Original Paper: Endoscopy                                                                                                 ...
ever most prefer to perform endoscopic examinations                           The data were analyzed with Statview 4.5 (Ab...
Fig. 1. Patients’ appraisal of the esophagogastroduodenoscopy. Val-   Fig. 2. Patients’ appraisal of the colonoscopy (for ...
We utilized background music without headphones so                         and 1 month afterwards, no difference between t...
Upcoming SlideShare
Loading in...5

Perception of Gastrointestinal Endoscopy by Patients and ...


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Perception of Gastrointestinal Endoscopy by Patients and ...

  1. 1. Original Paper: Endoscopy Received: December 18, 2002 Digestion 2003;68:5–8 Accepted: May 19, 2003 DOI: 10.1159/000073219 Published online: August 29, 2003Perception of GastrointestinalEndoscopy by Patients and Examinerswith and without Background MusicJanek Binek Markus Sagmeister Jan Borovicka Matthias KnierimBernhard Magdeburg Christa MeyenbergerGastroenterology Unit, Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, SwitzerlandKey Words physicians (9.3%) and in 11 examinations by the nursesEndoscopy W Gastrointestinal endoscopy W Music W (7.3%). Conclusions: Music has little influence on pa-Conscious sedation tients’ experience of gastrointestinal endoscopy. Nev- ertheless, the majority of patients felt music to be helpful and expressed a preference for music during any futureAbstract examination. This positive attitude to music of patients isBackground/Aims: Several studies have reported im- in contrast with the assessment of some endoscopistsproved patient comfort with music in the preoperative and nurses.setting, however music has seldom been assessed dur- Copyright © 2003 S. Karger AG, Baseling gastrointestinal endoscopy. We aimed to assess howbackground music may influence the perception of pa-tients and examiners involved in endoscopic examina- Introductiontions. Methods: 301 patients (128 females, 173 males;mean age 59 years) were included in the study (EGD and Many patients express anxiety prior to gastrointestinalcolonoscopy) in a prospective fashion. 90 EGD and 61 endoscopy. Several non-randomized, observational stud-colonoscopies were performed with music (50.17%) and ies have found beneficial effects of music in the preopera-102 EGD and 48 colonoscopies without music (49.83%). tive setting, during medical examinations or in the imme-Patients, nurses and endoscopists completed a question- diate postoperative recovery period. These findings havenaire. Results: No significant differences in demographic been supported by two randomized controlled studiesdata were found between the patients examined with or that reported a reduction in the use of the sedative medi-without music. Tolerance to the examination, pain sen- cation with the use of relaxation music during colonosco-sation and perception of the endoscopy room ambiance py [1, 2]. Other well-designed studies did not find anywere similar in both groups. The majority of patients influence of music on the dosage of the premedication or(83.4%) expressed a preference for music during any anesthetic agents in a variety of interventional proceduresfuture endoscopic examination and none perceived the [3–7]. Music is not used routinely during endoscopic pro-music as disturbing. During the 151 examinations, music cedures. Some physicians start endoscopy without seda-was considered unpleasant in 14 examinations by the tion [8, 9], particularly in non-anxious patients [10], how- © 2003 S. Karger AG, Basel J. Binek MDABC 0012–2823/03/0681–0005$19.50/0 Gastroenterology Unit, Department of Internal MedicineFax + 41 61 306 12 34 Kantonsspital St. GallenE-Mail karger@karger.ch Accessible online at: CH–9007 St. Gallen (Switzerland)www.karger.com www.karger.com/dig Tel. +41 71 494 12 16, Fax +41 71 494 28 62, E-Mail janek.binek@kssg.ch
  2. 2. ever most prefer to perform endoscopic examinations The data were analyzed with Statview 4.5 (Abacus w). Demo-with conscious sedation or under general anesthesia [11]. graphic data were tested by unpaired t-test or ¯2 test. The perception of the examination in both groups was compared using a non-para-In the USA only one fifth of patients undergoing colonos- metric unpaired (Mann-Whitney) test. p values ! 0.05 were consid-copy are willing to undergo the examination unsedated ered significant.