Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
The Effect of BATHE Method on Preoperative Anxiety, Patient Satisfaction and Individual Anesthesia Concerns: Randomized, Placebo-Controlled, Clinical Trial
BATHE Metodunun Preoperatif Anksiyete, Hasta Memnuniyeti ve Bireysel Anestezi Endişeleri Üzerine Etkisi: Randomize, Plasebo-Kontrollü Klinik Çalışma
İsmail KARAKOYUNa, Ahmet Cemil İŞBİRb, Oğuz GÜNDOĞDUb, Onur AVCIb, İclal ÖZDEMİR KOLb, Sinan GÜRSOYb, Kenan KAYGUSUZb
aClinic of Anesthesiology and Reanimation, Van Özalp State Hospital, Van, TURKEY
bDepartment of Anesthesiology and Reanimation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, TURKEY
Turkiye Klinikleri J Anest Reanim. 2021;19(3):114-23
doi: 10.5336/anesthe.2021-85696
Article Language: EN
Full Text
ABSTRACT
Objective: The aim of this study is to determine the causes of concern among the patients who will undergo elective surgical operations and receive general anesthesia, to gauge their preoperative anxiety levels and to study the effects of the BATHE method on preoperative anxiety and patient satisfaction. Material and Methods: Five hundred adult patients who were planned to undergo elective surgery with general anesthesia were included in the study. Before the preoperative examination, demographic data of all patients, their three biggest fears about anesthesia and Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores were recorded. Then, the patients were divided into two groups with a closed envelope randomization method with 250 patients in each. The patients underwent BATHE anamnesis or standard anamnesis methods according to their groups, then their APAIS and patient satisfaction scores were recorded. Results: The most feared cause of anesthesia in all patients was 'not waking up after surgery'. The APAIS anxiety score was found to be higher in women, young people, married people with children, people with no prior anesthesia experience and people with a higher degree of education. Anxiety values were found to be higher in gynaecology patients and obstetrics. The difference between APAIS scores before and after the examination was higher in the group using the BATHE method during the preoperative visit compared to the standard anamnesis group. The patient satisfaction score of the patients in the BATHE group was higher than the standard anamnesis group. Conclusion: We concluded that the inclusion of BATHE interview technique in preoperative examination may reduce preoperative anxiety.

Keywords: Anxiety; anesthesia; patient satisfaction
ÖZET
Amaç: Bu çalışmada; elektif cerrahi operasyon geçirecek ve genel anestezi alacak hastalarda anesteziye dair endişe nedenlerini belirlemek, bu hastaların preoperatif anksiyete düzeylerini ölçmek, preoperatif muayenede BATHE görüşme tekniği uygulanmasının preoperatif anksiyete ve hasta memnuniyeti üzerine etkilerini araştırmak amaçlanmıştır. Gereç ve Yöntemler: Elektif şartlarda cerrahi plananan ve anestezi yöntemi olarak genel anestezi uygulanacak 500 erişkin hasta çalışmaya dâhil edildi. Preoperatif muayene öncesi tüm hastaların demografik verileri, anesteziye dair en çok korktukları 3 neden ve Amsterdam Preoperatif Anksiyete ve Bilgi Ölçeği [Amsterdam Preoperative Anxiety and Information Scale (APAIS)] skorları kaydedildi. Daha sonra hastalar kapalı zarf randomizasyon yöntemi ile 250 kişilik 2 gruba ayrıldı. Bulundukları gruplara göre BATHE anamnez veya standart anamnez yöntemleri uygulanan hastaların muayene çıkışında APAIS ve hasta memnuniyet skorları kaydedildi. Bulgular: Tüm hastalarda anesteziye dair en çok korkulan neden; 'ameliyat sonrası uyanmamak' idi. Kadınlarda, genç yaş grubunda, evli ve çocuk sahibi olanlarda, daha önceden anestezi deneyimi olmayanlarda ve eğitim durumu yüksek olanlarda APAIS anksiyete skorları daha yüksek bulunmuştur. Cerrahi bölüm olarak ise obstetrik ve jinekoloji hastalarında anksiyete değerleri daha yüksek görülmüştür. Preoperatif vizit sırasında BATHE methodu kullanılan grubun muayene öncesi ve sonrası APAIS skorları arasındaki fark standart anamnez uygulanan gruba göre daha yüksek bulunmuştur. Yine BATHE grubundaki hastaların hasta memnuniyet puan ortalaması standart anamnez grubuna göre daha yüksek bulunmuştur. Sonuç: Preoperatif muayeneye BATHE görüşme tekniğinin dâhil edilmesinin preoperatif anksiyeteyi azaltabileceği kanaatine vardık.

