# Graphic Novel for Patients Affected by Pancreatic Lesions Undergoing Endoscopic Ultrasound with Fine Needle Biopsy: A Pilot Randomized Study

## TL;DR

A pilot study found that a graphic novel may help reduce anxiety in patients undergoing endoscopic ultrasound with fine needle biopsy for pancreatic lesions.

## Contribution

This study is one of the first to explore the use of a graphic novel as a tool to reduce patient anxiety before a diagnostic medical procedure.

## Key findings

- Patients who received the graphic novel had lower anxiety scores compared to controls, though differences were not statistically significant.
- The graphic novel group had fewer patients with pancreatic cancer and fewer symptoms compared to the control group.
- Subgroup analyses suggested potential benefits for specific patient groups, such as those with children or no prior surgical experience.

## Abstract

Background/Objectives: Endoscopic Ultrasound with Fine Needle Biopsy (EUS-FNB) of pancreatic lesions often induces patient anxiety. Graphic medicine, an emerging health communication tool, could potentially mitigate this. This pilot study aimed to explore the feasibility of a graphic novel in reducing anxiety in adult patients awaiting EUS-FNB. Methods: This prospective, single-center, randomized pilot study was conducted from June 2024 to March 2025 in patients aged 18–89 years. The intervention group received a comic panel detailing the EUS-FNB routine, while controls had standard care. Anxiety was measured using the Beck Anxiety Inventory (BAI) and modified DASS-21 (mASS-14). Results: Overall, 65 patients (33 “Graphic Novel”, 32 “Control”) were included. Mean BAI was 4.88 (graphic novel) vs. 7.25 (controls, p = 0.092), and mASS-14 was 4.97 vs. 6.22 (p = 0.261). Anxiety prevalence was low (4.6% BAI, 13.8% mASS-14). Controls were more symptomatic (69.2%) and had a higher rate of pancreatic cancer (n = 20) compared to the graphic novel group (n = 6). Subgroup analyses showed that BAI was slightly lower for patients with children and no prior surgical experience when using graphic novels. Trends for lower anxiety appeared in those on chronic medication, under surveillance, or with solid/suspected metastatic lesions. Conclusions: This pilot study suggests that a graphic novel may help to reduce anxiety and stress scores in patients undergoing diagnostic procedures for pancreatic lesions. However, it needs confirmation in larger, adequately powered trials.