[12]. The systematic use of other measures to improvepatient tolerance to gastrointestinal procedures is unusu-al, possibly because the use of sedation has been shown to Resultsbe safe [13]. Detailed information about the procedure, acalm and relaxed atmosphere or the presence of a relative 301 outpatients and inpatients were analyzed (128during the endoscopy as well as the viewing of videotapes females and 173 males; mean age 59 years). 151 examina-before the examination seem to play a secondary role [14, tions (90 EGD and 61 colonoscopies) were performed15]. Few studies have studied the use of music during with music and 150 (102 EGD and 48 colonoscopies)endoscopic procedures, and only the attitudes of patients without music. There was no statistical difference in theand not of examiners have been assessed [1, 16–20]. Our age or sex distribution between the m+ and m– groups forstudy investigated how background music may influence patients undergoing EGD or colonoscopy (for age in EGDthe experience of patients undergoing endoscopy, and p = 0.13, in colo p = 0.31; for sex in EGD p = 0.65, in coloprovides the first data concerning the acceptance of music p = 0.25).by the medical staff. Choice of music: 23 (25.6%) patients in the EGD m+ group preferred light music and 67 (74.4%) classical. The majority of patients in the colo m+ group favored classical Patients and Methods music: 46 (75.4%) versus 15 (24.6%). Sedation: In the EGD group all 90 patients received From March to April 1999, consecutive patients referred forupper (EGD) or lower gastrointestinal (colo) endoscopy were exam- sedation with midazolam (median dose 2.5 mg in bothined with music (m+). A control group was examined without music EGD m+ and EGD m–) on commencing the examination(m–). Our study was not randomized. In the daily routine it was not (p = 0.21). Sixteen patients also received pethidine (me-possible for us to perform a randomization. So we chose to examine dian dose 25 mg in EGD m+ and EGD m–, p = 0.46).the patients sequentially with music and without music. The patients During colo m+, 22 patients received midazolam (me-were enrolled in the study after obtaining informed consent. Exclu-sion criteria included: inability to answer questions because of severe dian 2.5 mg) and 16 additional pethidine (median 25 mg).illness, impaired consciousness, impaired hearing and emergency In the colo m– group, 18 patients received midazolaminterventions. In total, 20 patients were excluded from the study. (median dose 2.5 mg) and 22 pethidine (median dosePatients could choose between two styles of music (non-classical/ 37.5 mg). We found no difference between the colo m+light or classical). The music was played in the background and the and m– (for midazolam p = 0.28 and for pethidine, p =volume was adjusted to permit normal conversation. EGD was per-formed after topical anesthesia with an anesthetic throat spray (lido- 0.66) concerning the demand for sedation.caine 10%), intravenous injection of midazolam, and occasionally Patient assessment of the examination: For the EGDpethidine. Total colonoscopy or sigmoidoscopy was usually per- group we found no significant differences between m–formed without sedation except in those cases where the patient was and m+ for the general perception of the examination,very anxious before the examination or if patients felt the examina- assessment of pain, tolerance of the procedure, and thetion as painful. All patients were monitored by continuous pulse ox-imetry and heart rate measurement. During the endoscopy, conver- perception of the ambiance of the endoscopy roomsation related to patient care was allowed. (fig. 1). In the colo group (fig. 2) the general evaluation of After recovery from the sedation a validated 100-mm visual ana- the examination was significantly better with musiclogue scale [21] was used to assess the patient’s experience of the (score-median values 8 colo m– versus 9 colo m+, p =endoscopic procedure (general appraisal of the examination, pain, 0.037).tolerance and ambiance of the endoscopy room). The m+ patientswere also asked to choose the most appropriate descriptor: unpleas- Assessing the 151 m+ examinations, 128 patientsant, indifferent, or helpful (relaxing, calming) that described their (84.7%) considered the music had been helpful (relaxingresponse to music during the procedure. Patients listening to music or calming), 16 were indifferent, and 7 did not answer thewere also asked to state if they would choose to listen to music during question. No patient considered the music had beena future endoscopic examination. The medical staff involved in the unpleasant. In the event that a further endoscopic exami-examination (8 nurses and 6 medical physicians) assessed their expe-rience of the music in the same manner and the endoscopist also nation should be necessary, 126 (83.4%) patients indi-recorded if the music had been turned off during the examination. cated that they would like to listen to music again.6 Digestion 2003;68:5–8 Binek/Sagmeister/Borovicka/Knierim/ Magdeburg/Meyenberger
