# The Effect of Audio and Audiovisual Distraction on Pain and Anxiety in Patients Receiving Outpatient Perineal Prostate Biopsies: A Prospective Randomized Controlled Study

## TL;DR

This study tested if music or videos could reduce pain and anxiety during prostate biopsies and found that videos made patients feel the procedure was shorter, though pain and anxiety levels were not significantly reduced.

## Contribution

The study is the first to show that audiovisual distraction can reduce perceived procedure duration during prostate biopsies, suggesting a potential low-cost comfort improvement.

## Key findings

- Audiovisual distraction significantly reduced the subjective perception of procedure duration.
- There was no significant reduction in pain or anxiety levels with audiovisual or audio distraction.
- Audiovisual distraction showed no significant effect on heart rate, blood pressure, or anxiety inventory scores.

## Abstract

Prostate biopsies are a common medical procedure to diagnose prostate cancer, but can cause significant anxiety and discomfort for patients. To address this, we investigated whether audio or audiovisual distraction can help to reduce pain, anxiety and stress during the procedure. Our study included 168 male patients undergoing prostate biopsies, divided into three groups: one group received no intervention, the audio distraction group listened to music via headphones, and the audiovisual distraction group received audiovisual glasses to watch documentaries of their interest. We found that audiovisual distraction significantly reduced the subjective perception of the duration of the procedure. However, audiovisual distraction did not significantly lower pain or anxiety levels compared to the control group. Even so, these findings highlight the potential of audiovisual distraction as a simple, cost-effective way to improve patient comfort during outpatient procedures, with implications for broader investigation in outpatient procedures.

Background/Objectives: Audio and audiovisual distraction can be effective additive tools to reduce anxiety and pain in patients receiving outpatient procedures (OP). Audiovisual distraction tools already showed positive effects on pain perception in some urological procedures. To identify the effects of audio and audiovisual distraction on pain and anxiety in patients receiving perineal prostate biopsy (PPB), we performed a prospective randomized controlled study. Methods: We recruited 168 male patients undergoing PPB which were randomized into three groups: a control group (CG), an audio distraction group (ADG) and an audiovisual distraction group (AVDG). The CG received no intervention, while the ADG received audio distraction and the AVDG received audiovisual distraction while PPB was performed. The primary endpoint was pain perception, measured in the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS). Secondary endpoints were subjective and objective procedure time (SPT/OPT), heart rate, blood pressure, cortisol blood levels and scores in the State-Trait Anxiety Inventory (STAI) questionnaire. Results: Demographics of each group were similar (CG = mean age (a) = 69.5; ADG a = 67 years; AVDG a = 67). We did not find any significant difference regarding our primary endpoint, pain perception (p = 0.384). In contrast, we examined a highly significant difference between SPT and OPT, comparing AVDG to CG (p < 0.001) and AVDG to ADG (p < 0.001), but not for ADG to CG (p = 0.348). There was no significant difference in the secondary endpoints, heart rate, blood pressure, STAI scores and willingness to repeat the procedure. Conclusions: Our study shows that audiovisual distraction can significantly shorten SPT for patients receiving PPB, which may represent their comfort throughout the procedure. To accelerate the wider implementation of audiovisual distraction as a cost-efficient tool in outpatient urological procedures, further studies should examine its effect on different OPs with a more heterogeneous patient group.