Anahtar Kelimeler: Anksiyete; anestezi; hasta memnuniyeti
REFERENCES:
  1. Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89(6):1346-51. [Crossref]  [PubMed] 
  2. Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiol. 2018;84(11):1307-17. [Crossref]  [PubMed] 
  3. Yilmaz Inal F, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. The effect of preoperative anxiety and pain sensitivity on preoperative hemodynamics, propofol consumption, and postoperative recovery and pain in endoscopic ultrasonography. Pain Ther. 2021. [Crossref]  [PubMed]  [PMC] 
  4. Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Euteneuer F, et al. Preoperative anxiety in adults-a cross-sectional study on specific fears and risk factors. BMC Psychiatry. 2020;20(1):140. [Crossref]  [PubMed]  [PMC] 
  5. Altinsoy S, Caparlar CO, Ergil J. Relação entre ansiedade pré-operatória e consciência durante a anestesia: estudo observacional [The relation between preoperative anxiety and awareness during anesthesia: an observational study]. Braz J Anesthesiol. 2020;70(4):349-56. [Crossref]  [PubMed] 
  6. Baran O, Mordeniz C, Arar MC, Günkaya M. The effect of video information on preoperative anxiety levels in patients undergoing total knee replacement. J Acad Res Med. 2020;10(2):122-8. [Crossref] 
  7. Hicks JA, Jenkins JG. The measurement of preoperative anxiety. J R Soc Med. 1988; 81(9):517-9. [Crossref]  [PubMed]  [PMC] 
  8. Markland D, Hardy L. Anxiety, relaxation and anaesthesia for day-case surgery. Br J Clin Psychol. 1993;32(4):493-504. [Crossref]  [PubMed] 
  9. Haugen AS, Eide GE, Olsen MV, Haukeland B, Remme AR, Wahl AK. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. J Clin Nurs. 2009;18(16):2301-10. [Crossref]  [PubMed] 
  10. Lieberman JA 3rd, Stuart MR. The BATHE method: incorporating counseling and psychotherapy into the everyday management of patients. Prim Care Companion J Clin Psychiatry. 1999;1(2):35-8. [Crossref]  [PubMed]  [PMC] 
  11. Stuart MR, Lieberman JA, Seymour J. The fifteen minute hour: a short-term approach to psychotherapy in primary care. 4th ed. Philadelphia: Saunders; 2008. [Crossref] 
  12. Lieberman JA 3rd. BATHE: an approach to the interview process in the primary care setting. J Clin Psychiatry. 1997;58 Suppl 3:3-6; discussion 7-8. [PubMed] 
  13. Hepner DL, Bader AM, Hurwitz S, Gustafson M, Tsen LC. Patient satisfaction with preoperative assessment in a preoperative assessment testing clinic. Anesth Analg. 2004;98(4):1099-105. [Crossref]  [PubMed] 
  14. DeMaria S Jr, DeMaria AP, Silvay G, Flynn BC. Use of the BATHE method in the preanesthetic clinic visit. Anesth Analg. 2011;113(5):1020-6. [Crossref]  [PubMed] 
  15. Ayvat P, Arslan Yurtlu D, Özgürbüz U, Güntürkün F, Katircioğlu K, Kizilkaya M. Does preoperative anxiety decrease with BATHE method? A pros pective randomized study. Noro Psikiyatr Ars. 2020;57(2):141-7. [PubMed]  [PMC] 
  16. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam preoperative anxiety and information scale (APAIS). Anesth Analg. 1996;82(3): 445-51. [Crossref]  [PubMed] 
  17. Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients - experience of a single unit. Acta Anaesthesiol Taiwan. 2012;50(1):3-6. [Crossref]  [PubMed] 
  18. Turzáková J. Amsterdam preoperative anxiety and information scale validation study. In: Sollár T, ed. Anxiety and Coping in Hospitalized Patients. Measurement Tools and Findings. 1st ed. Krakow, Poland: Miedzynarodowa Fundacja Scientia, Arts, Educatio; 2014. p.31-51. [Link] 
  19. Bakalaki VA, Kostakis ID, Lampadariou A, Kyrozis A, Chalkias A, Pandis D. Reliability and validity of a modified Amsterdam preoperative anxiety and information scale (Apais). MEJ Anest. 2017;24(2):243-51. [Link] 
  20. Demir A, Turan S, Balaban F, Karadeniz Ü, Erdemli Ö. Anestezi uygulamaları ile ilgili olarak preanestezik değerlendirme sırasında hastalarda yapılan anket çalışması. Türk Anesteziyoloji ve Reanimasyon Dergisi. 2009; 37(4): 225-33. [Link] 
  21. Turhan Y, Avcı R, Özcengiz D. Elektif cerrahi hazırlığında preoperatif ve postoperatif anksi yetenin hasta memnuniyeti ile ilişkisi [The relationship between preoperative and postoperative anxiety, and patient satisfaction in preparation for elective surgery]. Anestezi Dergisi. 2012;20(1): 27-33. [Link] 
  22. Aykent R, Kocamanoğlu İS, Üstün E, Tür A, Şahinoğlu H. Preoperatif anksiyete nedenleri ve değerlendirilmesi: APAIS ve STAI skorlarının karşılaştırılması [The reasons and evaluation of preoperative anxiety: a comparison of APAIS ans STAI scores]. Turkiye Klinikleri J Anest Reanim. 2007;5(1):7-13. [Link] 
  23. Taşdemir A, Erakgün A, Deniz MN, Çertuğ A. Preoperatif bilgilendirme yapılan hastalarda ameliyat öncesi ve sonrası anksiyete düzeylerinin State-Trait Anxiety Inventory Test ile karşılaştırılması [Comparison of preoperative and postoperative anxiety levels with State-Trait-Anxiety Inventory Test in preoperatively informed patients]. Turk J Anaesth Reanim. 2013;41:44-9. [Link] 
  24. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45(3):298-307. [Crossref]  [PubMed] 
  25. Cuvaş Ö, Aslanargun P, Aslan E, Yücel F, Dikmen B, Ceyhan A. Sigara içiminin preoperatif anksiyete üzerine etkisi [The effect of cigarette smoking on preoperative anxiety]. Türk Anest Rean Der Derg. 2010;38(5):348-55. [Link] 
  26. Miller RD. Psychological preparation and preoperative medication. Anesthesia. 3rd ed. New York: Churchill-Livingstone; 1990. p.895-928. [Link] 
  27. Barabady A, Baghdassarians A, Memary E, Yazdani A, Barabady A, Sayadi S. Effect of Benson's relaxation technique on propofol consumption and preoperative anxiety of patients undergoing cataract surgery. Anesth Pain Med. 2020;10(3): e100703. [Crossref]  [PubMed]  [PMC] 

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