The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

Abstract

Background Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure. Method We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded. Results We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17–52% (cancer), 25–47% (chronic kidney disease) and 0.2–80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality. Conclusion Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.

Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population

“…In 2007, a large US-based survey evaluated the epidemiology of needle phobia using the DSM criteria and reported a strikingly low prevalence (2.1%) of BII phobia in the total adult population [ 16 ]. On the other hand, a review of the literature focusing on adults with different chronic diseases used a broader definition as discomfort, anxiety, fear, distress and/or phobia related to needles [ 22 ]. The study reported higher rates of needle fear, with prevalence ranging from 17% to 52% among adults with past or current experience of chemotherapy and from 25% to 47% among adults receiving peritoneal dialysis or hemodialysis [ 22 ].…”

“…Multiple innovation-related (e.g., using smaller/thinner needles or autoinjectors) [ 17 – 21 ] and other strategies (e.g., educational and psychological interventions) [ 22 , 23 ] to address needle phobia were presented in the literature. However, these assessments were generally limited to evaluating a single approach without comparing different approaches/strategies to address needle fear.…”

Optimizing the Use of Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes: Executive Summary

“…Although concerns about injectable medications are well established among both people with diabetes and clinicians (30), clinicians should strive to be a catalyst for overcoming, rather than propagating, any concerns on the part of people with diabetes. One helpful strategy is to have people self-administer their first dose of an injectable GLP-1 receptor agonist in the clinic and then ask if they have any concerns with the experience.…”

A one‐time pneumatic jet‐injection of 5‐fluorouracil and triamcinolone acetonide for treatment of hypertrophic scars—A blinded randomized controlled trial

“…[11][12][13] Despite good clinical efficacy, patients are often reluctant to repeated needle injections due to associated pain, needle fatigue, and needle phobia. 14 Additionally, the treatment is hard to standardize, and outcomes heavily rely on the practitioner's experience.…”

“…Recently the combination of corticosteroids and the antiproliferative agent 5‐fluorouracil (5‐FU) demonstrated better efficacy and safety profile compared to corticosteroids alone 11–13 . Despite good clinical efficacy, patients are often reluctant to repeated needle injections due to associated pain, needle fatigue, and needle phobia 14 . Additionally, the treatment is hard to standardize, and outcomes heavily rely on the practitioner's experience.…”