Novel predictive factors for patient discomfort and severe cough during bronchoscopy: A prospective questionnaire analysis.

During bronchoscopy, discomfort is mainly caused by an unavoidable cough; however, there are no reports of any predictive factors for strong cough during bronchoscopy identified before the procedure. To clarify the factors underlying the discomfort status and predictive factors for strong cough during bronchoscopy, we prospectively evaluated patients who underwent bronchoscopy at Kyorin University Hospital between March 2018 and July 2019. Before and after bronchoscopy, the enrolled patients answered a questionnaire regarding the procedure. At the same time, bronchoscopists evaluated cough severity using a four-grade cough scale. We evaluated patient characteristics and predictive factors associated with bronchoscopy from the perspective of discomfort and strong cough. A total of 172 patients were ultimately enrolled in this study. On multivariate logistic regression analysis, comparison of the subjective data between the discomfort and comfort groups revealed that factors that were more common in the former group were younger age (OR = 0.96, p = 0.002), less experienced bronchoscopist (OR = 2.08, p = 0.047), and elevation of cough score per 1 point (OR = 1.69, p < 0.001). Furthermore, the predictive factors for strong cough prior to performing bronchoscopy were female sex (OR = 2.57, p = 0.009), EBUS-TBNA (OR = 2.95, p = 0.004), and prolonged examination time of more than 36 min (OR = 2.32, p = 0.022). Regarding patients' discomfort, younger age, less experienced bronchoscopist, and the elevation of cough score per 1 point were important factors for discomfort in bronchoscopy. On the other hand, female sex, EBUS-TBNA, and prolonged examination time were crucial factors for strong cough.

Questionnaire survey on patient awareness of invasive rebiopsy in advanced non-small cell lung cancer.

BACKGROUND: Treatment strategies for patients with non-small cell lung cancer (NSCLC) depend on various factors including physical condition, complications, tumor histology, and molecular profiling. Even if initial chemotherapy is efficacious, almost all patients develop treatment resistance. Invasive rebiopsy from sites of recurrence might provide insight into resistance mechanisms and aid in the selection of suitable sequential antitumor drugs. However, invasive rebiopsy might be challenging because of limited tissue availability and patient burden. Therefore, this study aimed to assess awareness of invasive rebiopsy among non-small cell lung cancer patients. METHODS: This prospective questionnaire survey was performed between June 2015 and March 2016 in patients with advanced non-small cell lung cancer. The survey was carried out at two time points: before starting first-line chemotherapy (cohort 1), and at the time of disease progression after initial chemotherapy, but before second-line chemotherapy (cohort 2). RESULTS: In this study, 50 and 30 patients were enrolled in cohorts 1 and 2, respectively. In cohort 1, 37 (74%) patients agreed to rebiopsy, if disease progression occurred, whereas 18 (60%) patients in cohort 2 agreed to invasive rebiopsy at disease progression. The primary reasons for rebiopsy rejection were poor physical condition and patient burden related to the initial biopsy. Seven patients answered the survey questions during the treatment course, and the acceptance rate was lower among patients who agreed to rebiopsy at disease progression than before treatment. CONCLUSIONS: Invasive rebiopsy can lead to distress in some patients. To improve the consent rate for tissue rebiopsy, treatment strategies including rebiopsy should be discussed with patients during the early treatment phase.

Identification of factors during bronchoscopy that affect patient reluctance to undergo repeat examination: Questionnaire analysis after initial bronchoscopy.

