrumentos psicológicos e médicos.

The research focuses on Tourette Syndrome (ST), having as instruments the Rorschach and the Cintilography for comparative and correlational study between the results of the instruments. The sample was comprised of 8 children diagnosed with ST (Gr1), the study had Gr2 (control). T-Test was used for comparison of difference, with level of < .05. The hypotheses of highest indicator of release of the impulses and the emotional reactions had been confirmed, as well highest anxiety, affective lack and necessity of human contact in the Gr1. The correlacional study (Pearson) between neurofunctionals alterations and data from the Rorschach indicated significant correlations (<.01) between confusion of thought, tendency to escape from reality, adaptability and mental block (Rorschach), and neuroimaging variables. These findings seem to demonstrate that there are significant differences in personality among children suffering from ST children and non-carriers, and that it is possible to carry through studies of association and correlation between psychological and medical instruments.

Paediatric 99mTc-DMSA imaging: Reducing distress and rate of sedation using a psychological approach.

AIM: To evaluate the effect of a psychological approach on distress and sedation rates in children undergoing dimer captosuccinic acid-labelled with technetium-99 (99mTc) DMSA imaging. MATERIALS AND METHODS: Baseline data, on a retrospective consecutive sample of children examined using DMSA over a 6-month period (n = 81), were collected via medical note search and postal questionnaire. A further consecutive sample of 40 children was recruited prospectively to the intervention, which consisted of distraction during medical procedures and environmental manipulation. In addition half of the intervention group were provided with a photo-booklet depicting a coping child model, together with a letter offering advice to parents on how to prepare their child for the procedure. RESULTS: Sedation rates were lower (p = 0.003) and service satisfaction ratings higher (p = 0.002) in the Intervention group as compared with the Baseline group. Within the intervention condition, children who received the photo-booklet displayed less distress before the procedure (p = 0.01) than those who did not. Also families who received the photo-booklet were more likely to attend the appointment (p = 0.024). CONCLUSION: In this study, the use of a psychological approach was associated with lower rates of distress and sedation in children undergoing 99mTc-DMSA imaging, without compromising image quality.

Issues surrounding preparation, information and handling the child and parent in nuclear medicine.

A successful pediatric nuclear medicine examination can be defined as a high-quality study coupled with the child and parent feeling that their emotional needs have been considered. To achieve this goal requires a team approach by all members of the nuclear medicine department as well as a comprehensive explanation of the procedure to the child and parent. Success often depends not so much on a department with the latest gamma camera but a department with an understanding of the needs of children and value of small items such as toys, posters, appropriate books and so on. The recognition that a child requires twice as long as an adult for the same examination dictates an appropriate appointment system to ensure that the staff have sufficient time to devote to the child and parent.