  3. 3. Fig. 1. Patients’ appraisal of the esophagogastroduodenoscopy. Val- Fig. 2. Patients’ appraisal of the colonoscopy (for values, see figureues: medians (lines); 25–75% percentiles (boxes); 10–90% percen- 1).tiles (bars); 5–95% percentiles (dots) without (g) and with (i) mu-sic. Medical staff appraisal of music during the procedure: decrease in the sedation dosage during colonoscopy [1].Assessing the 151 m+ examinations, endoscopy nurses Nevertheless, music is seldom utilized during endoscopicconsidered the music disturbing in 11 examinations (9 procedures, and there is little data on patients’ perceptionEGD and 2 colo, 7.3%), felt indifferent in 66 examina- of music and no published data on the acceptance of mu-tions (43.7%) and liked the music in 74 examinations sic by the medical staff.(49%). The endoscopists were disturbed by the music in Our study is the first to assess the perception of gas-14 examinations (6 EGD and 8 colo, 9.3%), felt indiffer- trointestinal endoscopic examinations with music by theent in 69 examinations (45.7%) and liked the music in 68 patients and the medical staff. We analyzed the percep-examinations (45%). In 2 cases the music was turned off tion and sensations by patients and the medical staff onduring the procedure (1 EGD and 1 colo). the utilization of music in 151 consecutive endoscopies The appraisal of music during endoscopy was signifi- with a control group of 150 patients. Our evaluationcantly more positive among the patients than the endos- found no significant differences in patients’ perception ofcopy staff (examiners and nurses did not like to hear mus- pain, tolerance of the endoscopic procedure or the am-ic in 14 and 11 cases respectively; no patient disliked the biance in the endoscopy suite. Patients undergoing colon-music, p ! 0.01). The reasons for disliking music were: oscopy felt that music was beneficial in their general eval-difficult therapeutic procedures (music turned off during uation (median score 8 vs. 9, p = 0.037). This small differ-2 examinations because of dilatation and polypectomy) or ence in a single parameter is difficult to interpret, and wethe music was felt to be repetitive, monotone, tedious, considered the finding clinically irrelevant. Nevertheless,inappropriate or irritating. the majority (84.7%) of the patients felt music to be help- ful, and 83.4% of all patients expressed a preference for music during any future endoscopic examination. No Discussion patient was disturbed by the music. In contrast to pa- tients’ positive assessment of music, the examiners and Several reports indicate that music might improve nurses were disturbed by its presence during 9.3% ofpatients’ comfort in the preoperative setting, during med- upper and 7.3% of lower gastrointestinal endoscopiesical examinations or in the immediate postoperative re- respectively (p ! 0.01), and in 2 cases the music wascovery period. A recent randomized study showed a turned off.Perception of Music during Endoscopy Digestion 2003;68:5–8 7
  4. 4. We utilized background music without headphones so and 1 month afterwards, no difference between the twothat the medical staff as well as the patient had to listen to groups was present and the authors concluded that musicthe music. One explanation for the different assessments could not replace conscious sedation.of music by patients and endoscopy staff might be that the Despite the failure of this and most previous studies tomusic style was chosen solely by the patient. This effect demonstrate objective benefits of music during endosco-could be avoided if the music is played through head- py, a large proportion (84.7%) of patients found musicphones. However, this has the clear disadvantage that that helpful during the procedure and expressed a preferencethe patient is ‘isolated’ and that verbal communication for music during any future examination (83.4%). Weduring the examination (e.g. explaining findings or thera- believe that this should encourage us to offer music topeutic steps) might be more difficult. patients undergoing endoscopy. If the endoscopy staff is Patients were consecutively examined with and with- disturbed by background music, then headphones couldout music, and there was no randomization. However, in be offered to the patient.the statistical analysis there was no difference in sex, age We conclude that background music did not produce aand sedation between the two groups. Therefore, we con- relevant effect on patients’ perception of gastrointestinalclude that the two examined groups are comparable. endoscopic examinations even if they potentially want it. Our results confirm the findings of other studies [20] Nevertheless, the majority of patients felt music had beenthat found the ambiance in the endoscopy room to have helpful and expressed a preference for music during anylittle effect on patients’ experience of the procedure. We future procedure. The positive assessment of music bydid not assess anxiety scores prior to the procedure, how- patients is in contrast to the more variable attitude toever if sedation is used, anxiety may not greatly influence music articulated by the endoscopy staff. Nevertheless,the tolerance of the procedure [19]. Trinchet et al. [16] we suggest that music be offered to patients undergoingalso failed to identify any benefit of music in their study endoscopy. Should this intervention disturb examinerswith 60 patients. Immediately following the examination we suggest that patients should be offered headphones. References 1 Lee DWH, Chan KW, Poon CM, Ko CW, 8 Nichols AM, Cunningham JT: Upper endosco- 15 Goenka P, Manalo G, Jobson BJ, Neumann Chan KH, Sin KS, Sze TS, Chan ACW: Relax- py without sedation (abstract). Gastrointest JK, Thomas E: Informed consent for colonos- ation music decreases the dose of patient-con- Endosc 1982;28:140. copy by videotape vs. printed material: A pro- trolled sedation during colonoscopy: A pro- 9 Al-Atrakchi HA: Upper gastrointestinal endos- spective randomized comparative study of pa- spective randomized controlled trial. Gastroin- copy without sedation: A prospective study tients’ understanding and stress (abstract). test Endosc 2002;55:33–36. of 2,000 examinations. Gastrointest Endosc Gastrointest Endosc 1999;49:AB196. 2 Schiemann U, Gross M, Reuter R, Kellner H: 1989;35:79–81. 16 Trinchet JC, Chaumont J, Beaugrand M, Fer- Improved procedure of colonoscopy under ac- 10 Fisher NC, Bailey S, Gibson JA: A prospective, rier JP: La musique adoucit-elle l’endoscopie? companying music therapy. Eur J Med Res randomized controlled trial of sedation vs. no Une étude controllée chez 60 malades. Gas- 2002;7:131–134. sedation in outpatient diagnostic upper gas- troenterol Clin Biol 1985;9:86–87. 3 Corah NL, Gale EN, Pace LF, Seyrek S: Relax- trointestinal endoscopy. Endoscopy 1998;30: 17 Escher J, Höhmann U, Anthenien L, Dayer E, ation and musical programming as means of 21–24. Bosshard C, Gaillard RC: Musik bei der Ga- reducing psychological stress during dental 11 Balsells F, Wyllie R, Kay M, Steffen R: Use of stroskopie. Schweiz Med Wochenschr 1993; procedures. J Am Dent Assoc 1981;103:232– conscious sedation for lower and upper gas- 123:1355–1358. 234. trointestinal endoscopic examinations in chil- 18 Palakanis KC, DeNobile JW, Sweeney WB, 4 Rickert VI, Kozlowsi KJ, Warren AM, Hendon dren, adolescents, and young adults: A twelve- Blankenship CL: Effect of music therapy on A, Davis P: Adolescents and colposcopy: The year review. Gastrointest Endosc 1997;45: state anxiety in patients undergoing flexible sig- use of different procedures to reduce anxiety. 375–380. moidoscopy. Dis Colon Rectum 1994;37:478– Am J Obstet Gynecol 1994;170:504–508. 12 Early DS, Sifuddin T, Johnson JC, King PD, 481. 5 Dubois JM, Bartter T, Pratter MR: Music im- Marshall JB: Patient attitudes toward undergo- 19 Bampton P, Draper B: Effect of relaxation proves patient comfort level during outpatient ing colonoscopy without sedation. Am J Gas- music on patient tolerance of gastrointestinal bronchoscopy. Chest 1995;108:129–130. troenterol 1999;94:1862–1865. endoscopic procedures. J Clin Gastroenterol 6 Heiser RM, Chiles K, Fudge M, Gray SE: The 13 Froehlich F, Schwizer W, Thorens J, Kohler M, 1997;25:343–345. use of music during the immediate postopera- Gonvers JJ, Fried M: Conscious sedation for 20 Stermer E, Levy N, Beny A, Meisels R, Tamir tive recovery period. AORN J 1997;65:777–8, gastroscopy: Patient tolerance and cardiorespi- A: Ambience in the endoscopy room has little 781–785. ratory parameters. Gastroenterology 1995;108: effect on patients. J Clin Gastroenterol 1998; 7 Cruise CJ, Chung F, Yogendran S, Little D: 697–704. 26:256–258. Music increases satisfaction in elderly outpa- 14 Gebbensleben B, Rohde H: Angst vor der ga- 21 Revill SI, Robinson JO, Rosen M, Hogg MU: tients undergoing cataract surgery. Can J strointestinalen Endoskopie – ein bedeutsames The reliability of a linear analogue for evaluat- Anaesth 1997;44:43–48. Problem? Dtsch Med Wochenschr 1990;115: ing pain. Anesthesia 1976;31:1191–1198. 1539–1544.8 Digestion 2003;68:5–8 Binek/Sagmeister/Borovicka/Knierim/ Magdeburg/Meyenberger