BACKGROUND: Re-biopsy by bronchoscopy is an important part of treatment for patients with relapsed lung cancer; however, some patients refuse to undergo a re-examination due to discomfort during their first bronchoscopy. The aim of the present study was to determine factors causing discomfort during bronchoscopy and to identify the factors that affect patients' reluctance to undergo repeat examinations via a questionnaire administered immediately after the initial bronchoscopy. METHODS AND FINDINGS: We evaluated 283 patients who underwent bronchoscopy at Chiba University Hospital between September 2015 and March 2017. Following bronchoscopy, the patients answered a questionnaire regarding the procedure. We identified patient characteristics and factors related to bronchoscopy that were associated with patients' reluctance to undergo re-examination. Two hundred nine patients were ultimately enrolled in the study. The factors affecting patient tolerance for re-examination were female sex (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.43-5.53), discomfort during the examination (OR, 1.70; 95% CI, 1.13-2.56), and unexpectedness of discomfort during the examination (OR, 1.83; 95% CI, 1.19-2.81). Patients experienced discomfort most frequently owing to throat anesthesia (n = 50 [24%]). CONCLUSIONS: Comfort during bronchoscopy is an important factor influencing patient tolerance for re-examination. Expectations of discomfort during bronchoscopy, as indicated by instructions provided before examination, and throat anesthesia are also important factors. Detailed explanations about bronchoscopy and improvement of the methods of throat anesthesia could decrease patient discomfort and may help decrease patients' reluctance to undergo re-examinations.

High-risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study.

AIMS AND OBJECTIVES: To understand the experiences of high-risk respiratory patients undergoing bronchoscopy with conscious sedation. BACKGROUND: Due to possible complications, high-risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as "conscious sedation," this facilitates depression of the patient's consciousness without causing respiratory compromise. Previously, studies have investigated patient experience using quantitative methods. This is the first study that has explored the patient experience during bronchoscopy from a qualitative perspective. DESIGN: Qualitative, phenomenological approach as described by Van Manen. METHODS: The setting was an endoscopy unit within an Australian tertiary hospital. Unstructured interviews were conducted with 13 patients with chronic obstructive pulmonary disease who underwent day-case bronchoscopy. All participants received conscious sedation. They were interviewed twice, within a week, postprocedure. Interviews were transcribed verbatim and analysed using Van Manen's interpretive approach. FINDINGS: Participants had varying experiences. Five themes emerged from the analysis: Frustration and fear; Comfort and safety; Choking and coughing; Being aware; and Consequences. Whilst not all participants experienced procedural awareness or remembered it, for those who did it was a significant event. Overall, experiences were found to be negative; however, participants accepted and tolerated them, perceiving them as necessary to obtain a diagnostic result. CONCLUSION: The findings demonstrate that often patients are aware during the procedure and their experience may be uncomfortable and distressing. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for patient preparation pre- and post-bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware, healthcare professionals should provide patient-focused explanations of what is happening during the procedure, as well as providing ongoing reassurance that everything is going as planned.

Evaluation of factors that influence anxiety and satisfaction in patients undergoing bronchofiberoscopy with analgosedation.

INTRODUCTION: Bronchofiberoscopy (BF) is a key tool used in the management of patients with respiratory diseases. Describing factors that contribute to patient anxiety surrounding BF has the potential to influence patient management and willingness to undergo the procedure again in the future if needed. OBJECTIVES: This study sought to understand what factors influence anxiety and satisfaction experienced by patients undergoing BF under conscious sedation. METHODS: This study had a prospective observational character and evaluated 463 consecutive patients undergoing BF. Participants were divided into two groups, those undergoing BF for the first time and those who had undergone the procedure at least once in the past. Data were collected from three questionnaires prepared by the research team. RESULTS: Patients who had undergone multiple bronchoscopies were more satisfied with their physician's explanation of the procedure (P < 0.0001), had a better understanding of the indications (P < 0.0001) and potential complications (P < 0.0001) of BF and knew what specific procedure was planned (P < 0.001). Patients undergoing BF for the first time experienced anxiety before the procedure more frequently (P < 0.001). No significant difference in satisfaction was observed between patient groups and 89% would agree to BF in the future. CONCLUSIONS: Patients who had previously undergone BF were better prepared for their procedure; however, satisfaction levels after the procedure were similar in both groups. Results suggest that medical staff should target patients who have not undergone BF previously to relieve anxiety.

