From the Journals

Stress balls, hand-holding no help during dermatology procedures


 

FROM JAMA DERMATOLOGY

Stress balls and hand-holding failed to lower patient anxiety during head and neck skin cancer removals under local anesthesia, according to a randomized trial of 135 patients at Northwestern University, Chicago.

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Such measures have been shown to help in other fields, such as cataract surgery, so the study team wanted to try them in dermatology. A total of 45 patients were given a rubber ball to squeeze, 45 had a female researcher place her hand on top of theirs, and 45 received usual care.

In all three groups, anxiety levels were a little over 3 points on a 10-point Visual Analog Scale (VAS) before surgery and around 2 points during it. The 6-item State Trait Anxiety Inventory score was just under 9 in all three groups right after the procedure, meaning patients weren’t very anxious. Physiological measures did not change from before to after the procedure or between groups. Postoperative pain scores were all under 1 on a 10-point scale, and patients in all three groups were highly satisfied with their encounter, the researchers said in JAMA Dermatology.

“Many patients commented anecdotally on the calming effect of hand-holding or stress ball use,” so “it was surprising that the total data did not show these interventions to preferentially decrease anxiety or alleviate pain,” Arianna F. Yanes, a medical student at Northwestern University, and her coinvestigators said.

It could be that standard measures – giving patients an opportunity to ask questions, making sure they feel comfortable, and the like – are enough. However, “hand-holding and stress balls may still provide stress relief in patients who are particularly anxious before the procedure.” Perhaps patients would have preferred having their hand held by a loved one instead of a stranger, the investigators said.

Meanwhile, patients who researched their operation online beforehand had higher preoperative anxiety scores (3.84 vs. 2.62 points on the VAS; P = .04), but they could have been more anxious from the start.

The mean subject age was 66 years, and 62% were men.

The work was funded by Northwestern University and a grant from Merz. The investigators had no relevant disclosures.

SOURCE: Yanes AF et al. JAMA Dermatol. 2018 Jul 18. doi:10.1001/jamadermatol.2018.1783.

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