Uncertain test results provoke more anxiety than malignant disease

Not knowing your test results can be more stressful than actually having a confirmed diagnosis, according to a study presented Nov. 29 at the RSNA annual conference. The uncertainty patients experience in the waiting room is as serious a stressor as knowing they have a malignant disease, the researchers found.

“We found this uncertainty is one of the most challenging parts, because once you know what the diagnosis is, you can plan,” said lead author Dr. Elvira Lang, an associate professor of radiology at Harvard Medical School. “Psychologically, that is much easier to bear than hanging in the air.”

There really is no such thing as just a diagnostic test, she said. The uncertainty is more stressful than awaiting risky treatment, she said.

Lang and her colleague, Nicole Flory, Ph.D., studied stress levels in 214 women scheduled for different diagnostic and treatment procedures. They measured stress and anxiety levels with four standardized tests: the State Trait Anxiety Inventory, Impact of Events Scale, Center for Epidemiological Studies Depression Scale, and Perceived Stress Scale.

The study found the patients who were most stressed were the 112 women awaiting breast biopsy. They had an average score of 48 out of 80 on the State Trait Anxiety Inventory, where patients rate their comfort level while waiting for a procedure.

The 42 women awaiting hepatic chemoembolization for liver cancer had an average score of 26, while the 60 awaiting uterine fibroid embolization for uterine myoma had an average score of 24.

“The women who came for diagnosis of breast cancer were significantly more stressed than even women who came in for chemoembolization,” Lang said.

Scores for the other three standardized tests weren’t much different, with the highest stress ratings coming from breast biopsy patients.

While the study sampled only women, men experience the same anxiety, Lang said.

“There are similar models published on the effect of stress hormones for men undergoing prostate biopsy,” she said. “For men, if they don’t know what the diagnosis is, they are more stressed than if they are told they have cancer.”

Lang said the good news is that doctors can learn to alleviate the stress of patients coming in for diagnostic procedures by using language that is more helpful for the patient and frames the experience in a better way.

“Don’t give negative suggestions like, ‘This hurts,’ ‘It’s gonna sting,’ ‘It’s not that bad.’ That is the one thing we published that gives patients more pain and more anxiety,” Lang said.

Since concluding the study, Lang started a company that coaches professionals and patients in dealing with anxiety associated with diagnostic tests. She also wrote a book, Patient sedation without medication, on the subject.