Effect of Verbal Empathy and Touch on Anxiety Relief in Patients Undergoing Flexible Bronchoscopy: Can Empathy Reduce Patients' Anxiety?

BACKGROUND: Patients undergoing flexible bronchoscopy usually experience anxiety before and during the procedure. OBJECTIVES: We performed this study to investigate whether verbal empathy and intentional touch from a bronchoscopist could reduce anxiety in patients undergoing flexible bronchoscopy. METHODS: We conducted a prospective randomized trial in a university-affiliated hospital. Participants were randomly assigned to one of the following groups: a control group, a verbal empathy group, or a verbal empathy and touch group. The staff pulmonologist performing bronchoscopy expressed verbal empathy and used touch by speaking to the patient (using predefined short statements) and making eye contact, and by laying his/her left hand on the patient's right shoulder. We assessed the level of patient anxiety with a visual analog scale before and after the intervention. RESULTS: Participants were 267 patients with a median age of 65 years; 62.2% were men. Although there were no differences in changes in anxiety between the three groups, subgroup analysis of the visual analog scale including participants with higher baseline anxiety (empathy and touch group participants with anxiety ≥60 mm; empathy group and empathy and touch group participants with anxiety ≥70 mm) showed a larger reduction in anxiety than the control group. CONCLUSIONS: Verbal empathy and touch given by a bronchoscopist before bronchoscopy reduced anxiety in patients with high baseline anxiety levels.

Patient experience surrounding bronchoscopy.

Fiberoptic bronchoscopy (FOB) is a commonly performed procedure in thoracic medicine associated with significant discomfort, which greatly impacts patient satisfaction with the procedure. The UK DoH and BTS stress the benefits of collecting and reviewing patient experiences of a service and how this information should shape service provision. In this current study we assess a number of tolerance and satisfaction related factors in 108 consecutive patients undergoing FOB. We demonstrate a highly significant relationship between patient reported comfort and complete amnesia of FOB. We fail to demonstrate a relationship between patient reported comfort during FOB and the bronchoscopist's assessment of tolerance. We also suggest a relationship between poorer patient reported comfort and a lower WHO performance status. The identification of factors associated with satisfaction with FOB will allow creation of strategies to improve patient experience and lead to better outcomes.

Does "patient-reported discomfort" from bronchoscopy differ over time?

BACKGROUND: The optimal time to assess patient satisfaction with bronchoscopy has not been established. This study aimed to compare patient comfort scores recorded immediately after bronchoscopy with those obtained at follow-up, 7 to 14 days later. METHODS: A total of 240 patients undergoing bronchoscopy were recruited. Immediately after the procedure, patients scored the discomfort they had experienced from 0 (no discomfort) to 4 (severe discomfort). In addition, nursing staff recorded measures of comfort and sedation. At follow-up, patients again scored the discomfort they had experienced during the bronchoscopy. RESULTS: Complete data were analyzed on 180 patients (75%). The majority of patients tolerated the procedure well, although a significant minority experienced at least moderate discomfort (28.9%). No significant difference was found between the immediate and the follow-up comfort scores (Wilcoxon P=0.79). The comfort score recorded by the nurses was related to both immediate (Spearman 0.22, P<0.01) and follow-up scores (Spearman 0.28, P<0.01) of the patients. A number of variables that may influence patient comfort during bronchoscopy were assessed; only age was found to influence the comfort score. A large number of younger patients (age less than 60) reported a higher immediate discomfort score (χ2=7.69, P<0.05) despite the fact that older patients received lower doses of midazolam (P<0.05). However, the type of samples taken or patient position during the procedure did not influence the comfort score. CONCLUSIONS: The comfort score assessed immediately after the procedure is similar to that recorded at a later date, and it relates to the score assessed by the nursing staff. Younger patients reported higher immediate discomfort.

Influence of additional post-bronchoscopy visit on patient satisfaction after flexible bronchoscopy.

