JAMA: Anxiety Disorders Topic Collection

Music Therapy for Reducing Anxiety in Critically Ill Patients Music Therapy for Reducing Anxiety in Critically Ill Patients

Azoulay E, Chaize M, Kentish-Barnes N. — Wed, 12 Jun 2013 00:00:00 GMT

The vast majority of critically ill patients who receive mechanical ventilation now survive, even those with acute lung injury or acute respiratory distress syndrome. Over the past decade, an increasing number of studies have focused not only on survival, but also on the patients' experience of critical care. These studies have evaluated 3 periods: the intensive care unit (ICU) stay (confusion, delirium, acute stress, nightmares, hallucinations, and sleep disorders), the first few weeks or months after ICU discharge (symptoms of posttraumatic stress disorder [PTSD], cognitive impairment, and depression), and the period beyond one year after ICU discharge. Many of these studies have shown a significant association between the amount of ICU sedation and decline in factual memory, presence of delusional memory, and additional PTSD-related symptoms.

Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support A Randomized Clinical Trial Patient-Directed Music Intervention

Chlan LL, Weinert CR, Heiderscheit A, et al. — Wed, 12 Jun 2013 00:00:00 GMT

Importance

Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.

Objective

To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.

Design, Setting, and Patients

Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.

Interventions

Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).

Main Outcomes and Measures

Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).

Results

Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.

Conclusions and Relevance

Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.

Trial Registration

clinicaltrials.gov Identifier: NCT00440700

Encouraging Patients to Ask Questions How to Overcome “White-Coat Silence” Encouraging Patients to Ask Questions

Judson TJ, Detsky AS, Press MJ. — Wed, 12 Jun 2013 00:00:00 GMT

The focus of an ongoing effort in health care quality improvement is to encourage patients to ask questions during their care. In September 2011, the Agency for Healthcare Research and Quality (AHRQ) launched the Questions Are the Answer campaign (Table) and has used $20 million of donated marketing outreach toward building patient engagement through asking questions (Farah Englert, AHRQ, November 15, 2012, written communication). In 2002, the Joint Commission created Speak Up, an initiative that promotes patient involvement in care and emphasizes the importance of asking questions (Table).