Is Positive Communication Sufficient to Modulate Procedural Pain and Anxiety in the Emergency Department? A...

Area of Science:

• Medical Communication
• Pain Management
• Patient Comfort

Background:

• Therapeutic communication may improve patient comfort during medical procedures.
• Limited research exists on therapeutic communication's effectiveness in clinical settings with adequate blinding.
• The impact of message content and delivery on patient experience during procedures like peripheral intravenous catheter (PIC) placement is not fully understood.

Purpose of the Study:

• To investigate the effect of positive messaging and empathetic nurse interaction on pain and anxiety during PIC placement in the emergency department (ED).
• To compare the efficacy of audio-taped messages versus nurse-delivered messages in modulating patient experience.
• To test the hypothesis that positive messaging and empathetic interaction lead to analgesia and anxiolysis.

Main Methods:

• A 2+2 randomized controlled trial (NCT03502655) was conducted in two phases.
• Phase 1: Double-blind delivery of positive vs. standard audio-taped messages (N=131).
• Phase 2: Single-blind delivery of positive vs. standard nurse-delivered messages (N=120).

Main Results:

• Empathic behavior was higher in the positive message group during nurse-delivered interactions (median 3 vs. 2, p < .001).
• Contrary to hypotheses, neither message content nor delivery method significantly affected patient-reported pain or anxiety during PIC placement (p > .2).
• Low practitioner empathic behavior was noted in the audio-taped message phase.

Conclusions:

• Positive communication interventions did not significantly impact pain or anxiety associated with PIC placement.
• A potential floor effect, due to low procedural pain ratings relative to presenting conditions, may have limited the observed effects.
• Therapeutic communication alone may be insufficient to modulate mild procedural pain in the ED setting.