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Health anxiety has many damaging effects on patients with chronic illness. Physicians are often unable to alleviate concerns related to living with a disease that has an impact on daily life, and unregulated websites can overrepresent extreme anxiety-inducing outcomes. Educational clinician video interventions have shown some success as an acute anxiolytic in health settings. However, little research has evaluated if peer-based video interventions would be a feasible alternative or improvement.
This pilot study assesses the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. It investigates the degree to which patient testimonials can affect state anxiety, and whether patients are comfortable enough with the technology to share their stories.
Patients with CD (n=51) and those with UC (n=49) were shown testimonial videos of patients with CD during their physician consultations at Kitasato University Kitasato Institute Hospital in Japan. The video testimonials were collected from Dipex Japan, the Japan branch of an international organization specializing in understanding patient experiences. Patients completed a Visual Analogue Scale for Anxiety before and after viewing the videos, a Hospital Anxiety and Depression Scale (HADS) survey before the videos, and satisfaction surveys. Patients receiving infusion therapy participated in the study while receiving treatment to minimize hospital workflow disruption.
Anxiety reduction, on the Visual Analog Scale for Anxiety, was significant in the entire cohort both when viewed as an ordinal variable (
Our pilot results suggest that patient testimonial videos can reduce illness-related state anxiety for patients with CD and those with UC, especially in those with higher baseline state anxiety. The success of this study in reducing anxiety and achieving patient involvement suggests that video interventions for reducing anxiety might be a low-cost intervention that could scale to any number of hospitals, suggesting that technology can help scale up efforts to record and share patient testimonials. Future work can establish whether patient testimonials can be helpful in other contexts, such as before major surgeries or when a family member receives a difficult diagnosis.
Managing health anxiety is essential in treating chronic illness [
These challenges are amplified in patients with inflammatory bowel disease (IBD), who are estimated to have a 2- to 6-fold increased odds for developing an anxiety disorder [
Recent literature has examined how clinician educational video interventions can be used as an acute anxiolytic in health settings [
In this work, we describe a pilot study that assessed the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. This pilot study investigates whether patient testimonials can be integrated into the normal hospital workflow, and whether patients are comfortable enough with the technology to share their stories.
The study was conducted at the outpatient clinic of the Center for Advanced IBD Research and Treatment at Kitasato University Kitasato Institute Hospital. Randomly selected patients with a confirmed diagnosis of CD or UC were included in the study if they were older than 20 years. Patients were excluded from the study if they did not understand Japanese or participated in any other clinical trials. A total of 100 patients were included. See
Descriptives of patients and self-report measures (N=100).
Characteristic | Value | ||
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UCa | 49 | |
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CDb | 51 | |
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Male | 63 | |
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Female | 37 | |
Age (years), median (IQR) | 41.5 (30-50) | ||
Years since diagnosis, median (IQR) | 10 (5-20) | ||
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CD | 59 (37.5-108.5) | |
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UC | 0 (0-1) | |
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All | 5.6 (4.3) | |
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CD | 5.0 (4.4) | |
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UC | 6.3 (4.3) | |
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All | 26.8 (25.1) | |
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CD | 28.3 (26.4) | |
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UC | 25.2 (23.7) | |
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Low HADS-Ae, Low baseline VAS-Af | 64 | |
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Low HADS-A, High baseline VAS-A | 16 | |
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High HADS-A, Low baseline VAS-A | 8 | |
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High HADS-A, High baseline VAS-A | 7 | |
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Yes | 43 |
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No | 48 |
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No response | 9 |
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Video | 18 |
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Document | 23 |
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Audio only | 7 |
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Yesh | 71 |
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Noi | 29 |
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Yesj | 54 |
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Nok | 8 |
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Unsurel | 38 |
aUC: ulcerative colitis.
bCD: Crohn disease.
cCrohn’s Disease Activity Index for CD [
dLow HADS-A is below 11 [
eHospital Anxiety and Depression Scale
fVisual Analogue Scale for Anxiety
gQuestions were presented to patients in Japanese; English translations shown in table above.
hAmong patients with UC, the
iAmong patients with UC, the
jAmong patients with UC, the
kAmong patients with UC, the
lAmong patients with UC, the
This study was approved by the Research Ethics Committee of Kitasato University Kitasato Institute Hospital (#21006). Data analyzed in this study were anonymized. Patients signed consent waivers in Japanese consistent with Kitasato University Kitasato Institute Hospital practices and were not compensated.
The primary outcome metric for this study was the Visual Analogue Scale for Anxiety (VAS-A) [
All patients completed the Hospital Anxiety and Depression Scale (HADS) survey [
The videos were collected from DIPEx Japan [
Patients met with physicians before participating in the Hospital Senpai pilot. Participants completed the VAS-A and HADS, and then engaged with the testimonial videos through the software (
A screen capture of 6 pages of the Hospital Senpai video viewing software. Patient images are blurred in this screenshot but not the actual software.
