Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT.

OBJECTIVES: To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). METHODS: Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. RESULTS: One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. CONCLUSION: Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. KEY POINTS: • Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient experience.

Seeing what's happening on the inside: patients' views of the value of diagnostic cardiac computed tomography angiography.

OBJECTIVES: Cardiac computed tomography angiography (CCTA) is a commonly used diagnostic test for coronary artery disease. Despite its considerable clinical value, few studies have explored the psychological value of CCTA from the perspective of patients undergoing testing. This study aimed to investigate the patient-perceived value of diagnostic CCTA testing, specifically in relation to patients' perceptions of their heart health and health behaviours. DESIGN: The study used a qualitative methodology incorporating thematic analysis before and after testing. METHODS: Semi-structured interviews were conducted before and after the receipt of CCTA test results among 13 non-acute patients attending a heart clinic in New Zealand for diagnostic CCTA. Data analysis followed a thematic analysis approach applied at each interview time point. RESULTS: Three themes were identified from the pre-diagnostic interviews: expectations that testing would facilitate heart-related understanding; the role of CCTA as an essential requirement for considering the use of cardiac medication; and awareness of the importance of heart-healthy behaviours. Post-diagnostic interview analysis identified four themes: positive psychological responses to cardiac diagnosis; perceived value of viewing scan images; the potential impact of testing on health behaviour intentions; and patients' reflections on the procedure. CONCLUSIONS: These results suggest that CCTA has the potential to meet knowledge-gaining expectations that patients bring to clinic and may increase motivation of health-protective behaviours. Diagnostic CCTA may therefore provide an ideal opportunity to address patients' illness understanding and behavioural intentions. The effective utilization of scan images as a supplement to consultation may enhance such practice objectives and warrants further investigation. STATEMENT OF CONTRIBUTION: What is already known on this subject? Cardiac computed tomography angiography (CCTA) is an advanced diagnostic test that is particularly useful for early diagnosis of coronary artery disease. Cardiac computed tomography angiography is able to produce highly detailed images of the formation and build-up of calcium deposits in coronary vasculature, thus providing a window into an otherwise unseen disease process. Although CCTA is increasingly utilized by clinicians, little is known about its psychological value for cardiac patients undergoing the test. What does this study add? Cardiac computed tomography angiography testing can be a potentially important experience for cardiac patients in understanding their cardiac health. Cardiac computed tomography angiography could provide an opportune time to address patients' health behaviour intentions and treatment beliefs. Effective utilization of CCTA scan images in consultation may help to enhance consultation objectives.

Beliefs and attitudes about lung cancer screening among smokers.

The National Lung Screening Trial (NLST) recently reported that annual computed tomography (CT) screening is associated with decreased lung cancer mortality in high-risk smokers. Beliefs about lung cancer and screening, particularly across race and ethnicity, and their influence on CT screening utilization are largely unexamined. Our study recruited asymptomatic, high-risk smokers, 55-74 years of age from primary care clinics in an academic urban hospital. Guided by the self-regulation theory, we evaluated cognitive and affective beliefs about lung cancer. Intention to screen for lung cancer with a CT scan was assessed by self-report. We used univariate and logistic regression analyses to compare beliefs about screening and intention to screen among minority (Blacks and Hispanics) and non-minority participants. Overall, we enrolled 108 participants, of which 40% were Black and 34% were Hispanic; the mean age was 62.3 years, and median pack-years of smoking was 26. We found that intention to screen was similar among minorities and non-minorities (p=0.19); however, Hispanics were less likely to report intention to screen if they had to pay for the test (p=0.02). Fatalistic beliefs, fear of radiation exposure, and anxiety related to CT scans were significantly associated with decreased intention to screen (p<0.05). Several differences were observed in minority versus non-minority participants' beliefs toward lung cancer and screening. In conclusion, we found that concerns about cost, which were particularly prominent among Hispanics, as well as fatalism and radiation exposure fears may constitute barriers to lung cancer screening. Lung cancer screening programs should address these factors to ensure broad participation, particularly among minorities.

Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis.

This comparative analysis examined the cost-effectiveness of music therapy as a procedural support in the pediatric healthcare setting. Many healthcare organizations are actively attempting to reduce the amount of sedation for pediatric patients undergoing various procedures. Patients receiving music therapy-assisted computerized tomography scans ( n = 57), echocardiograms ( n = 92), and other procedures ( n = 17) were included in the analysis. Results of music therapy-assisted procedures indicate successful elimination of patient sedation, reduction in procedural times, and decrease in the number of staff members present for procedures. Implications for nurses and music therapists in the healthcare setting are discussed.

Emotional support for patients with cancer who are undergoing CT: semistructured interviews of patients at a cancer institute.

To understand and improve the experience of cancer patients undergoing computed tomography (CT), 79 patients who underwent CT at a cancer institute participated in semistructured interviews about their experiences with CT. All patients had previously undergone CT; 75% (n = 59), three times or more. Anxiety about results was the most common concern during first and subsequent CT examinations. Technical aspects were a common concern during initial scanning, but not subsequently. Methods of relaxation most used by patients during CT were following instructions (56% [n = 44]), meditating and visualizing (44% [n = 35]), and praying (42% [n = 33]). Patients suggested several ways in which the radiology staff can support them during the evaluation of their malignancy. Fifty-five (70%) of the patients said they would like the radiologist to tell them the results of their scanning. Optimal care of patients with cancer who undergo CT goes beyond technical to emotional and spiritual support.