Rationale: Patients awaiting cardiac surgery can experience pre-procedural anxiety. This anxiety is associated with increased analgesic needs, increased risk of mortality and prolonged recovery time. Adequate patient education can help diminish pre-procedural anxiety and minimize postoperative complications. Recent studies have demonstrated that Virtual Reality (VR) can function as a useful tool to diminish pre-procedural anxiety in several medical fields. Especially 360 degree VR could familiarize patients with their clinical pathway. Nevertheless, limited to no research on the application of 360 degree VR has been conducted in the context of cardiothoracic surgery yet. Objective: The aim of this study is to explore the effects and possible benefits of 360 degree VR on pre-procedural anxiety in patients awaiting elective cardiac surgery involving a sternotomy, compared to standard forms of patient education. Study design: Single-center, randomized controlled trial Study population: Patients aged 18 or older awaiting elective cardiac surgery involving a sternotomy.
Patients undergoing cardiothoracic surgery are inclined to experience a form of pre-procedural anxiety. Not only can these feelings of concern cause huge psychological discomfort for patients awaiting surgery, but this can also translate into somatic complications, especially for patients with coronary artery disease. These adverse events include a prolonged recovery time, increased risk of re-hospitalization and death amongst other implications and underline the necessity of addressing pre-procedural anxiety. Several approaches have been introduced in an attempt to contain these feelings of concern. Examples that have been applied in the field of surgery include pharmacological interventions as well as extensive patient education. Especially the latter has recently been proven to be effective in diminishing pre-procedural anxiety. A recent study highlighted the significance of 360-degree Virtual Reality patient education in limiting pre-procedural anxiety levels in patients undergoing percutaneous atrial septal closure. Their research demonstrated that thorough patient education using VR could prevent elevated scores of anxiety, possibly contributing to a diminished number of adverse events in this patient group. Alongside this study, several other researches have hinted at success or are investigating the benefit of VR in managing anxiety levels. Considering these promising results, the aim of the VR Patient Journey Trial is to evaluate the additional value of 360-degree Virtual Reality as a new modality in reducing pre-procedural anxiety in comparison with regular forms of patient education in patients undergoing coronary artery bypass grafting (CABG) procedures. This procedure remains the most performed type of cardiac surgery and accounts for a large homogenous patient group; an estimated 85% of procedures concern isolated CABG. Managing anxiety levels in this patient group can therefore greatly impact the overall level of patient well-being in cardiac surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
100
A 360-degree video that encompasses the entire clinical pathway. Patients are able to familiarize themselves with the hospital settings (nursery ward, operating room, intensive care unit).
Spielberger's State Trait Anxiety Inventory provides insight in the presence of anxiety.
This validated questionnaire provides insight in the presence of anxiety. It also measures the need for information.
Academic Medical Center
Amsterdam, North Holland, Netherlands
RECRUITINGState-Anxiety at baseline
State Anxiety (derived from Spielberger's State-Trait Anxiety Inventory) during outpatient clinic visit prior to surgery. Minimum score value 0, maximum score value 63. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: During outpatient clinic visit, prior to surgery
Trait-Anxiety at baseline
Trait Anxiety (derived from Spielberger's State-Trait Anxiety Inventory) during outpatient clinic visit prior to surgery. Minimum score value 0, maximum score value 63. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: During outpatient clinic visit, prior to surgery
Trait-Anxiety at follow-up
Trait Anxiety (derived from Spielberger's State-Trait Anxiety Inventory) during admission to hospital (1 day prior to surgery). Minimum score value 0, maximum score value 63. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: 1 day prior to surgery
State-Anxiety at follow-up
State Anxiety (derived from Spielberger's State-Trait Anxiety Inventory) during admission to hospital (1 day prior to surgery). Minimum score value 0, maximum score value 63. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: 1 day prior to surgery
Need-for-information at baseline
Need for information (derived from Amsterdam Preoperative Anxiety and Information Scale) during outpatient clinic visit prior to surgery. Minimum score value 4, maximum value 20. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: During outpatient clinic visit, prior to surgery
Need-for-information at follow-up
Need for information (derived from Amsterdam Preoperative Anxiety and Information Scale) during outpatient clinic visit prior to surgery. Minimum score value 4, maximum value 20. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: 1 day prior to surgery
Pre-procedural anxiety at baseline
Pre-procedural anxiety (derived from Amsterdam Preoperative Anxiety and Information Scale) during outpatient clinic visit prior to surgery. Minimum score value 4, maximum value 20. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: During outpatient clinic visit, prior to surgery
Pre-procedural anxiety at follow-up
Pre-procedural anxiety (derived from Amsterdam Preoperative Anxiety and Information Scale) during outpatient clinic visit prior to surgery. Minimum score value 4, maximum value 20. Lower outcome means less anxiety, higher outcome means worse anxiety.
Time frame: 1 day prior to surgery
HR at baseline
Heartrate in bpm (beats per minute) during outpatient clinic visit prior to surgery
Time frame: During outpatient clinic visit, prior to surgery
HR at follow-up
Heartrate in bpm (beats per minute) during admission to hospital (1 day prior to surgery)
Time frame: 1 day prior to surgery
HR in operation room
Heartrate in bpm (beats per minute) in the operation room on the day of surgery
Time frame: in the OR on the day of surgery
Diastolic blood pressure at baseline
Diastolic blood pressure (in mm/Hg) during outpatient clinic visit prior to surgery
Time frame: During outpatient clinic visit prior to surgery
Systolic blood pressure at baseline
Systolic blood pressure (in mm/Hg) during outpatient clinic visit prior to surgery
Time frame: During outpatient clinic visit prior to surgery
Diastolic blood pressure at follow-up
Diastolic blood pressure (in mm/Hg) during admission to hospital (1 day prior to surgery)
Time frame: 1 day prior to surgery
Systolic blood pressure at follow-up
Systolic blood pressure (in mm/Hg) during admission to hospital (1 day prior to surgery)
Time frame: 1 day prior to surgery
Diastolic blood pressure in OR
Systolic blood pressure (in mm/Hg) in the operation room on the day of surgery
Time frame: in the OR on the day of surgery
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