Not Having a Diagnosis Increases Patients' Anxiety

Waiting for a diagnosis can be one of the most stressful things in life, even more stressful that knowing you have a serious disease, concluded a study led by researchers from the Harvard Medical School in Boston, Massachusetts.

Elvira V. Lang, MD, associate professor of radiology at Harvard Medical School in Boston, Massachusetts and her colleague Nicole Flory, PhD, examined the stress levels of 214 women, who were scheduled to undergo different diagnostic and treatment procedures, and waited their turn.

Dr Lang said that “not knowing your diagnosis is a very serious stressor.

“It can be as serious as knowing that you have malignant disease or need to undergo a possibly risky treatment.”

Just before the procedures, the women filled in four standardized test, that measured anxiety and stress levels: the State Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CES-D), Impact of Events Scale (IES) and Perceived Stress Scale (PSS).

112 women were scheduled for a breast biopsy (a diagnostic procedure to investigate a suspicious lump in the breast), 42 waited for hepatic chemoembolization (a treatment for liver cancer) and 60 were programmed for uterine fibroid embolization (a treatment for uterine myoma or benign fibroids).

The patients with the higher levels of anxiety were breast biopsy patients, having an average STAI score of 48, compared with chemoembolization patients with a mean STAI score of 26, and fibroid embolization patients – with an average STAI score of 24.

CES-D scores were around 15 for breast biopsy patients, 14 for chemoembolization patients and 12 for fibroid embolization patients.

The difference was not very pronounced for the IES scores either, but breast biopsy patients still had the higher scores – 26 compared to 23.

Breast biopsy patients also had the highest PSS ratings, with an average of 18, compared to fibroid embolization patients – 16 and chemoembolization patients – 15.

Dr Lang said that “these results really drive the point home that the distress of not knowing your diagnosis is serious.

“We believe that healthcare providers and patients are not fully aware of this and may downplay the emotional toll of having a diagnostic exam.”

According to her, there are simple ways to relieve the patients' stress before a procedure, and “training the medical team in how to talk to patients makes a huge difference.

“This can diffuse tension right away and can help patients to shape expectations in a more helpful fashion.”

The study was presented at the annual meeting of the Radiological Society of North America (RSNA).