T H E L L E G E O F RAD IRAPHERS Radiography (1998) 4, 101-105

Value of interpersonal encounter endorsed by patients as intervention in magnetic resonance imaging

Geraldine O'Connor and Siobhan Cotter

UCD School of Diagnostic Imaging, Herbert Avenue, Dublin 4, Ireland (Received 2I October 1996; accepted 29 January I998)

Keywords: compliance; communication; imaging; anxiety; questionnaire.

Anxiety-reducing strategies are constantly advocated so that magnetic resonance imaging is perceived as being patient friendly. This follow-up study of patients' attitudes to magnetic resonance imaging focuses on three core features of the procedure; the response of patients regarding the need to make recommendations, distress related to results of the scan and patient comprehension of the explanation they receive before the procedure. The importance of how patients understand the explanation of the investigation is emphasized.

Introduction

Studies have shown that social factors can be critical in achieving patient compliance during magnetic resonance imaging (MRI) [I]. Investiga- tions have been undertaken so that those factors that cause difficulty to patients can be identified. Increasing emphasis is being placed on the nature of the interpersonal encounter [2]. In the magnetic resonance imaging department, patients are usually given an explanation of the imaging procedure before they are scanned. This can determine the perception patients have of the examination and even the successful completion of the procedure, since emotional distress during and following MRI is well documented [3]. This study written about here sought to review findings of an earlier study related to patient tolerance and acceptance of MRI and to identify any trends that might indicate changes in patients' attitudes since the previous study [4]. Patients in the previous research [4] were strongly in favour of introducing interventions to improve tolerance of the patient procedure. At that time, there was only one MRI scanner in this country, but now the number of MRI units has increased and the investigation is more familiar to patients. In addition, the Charter of Patients Rights for Hospital Patients has been promulgated [5]. The intention of this study was to sample the opinions

1078-8174/98/020101 +05 $18,00

of patients to give an awareness of how MRI is currently perceived and to provide information about staff response to meeting the objectives of the Charter.

The main findings of the earlier research were that: • The patients expressed a definite need to give

their personal recommendations for improving the procedure.

• Patients had high perceptions of the inter- personal ability of the staff in the department.

• There were high levels of patient anxiety con- cerning the results of the MRI examination.

Method

A questionnaire used previously was again used in this study (Fig. 1). Modifications were not intro- duced as the aim of the research was to compare findings with the previous study. The study con- tained three categories of questions; one section dealt with patient anxiety, one with the social skills of personnel in the imaging department and one with recommendations for improving the patient-related protocol. The 22 items in the questionnaire were chosen to reflect well docu- mented aspects of these three topics. A 5-point LIKERT scale for responses was used with I being

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Did you feel anxious about today's examination before you arrived in the department?

Was there something else that was a particular cause of anxiety to you when you came for the examination?

Did the time you spent waiting in the department cause you concern?

Are you anxious about the results of the examination?

5. Did you receive an explanation of the examination before you arrived in the department?

6. Did you receive an explanation of the examination in the department

. Were you relaxed while you were getting instructions about the examination?

. Are you in any way familiar with the type of technology being used here?

9. Was your concentration when 21. you were being given the information about the examination affected by noise around you or the appearance of the equipment?

10. Was your concentration 22. affected by other people around you?

11, Did you feel that the staff were too busy to delay them with further questions?

12. Were you influenced in any way by the appearance and mannerisms of the staff who dealt with you?

13. Were there any terms or words used that you did not understand?

14. Did you understand the explanation?

15. Was your understanding of the explanation affected by the sex of the person who gave the explanation?

16. Did you remember the information you were given?

17. Did you have a pre-conceived idea about the explanation?

18. If so, was this notion based on media reports?

19. Would you have liked to see a demonstration of how the equipment worked before you had your examination?

20. Would you have liked to ask for more information about the examination?

Would you have liked to receive a written explanation?

Would you welcome the opportunity to give your opinion/suggestions about the examination you have undergone?

Figure 1. The questionnaire.

Interpersonal encounter in MRI 103

a definite positive response and 5 being a definit:e negative response. This scale was chosen as a measuring tool to gain some understanding of the level of patients' attitudes. Measurement of an attitude requires an instrument such as a question- naire from which inferences can be made. It was chosen because it is popular and it offers a reliable rough ordering of responses and can give'some indication of the intensity of agreement or dis- agreement with a question [6]. According to Anderson, use of the LIKERT scale offers the ability to assess both questions and intensity of attitude [7].

