Going through magnetic resonance imaging - patients’ experiences and the value of information and preparation for adults and children

Abstract: Magnetic resonance imaging (MRI) is becoming an increasingly common form of exami¬nation for both adults and children. Although it is non-invasive and considered painless, both adults and children experience anxiety during the examination. The technique is sensitive to motion and for that reason many children are anaesthetised. The aim of this thesis was to improve patient care through exploring adult patients’ experiences of undergoing MRI, to examine the value of increased written information for adult patients and to examine whether children receiving age-adjusted preparation and realisation of MRI could go through the examination without deep sedation or anaesthesia. A further aim was to study over a five year period, the commonness of the use of MRI versus CT for children, and the occasions on which the children had deep sedation or anaesthesia. To examine the patients’ lived experience of going through an MRI examination, nineteen patients were interviewed and the interviews were analysed with hermeneutic phenomeno¬logical analysis (Paper I). A two group controlled experimental design was used to examine the impact that increased written information in connection with MRI had on patient anxiety and image quality (motion artefacts). The written information that was part of the prevalent routine was given to 118 adult patients (control group) while 124 patients received also in¬creased written information (intervention group). Anxiety was measured and image quality concerning motion artefacts was assessed (Paper II). Data from the radiological information system were scrutinised for all children between 0 and 15 years having had MRI or computer tomography (CT) over a period of five years (Paper III). A two-group controlled experimental design was used to examine whether or not children between the ages of three and nine could go through MRI awake. The usual preparation was given to 36 children (control group) and age-adjusted preparations and the opportunity to watch films during the MRI were given to 33 children (intervention group). Data were collected concerning the examination, motion artefacts, and parent satisfaction, and costs were calculated (Paper IV). The results showed that the essential feeling experienced when undergoing MRI was that of being in another world with a great variation in degree of perceived threat to one’s self-control. This had an impact on the effort it took for the patients to handle the situation and thus on their need for support (Paper I). Increased written information did not decrease patient anxiety but it did significantly decrease the number of patients assessed to have image motion artefacts (Paper II). For children under 16 years of age there was a significant increase in the number of MRI examinations compared to CT over the five year period: however, there was no decrease in the number of CT examinations. Deep sedation or anaesthesia was used on 43% of MRI and 7% of CT occasions (Paper III). Of the 36 children having MRI with the routine procedure, 30 had deep sedation or anaesthesia and six were awake. They all had acceptable examinations. Of the 33 children having age-adjusted preparations 30 had the examination awake with acceptable image quality, two refused the examination and one examination was terminated due to severe image motion artefacts. More children in the intervention group had motion artefacts (although the results were acceptable for diagnostic purposes) than in the control group. Parents were equally or more pleased with the care in the intervention group than in the control group and significantly so concerning communication. The costs were calculated to be lower in the intervention group (Paper IV). In conclusion the studies show that there are great variations in the experiences of patients undergoing MRI examinations and that care needs to be individualised. Although increased written information decreased the number of patients with image motion artefacts it was not enough to decrease patient anxiety. The number of MRI examinations for children are increasing, and with age-adjusted preparations and routines more children can undergo MRI without deep sedation or anaesthesia.