Distractions as Anxiolytics during Hemodialysis: A Pilot Study

Background: In-center hemodialysis is an emotional burden for patients. While its correlation with fatigue and depression is well-documented, little research exists on its correlation with anxiety and on anxiolytic interventions. This study aims to determine how to better analyze the anxiolytic effects of distractions during hemodialysis. Methods: Subjects were recruited at the Penn State Hershey Medical Center’s Outpatient Dialysis Unit. After an hour of a self-selected activity during treatment, subjects completed the State-Trait Anxiety Inventory (STAI) to determine their state (situational) and trait (personal) anxiety levels. The STAI-provided norm table was used to assign percentiles to each subject. Subjects were then grouped by activity and a two-tailed analysis was performed to compare mean state and trait anxiety percentiles for each group. Results: 14 out of 30 eligible individuals consented to the study. The average age was 57, and 2 subjects were older than the oldest age group (50-69) on the STAI norm table. 79% of subjects participated in a hobby. Average enjoyment was above 7/10 across all groups. No significant difference was found between mean state (s) and trait (t) anxiety percentiles in any of the 5 groups: TV/Radio (n=8, s=27.4%, t=36.6%, p=0.40), Social Media/Communication (n=2, s=48.5%, t=65.5%, p=0.70), Sleeping (n=2, 67.5%, t=53%, p=0.82), Games (n=1, s=33%, t=59%, N/A), or Reading (n=1, s=55%, t=59%, N/A). Conclusion: This pilot study did not find significant changes to subjects’ anxiety during hemodialysis with any of the above distractions but does elucidate considerations for future studies through its limitations. A multi-center interventional design would be more powerful and allow for analysis of less common distractions like reading. However, assigning interventions may blunt their anxiolytic effect, as subjects may perform activities they do not enjoy. Additionally, the STAI norm table excludes individuals older than 69, preventing accurate analysis for those patients. High school graduates struggled with the STAI vocabulary, and completion of a lengthy survey may alter anxiety levels and mask anxiolytic effects. Use of a custom inventory may therefore be preferable to the STAI. Through this study, it is evident a carefully tailored method is necessary to better understand anxiety and the anxiolytic effects of distractions during hemodialysis.