BACKGROUND/AIMS: Many patients undergoing a flexible bronchoscopy (FB) experience anxiety and discomfort during the procedure. We assessed whether an additional patient visit after a FB would improve patient satisfaction. METHODS: The study patients were randomly assigned to a control and post-visit groups. The physicians who were scheduled to perform the FB visited the study patients. The control group had one visit before the FB and the post-visit group had a before and after FB visit. The post-visit group received additional information and support during the second visit. Twenty-four hours after the FB, the participants completed questionnaires about discomfort and satisfaction with the procedure. RESULTS: The control and post-visit groups included 151 and 153 patients, respectively. The post-visit group reported having more information after the FB than the control group. The additional post-bronchoscopy visit improved the general patient tolerability of the procedure. The willingness to return for another FB was not affected by the post-bronchoscopy patient visit. CONCLUSIONS: The post-bronchoscopy visit improved patient satisfaction and general tolerability to the procedure. Subjective patient tolerability with the FB may be improved through a post-bronchoscopy visit by providing more information and emotional support to patients.

Bronchoscopy: What critical care nurses need to know.

Although bronchoscopies have been performed for over a century and are relatively safe when practice guidelines are followed, they are invasive and a real source of anxiety and fear for the patient. The role of the critical care nurse is essential to a successful outcome. This article provides an overview of the main diagnostic and therapeutic indications, contraindications, and possible complications. Also discussed are patient education; patient and staff safety; and considerations before, during, and after the procedure.

Smoking cessation in patients requiring bronchoscopy: the Bronchoscopy AntiSmoking Study (BASIS).

We investigated the readiness to quit and the smoking cessation rates of smokers requiring bronchoscopy and receiving advice quitting. This randomized controlled trial evaluated the effectiveness of two smoking cessation interventions, either a brief advice (control group), or a longer support, delivered at the time of bronchoscopy. We consecutively enrolled 233 adult smokers, regardless of the initial level of motivation to quit. Their mean (SD) age was 57 (12) years; males were 192. They had smoked a median of 44.5 pack-years. Their mean (SD) Fagerstrom score was 8 (2). There was no difference between groups. Surprisingly, 45% of participants were in the action stage at baseline; these 105 subjects had quit in the week immediately prior to the bronchoscopy. At 6- and 12-months follow-up visits, respectively 41% and 29% of participants in the intervention group and 27% and 13% in the control group objectively showed a 1-week point prevalence abstinence. The difference was significant at 6 months (p<0.05) but not at 1-year visit (p=0.052), even if there was a trend towards greater cessation rate in the intervention group. In multivariable logistic models, at the final visit being a quitter was positively associated with having been in the action stage at baseline and negatively with the Fagerstrom score and the presence of smokers in household. We conclude that the time of bronchoscopy may possibly predispose smokers to quit. Further efforts are needed to clear whether more protracted support might achieve higher long-term smoking cessation rates.

Influence of Additional Post-Bronchoscopy Visit on Patient Satisfaction after Flexible Bronchoscopy

BACKGROUND/AIMS: Many patients undergoing a flexible bronchoscopy (FB) experience anxiety and discomfort during the procedure. We assessed whether an additional patient visit after a FB would improve patient satisfaction. METHODS: The study patients were randomly assigned to a control and post-visit groups. The physicians who were scheduled to perform the FB visited the study patients. The control group had one visit before the FB and the post-visit group had a before and after FB visit. The post-visit group received additional information and support during the second visit. Twenty-four hours after the FB, the participants completed questionnaires about discomfort and satisfaction with the procedure. RESULTS: The control and post-visit groups included 151 and 153 patients, respectively. The post-visit group reported having more information after the FB than the control group. The additional post-bronchoscopy visit improved the general patient tolerability of the procedure. The willingness to return for another FB was not affected by the post-bronchoscopy patient visit. CONCLUSIONS: The post-bronchoscopy visit improved patient satisfaction and general tolerability to the procedure. Subjective patient tolerability with the FB may be improved through a post-bronchoscopy visit by providing more information and emotional support to patients.