The patients' willingness to make recommen- dations regarding the MRI protocol was assessed, as well as their fears concerning the results of the examination and their understanding of the explanations given. Responses to one question in each of the three sections of the questionnaire were targeted and analysed. These questions were selected as representing the key issues under investigation. This review sought to identify any change in patients' attitudes since the previous research when it was evident that these items were the most pertinent. A convenience sample of 25 patients was obtained by administering the questionnaire to all patients in a Dublin Hospital over a 2-day period. It was felt that there would not be any calendar effect in this patient group as these two days were typical of the depart- ment's workload and should adequately reflect the opinions of patients who attend this centre.

The survey was conducted following the MRI scan. A total of 25 adults, nine males and I6 females, participated, ranging in age from 19-78 years old. The mean age of the respondents was 40 years. Patients were separated into age categories and mean scores were computed. Three patients had undergone an MRI previously. The socio- demographic data of respondents was similar to that of the earlier study. The individual items were scored in a i -5 manner with I or 2 representing a negative response and 4 or 5 representing a positive one.

Results

Findings of the study are illustrated in (Fig. 2). The high level of apprehension concerning the results of the MRI examination recorded previously was also evident in this study. Seventy six percent (n=19) of these patients stated that they were

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Figure 2. Summation of findings. A=anxie ty about results; B=understand explanation; C=willingness to make recommendations.

anxious regarding the outcome of the scan. Sixty three percent (n=I2) indicated a more intense concern by choosing the 'definitely yes' category.

A total of 84% (n=21) of the patients surveyed indicated that they fully understood the explan- ation that they received, and it is notable that only one patient chose the 'no' category for this question. The three remaining respondents were uncertain regarding their understanding of the explanation. No significant gender difference was noted in the responses. Only 32% (n= 8) indicated that they would be willing to make recom- mendations to improve the MRI protocol. These patients ranged in age from 20-60 years and included three men and five women. This response is compared to that of our previous study in Fig. 3.

Discussion

The principal finding, which differs from the pre- vious study, was that patients declined the oppor- tunity to recommend improvements to the conduct of the MRI examination. Only 32% (n=8) indi- cated that they would like to do so, compared to 50% (n=25) in the earlier study (Fig. 3). This suggests that the needs of this group of patients are being addressed, in line with the objective of the Charter of Rights for Hospital Patients [5]. We believe that when patients' perceived needs are adequately met, then compliance is more likely to be achieved. Katz came to the conclusion that psychosocial interventions should be tailored to the individual patient [8]. Several studies have

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Figure 3. Patient willingness to make recommendations.

investigated patient anxiety levels before, during and after magnetic resonance imaging [9-Ii] . Anxiety-induced psychosocial changes have been reported. Various patient-related interventions have been introduced in imaging departments so that MRI is better tolerated by patients. A further consideration is the possibility that anxiety may induce physiological changes and degrade the image quality of scans [1]. Some centres have introduced guided imagery and relaxation techniques to alleviate anxiety [12].

The present study shows the benefit of the interpersonal encounter as a positive intervention in MRI. The impact that staff have on patients' experiences and expectations is well documented and supports the suggestion that sensitivity to the individual patient can frequently resolve problems associated with MRI. Diamond aptly endorsed this staff quality when he commented that he found the staff 'friendly' and that he was given an adequate explanation of MRI [13].

This study supports the belief that more attention to the interpersonal aspects of the MRI examination could result in improved acceptance by patients. This simple intervention could easily be overlooked.

When MRI was a relatively new technique, one American medical institute introduced a patient- focused programme to enable staff to antici- pate patients' needs. This protocol centred on thoroughly familiarizing patients with features of the procedure [I4]. Tamburrini eta] , suggested, following analysis of their questionnaire, that the interactive nature of the examination could be improved [I5]. Brand has described simple inter-

ventions based on understanding patients' psycho- logical state [16]. One physician, following his own experience, made the decision to prepare patients for MRI by thoroughly describing the procedure to them [17].

Conclusion

One cause of non-compliance is poor com- munication. Good communication between staff and patients is essential in the MRI department. Trends demonstrated in this follow-up study are in line with our previous findings and suggest that patient cooperation and satisfaction with MRI is related to the ability of staff to convey relevant information. It is apparent that the pre-scan inter- view in the imaging department is highly valued by patients. We suggest that this encounter is an important intervention in MRI and that it could be a most effective intervention in reducing unnecessary anxiety in patients undergoing MRI.

Acknowledgements

The authors would like to sincerely thank Dr P. Brennan for his considerable guidance and advice and Ms Rita Burns for typing the document.

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