Patients with needle phobia? Try stress-reducing medical devices

Stress-reducing butterfly needles reduced aversion by 68%, fear by 53%, and anxiety by 53% (P<.001). The stress-reducing designs most favored were butterfly designs, flowers, fish, and smiley faces. Stress-reducing IV bags significantly reduced aversion by 83%, fear by 53%, and anxiety by 73% (P<.001). Stress-reducing scalpels also significantly reduced aversion by 49%, fear by 36%, and anxiety by 37% (P<.001).

When analyzed separately, both children and adults responded favorably and similarly to the stress-reducing devices in all 3 domains (P<.01), although children had a higher mean stress level in all 3 domains to conventional devices (P<.05).

TABLE
Significant reductions in aversion, fear, and anxiety with stress-reducing syringes

Discussion

A fear of needles, syringe procedures, intravenous therapy, and medical devices is given the overall term of needle phobia, and can seriously compromise patient care.^1-7 Adults may express needle phobia verbally or even avoid coming to the physician’s office, while children may be more overtly fearful, anxious, or hysterical. Our study focused on the specific psychological components of stress—aversion, fear, and anxiety—induced by exposure to needles and medical devices.

Aversion, fear, and anxiety were each assessed with the relevant VAS, a reproducible and validated method for assessing stress components in clinical populations.^8-11 Using a conservative definition for moderate to severe stress (VAS ≥5), 80% of subjects experienced moderate to severe aversion, 63% suffered moderate to severe fear, and 62% experienced moderate to severe anxiety in response to conventional devices. Thus, significant levels of clinically relevant needle phobia are present in typical outpatient populations. Several approaches have been taken to prevent and treat needle phobia, including reassurance, education, avoidance of needles, postural and muscle tension techniques, benzodiazepines, nitrous oxide gas, topical anesthesia, cognitive therapy, participant modeling, distraction, meditation, hypnosis, and coaching—all with variable and inconsistent results.^1-7,12-18

We hypothesized that visual modifications to needles, syringes, and other medical devices would result in stress-reducing devices that would lessen patient needle phobia. The stress-reducing needles and medical devices were created by applying simple representative designs on winged needles, syringes, IV bags, and scalpels while maintaining the basic function of these devices (FIGURES 1-3).

Stress-reducing syringes resulted in a 79% decrease in aversion, 53% reduction in fear, and 51% decrease in anxiety in the overall patient population compared to the conventional syringes (P<.001). More importantly, in subjects with significant needle phobia (VAS scores ≥5), stress-reducing syringes reduced aversion by 81%, fear by 56%, and anxiety by 47% (P<.001). This corresponds to favorable responses of 98% for aversion, 87% for fear, and 74% in anxiety in subjects with needle phobia. Similarly, stress-reducing winged needles, IV bags, and scalps in needle-phobic individuals demonstrated significantly positive response rates for reducing aversion, fear, and anxiety. For the stress-reducing devices, each individual design was superior to the corresponding conventional device, indicating a dominant class effect of these stress-reducing medical devices, rather than the specific design.

Damping visual cues of threat

It is likely that decoration of a medical device actually is a neurophysiologic intervention, resulting in stimulation of brain areas not usually associated with the fear, anxiety, and aversion responses caused by viewing medical devices. In this sense, the intervention of decorating a medical device has a close parallel to other cognitive, distraction, and mind-body imagery methods of intervention.^1-7,12-18

However, unlike these other interventions, decoration of the medical device actually focuses the patient’s attention and interest on the medical device, yet fear, aversion, and anxiety of needles and syringes are still significantly reduced. This suggests that the decorations interfere with the established link between visual recognition of a perceived threat and the subsequent emotional response to that perceived threat. In the future, neuroimaging of brain activation in response to these decorated devices may provide a more telling explanation of their stress-reducing effects.

This study demonstrates unexpectedly high levels of stress and fear of medical devices in typical clinic patients, and significant reduction of these stress measures by the use of stress-reducing decorated medical devices. The most favorable implementation of this technology would be for these stress-reducing medical devices to be mass-produced and the decorations placed on the device at the factory rather at the site of service. Ultimate implementation of this technology will determined primarily by economic considerations and the acceptance of these aesthetic modifications by nursing, physician, and administrative staff in family practice units.

CORRESPONDENCE
Wilmer L. Sibbitt, Jr, MD, Department of Internal Medicine, 5th floor ACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131. E-mail: wsibbitt@salud.unm.edu