Randomised controlled trial of the effect of standard and detailed risk disclosure prior to bronchoscopy on peri-procedure anxiety and satisfaction.

BACKGROUND: Deciding what risks to disclose before a procedure is often challenging for clinicians. Consecutive patients undergoing elective fibreoptic bronchoscopy were randomised to receive simple or more detailed written information about the risks of the procedure and the effects on anxiety and satisfaction levels were compared. METHODS: A 100 mm anxiety visual analogue scale (VAS) and a modified Amsterdam preoperative anxiety (scored 4-20) scale (APAIS) were completed before and after reading the designated information leaflet. Following bronchoscopy, subjects completed a satisfaction questionnaire. RESULTS: Of 142 consecutive patients, 122 (86%) (mean age 57.8 years, 53% male) completed the study. Baseline demographic, clinical and anxiety measures were similar in the two groups. Those who received more detailed risk information had significantly greater increase in anxiety levels than those who received simple information on both the VAS (mean 14.0 (95% CI 10.1 to 17.9) vs 2.5 (95% CI -1.4 to 6.4), p<0.001) and the APAIS (1.73 (95% CI 1.19 to 2.26) vs 0.57 (95% CI 0.05 to 1.10), p<0.001). Almost twice as many of those receiving detailed risk information reported that they felt they had received too much information about complications or that the information they had received about bronchoscopy had been worrying. CONCLUSIONS: Provision of more detailed risk information before bronchoscopy may come at the cost of a small but significant increase in anxiety.

Music during bronchoscopic examination: the physiological effects. A randomized trial.

BACKGROUND: Patients scheduled for bronchoscopic procedures are often anxious and frightened. Reduction in the state of anxiety during an invasive procedure may prevent some possible complications. Music has been proposed as a safe nonpharmacological antianxiety intervention. OBJECTIVE: We followed up physiological indicators of anxiety (blood pressure, heart rate) during bronchoscopic examination to determine the effect of music on the level of anxiety. METHODS: Two hundred adult patients were included in the study. Blood pressure, heart rate, procedures performed during bronchoscopy and duration of examination were monitored. Patients' overall feelings during the procedure were rated from 0 (without unpleasant feelings) to 10 (unbearable). All patients used the Visual Analogue Scale (VAS). RESULTS: Two hundred adult patients referred for bronchoscopy were included in the study: 93 patients received music during the procedure and 107 served as control. There were no significant differences between the two groups in terms of age, sex, indications for bronchoscopy, procedures performed during bronchoscopy, duration of the examination and patients' subjective perception of the procedure. The mean hart rate, systolic and diastolic blood pressures were significantly lower in the music group compared to the control group. CONCLUSIONS: Our findings suggest that the application of music reduces anxiety during bronchoscopic examination as physiological indicators of anxiety, the mean heart rate, systolic and diastolic blood pressures, were significantly lower in the music group.

Prediction of patient discomfort during fibreoptic bronchoscopy.

OBJECTIVE: This study investigated the potential for predicting which patients would have a negative emotional reaction to bronchoscopy. METHODOLOGY: A questionnaire was distributed to 120 patients who had undergone diagnostic fibreoptic bronchoscopy. A visual analog scale to evaluate the patient's discomfort was adopted. Multiple linear regression analysis was used to determine factors significantly influencing discomfort. The regression model included the following variables: age, gender, symptoms, smoking habits, proximal bronchial brushing, distal bronchial brushing, bronchial washing, proximal transbronchial biopsy, transbronchial lung biopsy, examination time, the bronchoscopist's experience, and the patient's anxiety level. RESULTS: The bronchoscopist's experience (P = 0.001) and the patient's anxiety level (P < 0.001) were variables that significantly influenced discomfort. These results suggest that discomfort decreased with the bronchoscopist's experience and increased with the patient's anxiety regarding bronchoscopy. CONCLUSIONS: The results suggest that subjective discomfort can be predicted both by the bronchoscopist's experience and by a questionnaire about the patient's anxiety level before bronchoscopy. Therefore, it is recommended that the patient's anxiety level be determined through the use of a questionnaire before bronchoscopy, and that more experienced bronchoscopists should take charge if the patient is judged as being excessively anxious. If experienced bronchoscopists are unavailable, the more anxious patient should receive more sedatives.

