The effects of environment on patient anxiety in the mammography waiting room

The impact of the waiting room environment to a patient's perceived anxiety associated with screening and diagnostic mammography is an important factor in women's healthcare. It was hypothesized that the audio/visual environment of the waiting room does affect the patient's state anxiety, with more melodious or quiet environments yielding lower anxiety scores than noisy or harsh, factual, educational environments. METHODS: Women over the age of 18 years (n=620) who came for screening (n=253) or diagnostic work-up (n=367) in an outpatient clinic were given a Spielberger State Anxiety Inventory after exposure to one of six different audio/visual stimuli in the waiting room. These included 1) cable television programming, 2) videotaped Rodgers and Hammerstein movies, 3) no television or music, 4) easy-listening music, 5) educational videotapes of medical diseases and treatments (breast cancer, lung cancer, colon cancer, diabetes, aging and dementia, and heart disease), or 6) a series of videotapes by Siegel and Chopra on cancer survival. Waiting room time was recorded and grouped as short (≤15 min.), moderate (16-30 min.) and long (>30 min.) time exposed to the audio/visual stimulus. The anxiety scores were evaluated using a 3 Way ANOVA with Bonferoni post hoc for significant differences between treatment groups (p<0.05). RESULTS: Anxiety scores were significantly different between the screening and diagnostic groups (33.7 ± 0.6 vs. 39.8 ± 0.6). Patients exposed to educational videos on cancer survival experienced significantly more anxiety than those exposed to Rodgers and Hammerstein movies (40.6 ± 1.2 vs. 35.5 ± 1.0). There were no differences between all other audio/visual stimuli, no differences between waiting time and anxiety and no interaction effects between screening/diagnostic groups, audio/visual stimulus and waiting time. CONCLUSIONS: Diagnostic mammography yields greater state anxiety than screening mammography. Audio/visual presentation has no effect on state anxiety with the exception of educational videos on cancer survival yielding greater state anxiety than Rodgers and Hammerstein movies. Furthermore, the duration of time in the mammography waiting room does not influence state anxiety.