Effect of pretreatment education on anxiety in patients undergoing radiation therapy for the first time: A randomized clinical trial

Abstract

Background: Pretreatment anxiety is one of the most common problems in patients undergoing radiotherapy, especially for the first time. There are limited and contradictory studies on the effect of multimedia as compared with common education methods. This study was intended to evaluate the effect of pretreatment multimedia on patient anxiety in the head and neck cancer radiotherapy setting.

Methods: In a randomized clinical trial, 66 patients who resided in eastern Iran were recruited from three cancer treatment centers. The experimental group (n = 33) received a 20-minute multimedia presentation, while its print version of the same content was applied in the control group (n = 33). The study measure was evaluated by the Spielberger State-Trait Anxiety Inventory (STAI), which was answered by the participants at baseline after the visit by a cancer specialist deciding on radiotherapy and 2 weeks later prior to the starting of the treatment.

Results: The findings indicated that statistically significant differences were observed in anxiety scores between the groups with multimedia as compared to the control (p = 0.009). Pamphlet-associated education led to a notably larger mean difference in anxiety score between the baseline score and two-week posttreatment score in the controls than multimedia version in the experimental group (p < 0.001). However, adjustment for covariates showed no significant reduction in anxiety between them (p = 0.115).

Conclusion: Developing educational materials in written format can successfully reduce radiotherapy-associated anxiety in cancer patients. It may be ascribed to the nature of the media that deals with more detail and facilitates the flow of information.

Keywords:

• anxiety
• multimedia
• education
• radiotherapy
• head and neck cancer

PUBLIC INTEREST STATEMENT

Any program that enables patients to prepare for treatment could also help reduce their anxiety levels. Educational interventions proposed to be used before radiotherapy include face-to-face education provided by a radiotherapist, as well as group or individual education via visual tools, such as brochures and booklets, PowerPoint presentations, videotapes, e-learning, and printed materials supplemented with phone calls by a nurse. Comparative studies concerning the efficacy of multimedia tools in relation to written educational materials have revealed conflicting evidence. This study indicated that written materials instead of multimedia presentation appear to be more effective.

Acknowledgments

We are grateful to all the participants who volunteered to take part in this investigation. The present study is part of the research plan No. 930947, approved by the Research Department in Mashhad University of Medical Sciences, Mashhad, Iran. The authors hereby express their gratitude toward the authorities in Mashhad University of Medical Sciences for their sponsorship and also the authorities of Nursing and Midwifery Faculty for their invaluable supports.

Competing interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Fatemeh Heshmati Nabavi

Fatemeh Heshmati Nabavi is an assistant professor in the Department of Nursing Management (MUMS), School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Her main areas of research are medical education, nursing management, and qualitative study. She is also interested in studying patients with cancer, examining the causes of anxiety, and the ways of reducing such emotion. The latest articles published by her are the following: “Investigating the relationship between anxiety of school age children undergoing surgery and parental state-trait anxiety,” “Effect of a preoperative preparation program on anxiety in school-age children undergoing surgery using a factorial design,” and “Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process.”