[Paternalism in medicine: illustrated by the example of fiber optic bronchoscopy]. / Das Problem des Paternalismus in der Medizin: gezeigt am Beispiel einer Fiberbronchoskopie.

The question of when and how it is permissible for a physician to take a paternalistic approach to a patient is discussed. In the introduction, the physician-patient relationship is presented based on the empirical example of fiberbronchoscopy. An attempt to define the term paternalism more precisely leads to the result that not only are patients who are very limited in their autonomy (e.g. psychiatric and intensive-care patients) treated paternalistically, but that the patient status as such leads to a certain degree of paternalism. The example given is interpreted in detail and the pragmatic attitude of the physician to the patient "object" is criticized. Finally, a demand is made that the physician-patient relationship be a partnership, in which the physician appeals to the patient's autonomic components, addresses and encourages them. This latter approach is seen as an alternative to paternalism.

[Tolerance of fiberoptic bronchoscopy by self-administered questionnaire: in the words of the patients]. / Evaluation de la tolérance de la fibroscopie bronchique par auto-questionnaire: la parole aux patients...

INTRODUCTION: Fibreoptic bronchoscopy is currently undertaken by the majority of respiratory physicians, but under varying conditions. Though complications are rare the tolerance of this examination is sometimes poor, particularly when it is performed under local anaesthesia. The undesirable effects may reduce the value of the examination as well as causing discomfort for the patient. METHODS: A prospective study of the tolerance of the endoscopic examination was made on 100 consecutive patients by self-administered questionnaire. RESULTS: There were no major and 7 minor complications (7%). 45% of the patients were anxious but the experience of the operator tended to reassure them (p=0.07). 30% of the patients reported some pain, which tended to be exacerbated by anxiety (44% vs 18%, p=0.008) and the supine position (57% vs 43%, p=0.047). 37% of patients reported nausea, and 50% dyspnoea, without any significant predictive factor. 79% would agree to a repeat examination under the same conditions and 92% said that they had received information appropriate to the examination undergone. CONCLUSION: The tolerance of fibreoptic bronchoscopy under local anaesthesia is poor and perhaps overestimated by respiratory physicians. Patient information is essential. A national enquiry could lead to the standardisation of techniques.

[Assessment of anxiety levels in patients during diagnostic endoscopy]. / Valutazione dei livelli di ansia in pazienti sottoposti ad endoscopia diagnostica.

Patients with increased pre-endoscopic anxiety take advantage of the use of conscious sedation. However, the habit of using premedication varies according to the type of endoscopic examination. Aims of this study were: to evaluate whether different endoscopic procedures may have different effects on patient anxiety; and whether anxiety affects patient tolerance. 163 consecutive outpatients undergoing endoscopy (75 gastroscopy, 51 colonoscopy and 37 bronchoscopy) were interviewed to evaluate pre-endoscopy anxiety, by using the Spielberger State-Trait Anxiety Inventory. After endoscopy, endoscopists rated patient cooperation on a 10-cm visual analogue scale. Females had state and trait anxiety levels higher than males (50.49 +/- 1.37 vs 45.07 +/- 1.20, p < 0.01; and 44.46 +/- 1.06 vs 38.48 +/- 1.01, p < 0.01). Anxiety levels were not related with the type of endoscopic procedure. A direct relationship was observed between state and trait anxiety (p < 0.001). Patient cooperation to endoscopy was inversely related with both trait (p < 0.05) and state anxiety (p < 0.01). In conclusion, gastroscopy, colonoscopy and bronchoscopy seem to induce similar pre-endoscopy anxiety levels. Therefore, the different frequency in the use of intravenous sedation between bronchial and gastrointestinal endoscopy does not seem justified.