Reducing Fears about Blood Donation
Dr. Philippe Gilchrist, Dr. Elisabeth Huis in 't Veld, Dr. Janis France & Professor Christopher France
Reducing venipunture pain by addressing fears among whole-blood & plasma donors
DR. PHILIPPE GILCHRIST
Dr. Philippe Gilchrist is a Senior Lecturer and Program Director in Clinical Psychology, Macquarie University. His research concerns the emotional and physiological (e.g., cardiovascular) states linked to everyday environmental and social challenges.
In his recent DoRN Week of Talks presentation, Philippe presented a study that examined to what extent donor fear is associated with various donor outcomes in an Australian sample, and whether this fear can be addressed onsite to reduce adverse reactions and improve the donor experience.
To access Philippe’s free talk, please click on the video below.
Conquer your needle fear with AINAR: Artificial Intelligence for Needle Anxiety
Dr. Elisabeth Huis in 't Veld
Dr. Elisabeth Huis in ‘t Veld, MBA is an assistant professor and PI of Donor Cognition, situated at Tilburg University’s School of Humanities and Digital Sciences as well as Sanquin’s Donor Medicine Research department.
In her recent DoRN Week of Talks presentation, Elisabeth discusses the development of AINAR: Artificial Intelligence for Needle Anxiety. AINAR is a Biofeedback game that aims to help people with their needle fear and vasovagal reactions.
To access Elisabeth’s free talk, please click on the video below.
A tablet-based intervention to build the confidence of fearful high school blood donors
Dr. Janis France & Professor Christopher France
Dr. Janis France and Professor Christopher France are both researchers in the Department of Psychology at Ohio University with over 50 years of experience combined.
In their recent DoRN Week of Talks presentation, Janis and Chris discuss a recent RCT that examined whether teaching young donors strategies to address their fear can enhance their confidence, and possibly improve their retention in the donor pool. To view the related paper click here.
To access Janis and Chris’s free talk, please click on the video below.
Q & As
The DoRN Week of Talks provided a unique opportunity to engage in an easy and convenient Q & A with presenters. Below we have listed the questions that we received for Dr. Philippe Gilchrist, Dr. Elisabeth Huis in 't Veld, Dr. Janis France and Professor Christopher France, along with their answers.
Q&A- Dr. Philippe Gilchrist
Why do you think asking donors about fear did not increase fear?
Ensuring that asking about fear does not inadvertently increase fear among donors is important. Fortunately, I am not aware of any empirical data or theoretical reason to suggest that asking about fear (among donors or other otherwise healthy populations) could increase fear or subsequent fear-related reactions. The current findings are also consistent with previous studies demonstrating that asking about fear does not increase fear or influence frequency of reactions, consistent across inexperienced and experienced donors, and corroborated by observed reactions (France et al., 2012; France et al., 2013; France et al., 2019).
In addition to the lack of data or rationale to suggest asking about fear could increase fear, there is an argument that the simple act of asking about fear can be beneficial in itself. For example, there are circumstances when supressing an emotion can lead to increased stress on the body. More importantly, checking-in with a donor may also have the added benefit of conveying support.
Finally, volunteer donors also made up these samples and are likely more resilient than non-donor counterparts. Though donor fear (even relatively low levels of fear) is clearly an important predictor of adverse reactions and reduced retention, donors report significantly lower donation-related fears than non-donors (Gilchrist et al., 2019). Also, donation is a voluntary activity and those who are particularly fearful are unlikely to present at a centre.
Q&A- Dr. Elisabeth Huis in 't Veld
I was just curious how much of AINAR is specific to needle fear/ vasovagal reactions and how much could be used more generally (i.e., to curb general medical anxiety)?
Right now, we are specifically collecting a dataset recording responses to needles. I am not sure yet which aspects of needle fear are unique, and which ones overlap with general medical anxiety. I presume that at least some aspects will be unique. Hence, I think that even though AINAR might work for more general medical anxiety, it might not work as well. The only way to know is to try it! We do collect data using the “Threatening Medical Situation Inventory” questionnaire in our study, so we will at least have a measure of this from the personality side. However, the technique behind AINAR will be easily trainable on a new dataset which will allow us to make it more suitable for different situations.
With the eventual implementation of this, are you hoping that you can train blood donors pre-donation how to regulate their reactions when donating blood or are you anticipating that they will engage in the AINAR tasks just before donating blood (e.g., in the chair just before needle in) to get themselves into the ideal 'pre-donation' state?
Yes! I’m definitely targeting pre-donation hoping to get them in a good pre-donation state. I’m hoping that donors will use AINAR prior to the donation itself, and that they can put it away once the donor assistant wants to interact with them. I find with patients that they tell me that they already start to get anxious the day before, or the morning of, for example. These people might want to start playing a bit then, or maybe on the way to the blood bank if they are using public transport. In general, I’d recommend donors to play it in the waiting area, as we know for a fact that this is where the anxiety is rising steadily. However, our vision for AINAR is not for it to interfere with the wonderful donor assistants and their interaction with the donor. By then, AINAR should’ve done it’s work.
Q&A- Dr. Janis France & Professor Christopher France
Based on the small difference in vasovagal reactions between the control group and intervention group, I'm wondering about the psychological basis of vasovagal reactions after blood donations. Do you know if there is any existing research that examines the nocebo effect of blood donations?
There are several recent studies that could be viewed from the perspective of the nocebo effect, including research that has demonstrated that fear of blood draw is associated with significantly higher expectations of vasovagal reactions (France & France, 2018; 2019). Although simply asking a donor about their fear is not associated with a higher risk of vasovagal reactions (France et al., 2012; France et al., 2013; France et al., 2019; Gilchrist et al., 2019), it is possible that some donors may have had negative expectations regarding their chosen intervention that could have increased their risk for a vasovagal reaction. At the group level this does not appear to have been a problem as the frequency of vasovagal reactions did not differ between those who received an intervention (6.1%) relative to controls (6.8%), but an idiographic assessment of individual expectancies may be worth pursuing.
Could the results of the intervention been affected by high-school students inaccurately reporting fear (for example, if they were donating blood around their peers and wanted to potentially appear less afraid then they may have been)?
It is possible that participants may have been reticent to acknowledge fear. In the current study participants provided a private rating of fear on a tablet, hence it is unlikely that other donors would see their rating. Of course, this does not eliminate the possibility that donors wanted to downplay their fear to others or even to themselves. It is perhaps noteworthy that we have seen very similar distributions of fear ratings among high school blood donors assessed in three different cities in the US (France et al., 2013; 2019; 2020), with each of these studies suggesting that approximately half of the donors report some fear.