Effect of a Nature-View Curtain on Pain, Anxiety, and Fear During Thyroid Biopsy

Overview

Thyroid fine-needle aspiration biopsy (FNAB) may cause procedure-related pain, anxiety, and fear. This randomized controlled trial evaluated whether visual distraction with a nature-view curtain could reduce these outcomes. A total of 100 adults undergoing ultrasound-guided thyroid FNAB were randomly assigned in a 1:1 ratio to a nature-view curtain group or a standard-care control group. Participants in the intervention group were instructed to focus on a ceiling-mounted nature-view curtain throughout the biopsy, whereas participants in the control group underwent routine biopsy without this visual distraction. Pain intensity was the primary outcome; anxiety and fear of pain were secondary outcomes. Outcomes were assessed approximately 15 minutes before and approximately 15 minutes after the procedure.

This completed, two-arm, parallel-group, randomized controlled trial was conducted at Adana City Training and Research Hospital in Adana, Türkiye, between June 1, 2025, and February 28, 2026. The study included 100 adults scheduled to undergo ultrasound-guided thyroid fine-needle aspiration biopsy because of a suspected thyroid nodule or mass. Participants were stratified by sex and assigned in a 1:1 ratio to the nature-view curtain group or the standard-care control group using blocks of two. Within each sex stratum, the first participant in each block was assigned by coin toss, and the second was allocated to the other group. Both groups underwent routine ultrasound-guided thyroid fine-needle aspiration biopsy. Participants in the intervention group were instructed to focus throughout the procedure on a ceiling-mounted, 195 × 135 cm curtain displaying a nature scene. Participants in the control group underwent the routine biopsy procedure without nature-view curtain distraction. The biopsy procedure lasted approximately 5 to 10 minutes. Pain intensity, anxiety, and fear of pain were assessed approximately 15 minutes before and approximately 15 minutes after the procedure. Pain intensity assessed using the Visual Analog Scale was the primary outcome. Anxiety assessed using the Beck Anxiety Inventory and fear of pain assessed using the Fear of Pain Questionnaire-III were secondary outcomes. Because of the nature of the intervention, participants and study personnel were not masked. Statistical analyses were conducted by an independent statistician who received coded group data and was unaware of the group identities.