Pretest Clarification of Treadmill Implications Eases Anxiety

January 26, 2007

GRAFTON, New Zealand -- An ounce of reassurance may be worth a pound of cure for some chest pain patients undergoing diagnostic tests, researchers here report.

GRAFTON, New Zealand, Jan. 26 -- An ounce of reassurance may be worth a pound of cure for some chest pain patients undergoing diagnostic tests, researchers here report.

When a staff member at a cardiology clinic took the time to explain how results of a diagnostic stress test would be used -- including information about how normal results would be used -- patients with normal results were less likely to report continuing chest pain a month later, said psychologist Keith J. Petrie, Ph.D., of the University of Auckland School of Medicine.

Moreover, Dr. Petrie reported in the Jan. 26 issue of BMJ, chest pain patients who discussed the meaning of the test with a staffer before testing were more likely to say they felt reassured after testing than patients who were simply given an explanatory pamphlet or just a single sheet of paper that described the test.

Dr. Petrie noted that it was not unusual for chest pain patients to "remain anxious about their condition even after investigations and reassurance from their doctor."

For some patients that continuing anxiety can lead them to "use drugs inappropriately, and seek medical help from other health professionals for their symptoms."

Physicians typically explain test results to patients after the test, but Dr. Petrie and colleagues theorized that offering the explanation before the test would be more effective.

Thirty-four patients were randomized to the educational intervention, which included a brief discussion with a staff psychologist and an educational pamphlet, while 30 patients were randomized to receive the educational pamphlet before stress testing, and 28 were given just the information sheet before testing.

The psychologist asked patients if they had any questions and then briefly reiterated the main points of the pamphlet. They were "that a lot of people with chest pain worry that there might be something wrong with their heart; that if the result of the test is normal the patient's risk for coronary artery disease is as low as for anyone in the general population; and that just because the pain is not related to the heart does not mean that it is not real pain."

The psychologist also explained that there were many non-cardiac causes of chest pain and many of those causes were not as serious as coronary artery disease.

After testing, a mean of 42% of the patients in the discussion group said they were reassured (95% CI, 39.7-44.2), versus 39.2% of the patients who were given the pamphlet (95% CI, 36.1-42.3) and 35.8% of patients in the control group (95% CI 31.6-39.9).

Those differences were maintained at one month, he said.

Among patients who had normal stress test findings, 17% of the patients in the discussion group said they still had chest pain a month after testing (P