The emotional impact on patients of venous thromboembolism

Communicating a diagnosis of certain diseases, such as venous thromboembolism (VTE), can pose a major challenge. Since the emergence of the pandemic caused by Covid-19 and the publicity given to its association with VTE and death, patients’ fears and apprehension linked to the word “thrombosis” have increased greatly. There is a certain incompatibility between the physician’s objectives and the needs and anxieties of the patient who has suffered a VTE. In general, little attention is paid to emotional issues, but they rise to the surface when patients and their families are informed of the diagnosis.¹

The psychological and emotional impacts on patients are rarely assessed in studies investigating VTE. Feehan et al.² analyzed the psychological consequences for 907 patients with VTE, finding that around 40% of the study participants had daily fears of repeat thrombosis, 24.7% had abnormal levels of anxiety, and 11.6% had abnormal levels of depression. Younger patients reported greater VTE impact on their lives, with high levels of anxiety, fear, panic, nightmares, and symptoms of posttraumatic stress,³ while patients with VTE may have higher levels of anxiety than patients with other serious diseases, such as acute myocardial infarction.²

A Canadian study identified seven major themes related to patients’ experiences with VTE: acute impacts (initial shock and physical symptoms), sustained psychological distress (fear of recurrence and death), loss of self (changing habits and taking decisions for the future), challenges of VTE treatment (anticoagulation and elastic compression stockings), balance of life changes, negative experience with the medical system (delays and diagnostic errors), and VTE in the context of other conditions.⁴

Alarmist language and misplaced medical metaphors were identified as sources of anxiety in this context. Articles report phrases selected by patients as being highly harmful, such as: “you could have died if we did not make this diagnosis today”, “I’ve seen patients die from what you have”, and “you are a walking time bomb”.⁵ The physician should always use basic, layman’s language, at times and in places that are appropriate for communicating with the patient, using techniques for communicating bad news, such as the SPIKES protocol (setting up, perception, invitation, knowledge, emotions, strategy, and summary), for example. Constant checks should be made to ensure the patient understands every element covered and care must be taken with posture and non-verbal language, avoiding facial expressions of worry, tension, and indifference.⁵ Terms such as “postthrombotic panic syndrome” and “thromboneurosis” are increasingly common in the specialist literature.⁶

Physicians may contribute to postthrombotic psychological suffering, but they also can, and should, work to recognize and attenuate these manifestations, taking a range of actions, such as: ensuring early assessment by a specialist; actively listening to patients; dealing with their concerns; and providing information in hard copy and online about the disease and guidance about support groups, trustworthy websites, and specific keywords for searching the internet; in addition to employing educational resources, such as anatomic models, for example.⁷

The psychosocial impact of VTE can be highly traumatic, changing the patient’s life. Therefore, there is a real need to produce guidelines based on evidence specific to the management of these emotional sequelae and to implement programs for continuing medical education on the subject. Through recognition, dedication, and empathy, we can improve the experience of patients who have been the victims of VTE and contribute to their full recovery.

However, one question remains: “Do I communicate venous thrombosis cases to my patients in the best way possible?”.

• How to cite: Ribeiro AJA, Marques MA. The emotional impact on patients of venous thromboembolism. J Vasc Bras. 2022;21:e20220151. https://doi.org/10.1590/1677-5449.202201512
• Financial support: None.

REFERÊNCIAS

• ¹
  Goldhaber SZ. Emotional and psychological coping after venous thromboembolism. Thromb Haemost. 2009;102(6):1007-8. http://dx.doi.org/10.1160/TH09-09-0648 PMid:19967127.
  » http://dx.doi.org/10.1160/TH09-09-0648
• ²
  Feehan M, Walsh M, van Duker H, et al. Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: a cross-sectional structural equation model. Thromb Res. 2018;172:181-7. http://dx.doi.org/10.1016/j.thromres.2018.05.025 PMid:29843918.
  » http://dx.doi.org/10.1016/j.thromres.2018.05.025
• ³
  Højen AA, Dreyer PS, Lane DA, Larsen TB, Sorensen EE. Adolescents’ and young adults’ lived experiences following venous thromboembolism: “it will always lie in wait. Nurs Res. 2016;65(6):455-64. http://dx.doi.org/10.1097/NNR.0000000000000183 PMid:27801716.
  » http://dx.doi.org/10.1097/NNR.0000000000000183
• ⁴
  Genge L, Krala A, Tritschler T, et al. Evaluation of patients’ experience and related qualitative outcomes in venous thromboembolism: a scoping review. J Thromb Haemost. 2022;20(10):2323-41. http://dx.doi.org/10.1111/jth.15788 PMid:35730241.
  » http://dx.doi.org/10.1111/jth.15788
• ⁵
  Hernandez‐Nino J, Thomas M, Alexander AB, Ott MA, Kline JA. Communication at diagnosis of venous thromboembolism: lasting impact of verbal and nonverbal provider communication on patients. Res Pract Thromb Haemost. 2022;6(1):e12647. http://dx.doi.org/10.1002/rth2.12647 PMid:35071970.
  » http://dx.doi.org/10.1002/rth2.12647
• ⁶
  Hunter R, Lewis S, Noble S, Rance J, Bennett PD. “Post‐thrombotic panic syndrome”: a thematic analysis of the experience of venous thromboembolism. Br J Health Psychol. 2017;22(1):8-25. http://dx.doi.org/10.1111/bjhp.12213 PMid:27611117.
  » http://dx.doi.org/10.1111/bjhp.12213
• ⁷
  de Wit K. Do physicians contribute to psychological distress after venous thrombosis? Res Pract Thromb Haemost. 2022;6(1):e12651. http://dx.doi.org/10.1002/rth2.12651 PMid:35106433.
  » http://dx.doi.org/10.1002/rth2.12651

Publication Dates

• Publication in this collection
  10 Feb 2023
• Date of issue
  2023

History

• Received
  23 Nov 2022
• Accepted
  08 Dec 2022