RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
BIOPSY
July, 2006
Value,
Prevalence and Costs of Biopsy
A
biopsy is the removal of a small piece of tissue for
microscopic examination or testing. Biopsies can be done on
almost any part of the body. Biopsies are among the most
commonly performed medical procedures in the America.
For example, in 1995, about 600,000 prostate biopsies were
performed in the U.S.A.; 700,000 breast biopsies were
performed, at an average cost of $1,500 each; and a half
million biopsies of the GI tract were done in that year
(Agency for Health Care Policy and Research, 1995). Other
areas frequently biopsied include the liver, lungs, and
lymph structures.
Biopsies are an extremely valuable diagnostic tool, not
only for confirming or ruling out cancer, but for assessing
other conditions in the lungs, liver, and GI tract.
According to the National Institutes of Health, the two
major methods of biopsy are needle biopsy and open biopsy,
which is a surgical procedure. Needle biopsies generally
cost one third to one half as much as surgical biopsy, and
have a quicker recovery time (CNN, 1999). Endoscopic
biopsies are also frequently performed.
Problems
with Biopsy
The complication rate in all types of biopsies is quite
low. One to two percent of patients may develop significant
low blood pressure, which is often stress-related (Al
Amair, Al Bark & Al Trafi, 1997). However, biopsies
sometimes cause significant pain. For example, the American
Journal of Gastroenterology Editors (2001) wrote that
patient facing liver biopsy “frequently have anticipatory
anxiety, which would be expected of a procedure that is
associated with pain in 30% of patients, severe
complications in 0.3%, and death in 0.03%.”
A far
greater problem for many patients is fear of the results of
biopsy. For example, women who are called back after
screening mammography “may interpret need for further
examination as meaning a definite diagnosis of cancer,
referral to an operation, or even death,” according to Arja
Aro, Senior Researcher at the National Public Health
Institute of Finland (Aro, 2001). This fear of bad news
keeps some patients from getting timely biopsies.
This delay, however, endangers their lives and adds an
unknown, but significant amount to medical costs. Even when
patients do come for their biopsies, they may suffer from
tremendous anxiety, which can increase their need for
sedation and worsen their quality of life (Aro).
Therefore,
interventions that reduce patients’ anxiety and increase
their level of confidence are needed.
Pharmacologic
and Non-pharmacologic Anxiety Treatment in
Biopsy
Most patients undergoing biopsy receive pain medication and
sedation, either orally or intravenously. Because sedation
requires increased monitoring by medical staff, it
increases the costs, the recovery time, and the risk of low
blood pressure.
Hypnosis, self-hypnosis, relaxation and guided imagery can
reduce anxiety and pain in adults undergoing liver (Adams
& Stenn, 1992) and breast (Montgomery, Weltz, et al,
2002) biopsies, and in children undergoing bone marrow
aspiration (Zeltzer & LeBaron, 1982).
Similar techniques have resulted in reduced anxiety, fewer
complications, less need for medication and, in some cases,
shorter procedures in angiography (Lang & Mailton,
1994), upper intestinal endoscopy (Zimmerman, 1998),
abdominal surgery (Tusek, Church & Fazio, 1997), and
Magnetic Resonance Imaging (Friday & Dubal, 1990).
Conclusion
Guided imagery can reduce patients’ anxiety and improve
their ability to cope with biopsy-related stress. This
anxiety reduction could potentially result in improved
patient cooperation with ordered biopsies, reduced
medication use, and lower cost savings in some cases.
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