Patients completed an 11-question multiple choice and free-form survey on usability and satisfaction at the end of the study. Users answered questions in Japanese such as whether the content was relevant, how easy the video viewing process was, and whether the patients would share their story for future users.
We compare the VAS-A scores before and after video testimonials. In some domains, the VAS values are not normally distributed [
There was a statistically significant decrease in state anxiety (VAS-A) before and after watching testimonial videos across all patients both when interpreting VAS-A as an ordinal variable (
Sixty-nine percent (n=16) of patients with low HADS-A but high baseline VAS-A experienced a reduction in anxiety (see
Histogram plots of prevideo Visual Analogue Scale for Anxiety (VAS-A) scores minus postvideo VAS-A scores for different baseline VAS-A and HADS Anxiety (HADS-A) cohorts. Positive scores mean reduced anxiety. Patients with incomplete Hospital Anxiety and Depression Scale (HADS) responses were dropped.
Pre–Visual Analogue Scale for Anxiety (Pre-VAS-A) and Post-VAS-A scores for 2 subgroups. CD: Crohn disease; UC: ulcerative colitis.
Among all patients, 71% (n=100) responded that the videos were relevant and only 8% (n=100) said that they were not helpful. Importantly, patients with UC responded similarly even though all testimonial videos were from patients with CD (71% relevant, 10% not helpful, n=49). In addition, 42% (n=100) of all patients responded that they would be willing to share their stories on the platform for future patients.
This study suggests that patient testimonial videos can reduce state anxiety during hospital visits for patients diagnosed with IBD. It also demonstrates that video testimonials can be effectively integrated into the normal hospital workflow. Finally, surveys show that patients are willing to share their stories for future patients as part of the program.
Patients with high starting state anxieties demonstrated the greatest reduction in state anxiety. Similarly, patients with high starting state anxieties and low HADS-A consistently experienced reduced anxiety, indicating that patients without a formal anxiety disorder could potentially benefit from video testimonial intervention. For reference, the psychopharmacological intervention study with closest methodology investigating acute anxiolytic effect in the range of minutes-to-hours found a comparable VAS-A reduction [
Limitations of this work include using a rigorous control group of patients who watch unrelated or no videos, exploring the bias introduced by only sharing testimonials from volunteers, a patient cohort more representative of the population with CD and UC, and the bias introduced by patients knowing the physicians conducting the study.
This work suggests that patient testimonials might be a low-cost intervention that can reduce health anxiety during hospital visits. As long as patients continue to be willing to share their stories, the video testimonial framework presented in this study has the potential to easily scale, especially compared to more expensive or more time-intensive interventions. Further research can help establish how anxiety reduction leads to better patient adherence to treatment plans, satisfaction with their treatment, and overall outcomes. This work also highlights the possibility that patient testimonials can be helpful in other anxiety-inducing health situations, as well as in other conditions outside of IBD.
Supplementary details on data.
Crohn disease
Hospital Anxiety and Depression Scale
Hospital Anxiety and Depression Scale–Anxiety
inflammatory bowel disease
ulcerative colitis
Visual Analog Scale for Anxiety
The authors thank DIPEx for graciously allowing to use their videos; Miguel de Andrés-Clavera for his technical guidance; Joe Fry for his ruthless pursuit of funding; Jordan Tharpe and Stefanie Nickels for reviewing the paper and suggesting publication venues; and Joe Ledsam, Michael Howell, and Megan Jones Bell for reviewing the paper. This work was funded by Verily Life Sciences and Google Japan.
The data sets generated during and/or analyzed during the current study are not publicly available due to patient privacy.
JS was involved in the conceptualization, methodology, formal analysis, resources, data curation, writing-original draft, writing-review and editing visualization, and funding acquisition. HK was responsible for resources, project administration, and funding acquisition. PC carried out conceptualization, methodology, software, resources, and funding acquisition. YI was responsible for project administration. JR was involved in writing-original draft and writing-review and editing. TK and YM performed conceptualization, methodology, investigation, resources, data curation, supervision, and project administration. EA carried out methodology and investigation.
This work was funded by Google Japan and Verily US. TK has received grants from: AbbVie, Activaid, Alfresa Pharma, Bristol Myers Squibb, EA Pharma, Eli Lilly, Gilead, Google Asia Pacific, Janssen, JIMRO, JMDC, Kyorin, Mitsubishi Tanabe Pharma, Mochida, Nippon Kayaku, Otsuka Holdings, Pfizer, Takeda, and Zeria; lecture payment from: AbbVie, Activaid, Alfresa Pharma, EA Parma, Galapagos, Janssen, JIMRO, Kyorin, Mitsubishi Tanabe Pharma, Nippon Kayaku, Pfizer, Takeda, ThermoFisher Diagnostics, Zeria; expert testimony from: AbbVie, Activaid, Alfresa Pharma, EA Pharma, Janssen Japan K.K., KISSEI, Kyorin Pharmaceutical, Mitsubishi Tanabe, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, and Takeda.