DESCRIBING AND PREDICTING PREPROCEDURAL ANXIETY IN PATIENTS SCHEDULED FOR ADVANCED GASTROINTESTINAL ENDOSCOPY DURING THE COVID-19 PANDEMIC

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently with little attention given to a patient’s preprocedural anxiety issues. Preprocedural anxiety is an anticipated problem with any surgery or invasive procedure and if sustained or experienced excessively, is associated with negative clinical factors and complications. In the beginning of 2020, the United States was met with a global pandemic caused by the coronavirus SARS-CoV-2, termed COVID-19. There were recommendations to decrease medical procedural case volume in order to slow the spread of the virus, protect staff and patients from getting the virus, conserve personal protect equipment and reserve inpatient capacity of hospitals for COVID-19 patients. It is unknown how the changes brought by the pandemic affected the anxiety of patients preparing for surgery and procedures such as advanced endoscopy procedures. The purpose of this dissertation was to describe and evaluate biological, psychological and social attributes of patients undergoing endoscopy procedures. Research around endoscopy procedures has focused on the technological aspects of the procedures resulting in a deficit of study around the holistic experience of the patient. This dissertation contains three original manuscripts focused on this population. The first manuscript was a retrospective chart review of adult patients having a bronchoscopy procedure. The purpose of this study was to examine sociodemographic information, clinical characteristics and procedural data for predictors of procedural complications in patients undergoing bronchoscopy procedure with proceduralist supervised, nurse administered and monitored, moderate sedation. Logistic regression was used to evaluate for independent variables predictive of complication. General pulmonologist, as compared to interventional pulmonologist, (OR = 8.6 [95% CI, 2.032 – 36.711, p = 0.003]), presence of chronic obstructive pulmonary disease (OR = 3.8 [95% CI, 1.315 – 10.740, p = 0.013]) and longer procedural time (OR = 1.0 [95% CI, 1.004 – 1.078, p = 0.028]) were identified as independent factors in predicting complications. Significant differences between the two physician groups warrant further evaluation and additional research to explain physician type as a predictor of complications. The second manuscript was a literature review of validated instruments used to evaluate anxiety. The purpose was to identify, describe and review instruments used in research to evaluate preprocedural anxiety associated with gastrointestinal endoscopy and provide recommendations for use in the clinical setting and for future research. Thirty articles met criteria and three instruments, the State-Trait Anxiety Inventory, Beck Anxiety Inventory and Hospital Anxiety and Depression Scale-Anxiety, were identified. Based on strong psychometric measures in general populations and wide-spread use in research with gastroenterology populations, the State-Trait Anxiety Inventory is recommended for use in research. Additional recommendations include performing psychometric measures in endoscopy patient populations and investigating use of the shortened instrument for routine clinical use. The final manuscript was a cross-sectional descriptive study of 90 patients referred for advanced gastrointestinal endoscopy procedure during the COVID-19 pandemic. The purpose of this study was to describe the patients and to identify if physiological status, COVID-19 related delay of procedure, social support, COVID-19 related anxiety and procedure indication category were predictors of preprocedural anxiety. Fifty-eight percent of the patients scored high for preprocedural anxiety. Social support, quantified with the Multidimensional Scale of Perceived Social Support instrument, was identified as a predictor for anxiety (OR = 0.318 [95% CI, 0.170-0.597, p \u3c 0.001]) indicating that less social support is associated with higher preprocedural anxiety. Strategies to support and optimize social support should be implemented. Additional research is warranted to explore strategies for decreasing preprocedural anxiety in this population