Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer

Natalie Klug; Phyllis N Butow; Melissa Burns; Haryana M Dhillon; Purnima Sundaresan

doi:10.1016/j.jmir.2019.09.009

Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer

J Med Imaging Radiat Sci. 2020 Mar;51(1):12-21. doi: 10.1016/j.jmir.2019.09.009. Epub 2019 Nov 20.

Authors

Natalie Klug¹, Phyllis N Butow², Melissa Burns³, Haryana M Dhillon⁴, Purnima Sundaresan⁵

Affiliations

¹ Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
² Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia. Electronic address: phyllis.butow@sydney.edu.au.
³ Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia.
⁴ Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia.
⁵ Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 31759941
DOI: 10.1016/j.jmir.2019.09.009

Abstract

Background: To ensure precision of treatment, patients requiring radiation therapy for treatment of head and neck cancer (HNC) are stabilized using a fitted thermoplastic immobilization mask. Despite evidence that many patients experience significant anxiety when restrained in the mask, there is a lack of proven interventions to prevent or manage mask-related anxiety. The Promoting Action on Research Implementation in Health Services implementation framework promotes consideration of context and culture when developing interventions to ensure successful implementation if proven effective. Health professionals (HPs) play a crucial role in the management of patients' psychological concerns, yet no studies have explored their perspectives of mask anxiety and how it should be managed. The aim of this study, therefore, was to elicit and analyse HPs' perspectives of mask anxiety, using the Promoting Action on Research Implementation in Health Services framework, to guide the development of implementation-ready interventions to reduce mask anxiety.

Methods: Semistructured interviews were conducted with 20 HPs involved in the care of HNC patients, including radiation oncologists, radiation therapists, nurses, and psychologists, from nine hospitals in NSW, Australia. Framework analysis methods were used.

Results: Participants were on average 40 years old (range, 27-56), the majority were female (75%), and they had worked from 1 to 22 years with HNC patients. Six emergent themes were identified: (1) Mask anxiety is a significant problem but is easily missed; (2) Context matters; (3) Trust is critical; (4) Choice and control facilitate adjustment; (5) Psychological strategies are valued; and (6) Culture matters. Subgroup analysis also highlighted differences in perspectives between specialties.

Conclusions: Participants identified key principles underlying successful intervention. Two significant barriers to mask-anxiety intervention were identified: (1) a lack of empirical evidence surrounding its prevalence and predictors and (2) contextual and systematic hurdles making the health system potentially unresponsive to change. These data suggest a need for further descriptive studies and careful development of interventions which will address these hurdles.

Keywords: Head and neck cancer; context; culture; health professional perspectives; intervention; mask anxiety.

MeSH terms

Adult
Anxiety Disorders / prevention & control*
Female
Head and Neck Neoplasms / radiotherapy*
Humans
Immobilization / instrumentation*
Immobilization / psychology*
Interviews as Topic
Male
Middle Aged
Qualitative Research