Applying weighted blankets for 20 minutes reduced patient anxiety during cancer infusions.
A nurse-led project demonstrated that patients with cancer experienced reduced anxiety levels during infusions when weighted blankets were used as a supportive care measure, according to a study conducted at the Dana-Farber Cancer Institute ambulatory infusion clinic. The weighted blankets were applied for a minimum of 20 minutes during a patient’s first or second administration of a chemotherapy or immunotherapy infusion.
Data presented at the 48th Annual Oncology Nursing Society (ONS) Congress showed that before and after the application of the weighted blankets, the rates of extreme anxiety were 7% vs 0%, respectively; the rates of moderate anxiety were 30% vs 18%, the rates of very little anxiety were 28% vs 44%, and the rates of patients with no anxiety were 28% vs 38%.
In usability survey responses, 1 patient reported that the weighted blanket “was soothing and helped with my anxiety, making me more comfortable.” Additional patient feedback was largely positive. “It was relaxing, reassuring, and helps with my treatment,” another patient shared. “It was helpful and created a calm and secure feeling,” another responded.
Oncology Nursing News® spoke with the nurses from Dana-Farber Cancer Institute who spearheaded this intervention. These included infusion nurses Cherice Hermann, BSN, RN, OCN; and Victoria Cole, BSN, RN; director of nursing, Cynthia Arcieri, MS APRN OCN; and clinical nurse specialist, Megan Corbett MSN, RN, NPD-BC, OCN.
Oncology Nursing News: What was the rationale for conducting this research?
Hermann: It is acknowledged in the world of oncology that patients have a lot of anxiety when they get their diagnosis, [and] it resurfaces or becomes heightened when they start their first few treatments because they are starting to get the chemotherapy at that point. At Dana-Farber, patients report to us that anxiety is the third most common symptom they experience.
The literature tells us that, mostly, what has been used in the past in medicine [are] cognitive behavioral therapies such as biofeedback, desensitization, or counseling. Those kinds of treatments for patients who have really high anxiety [have been used], but other disciplines were starting to use this deep pressure tissue technique, which is what a weighted blanket is. They use [this approach] for individuals with autism, [at] schools, [or in] dental offices where there is high anxiety.
In our research, we realized that there is not much [research in] oncology [regarding] the use of a weighted blanket. We had read an article in the Clinical Journal of Oncology Nursing about a project that was done, and we took that to management and were able to get permission to do a weighted blanket project. With the weighted blanket we wanted to get one [where the weight] would be evenly distributed across the patient and we wanted the patient to be able to take it off if they wanted to. We were able to find one that met those criteria [and] it also met the criteria of being medical grade, meeting the infection control standards we have.
[Moreover], at the time we started this project, COVID-19 had hit and with COVID-19 came increased anxiety not only because [of the virus], but also [because] at that time we were not able to allow patients to have any support with them when they came to the clinic for their treatment or their appointment with a provider. They came alone and coming alone, getting all the information about having cancer, [hearing] what the doctor was going to recommend their treatment be, and then to start a treatment all alone [resulted in increased] anxiety. The nurses saw that and it compelled us to get started with the weighted blanket after reading that article.
How was the study conducted and what methods were used to assess levels of anxiety during treatment?
Cole: We would do a verbal consent at the teaching, which we have every time before a patient starts a treatment. Upon [the patient’s] arrival to clinic, the clinical assistant and the primary nurse would come together and collaborate to figure out exactly who was part of the study.
At that time the clinical assistant would get a presurvey, to evaluate the anxiety level that the patients had at that time. After the surveys were completed and the premedications were given, we would apply the weighted blanket. We always did the presurvey prior to [the weighted blanket use] because we did not want premedications, such as Benadryl, for instance, to determine and change the anxiety levels of the patients.
At that time, we would put the weighted blanket on the patients [and] we asked the patients to keep the weighted blanket on for at least 20 minutes. They were more than welcome to keep it on for longer, but if it felt a little too heavy for them, we [only] asked them to put it on for 20 minutes. After the 20 minutes were done, we gave them a post survey, again confidential, to fill out to see how their anxiety levels changed. In the surveys the patient self-reported on their anxiety levels.
What were the results seen after the application of the weighted blanket?
Arcierri: The results of our weighted blanket project were quite significant—we saw a nice decrease in patients’ anxiety after the application of the weighted blanket. What was wonderful to see is that patients who had extreme anxiety, which was approximately 6% of our patients before the weighted blanket, [had their anxiety levels go] down to 0% after the weighted blanket applications. Our patients who were moderately anxious went from 28% to 18%.
Additionally, we surveyed both the patients and the nurses about the usability of the blanket. What was great to read in their comment section was that the blanket was not too heavy, it was quite comfortable, and the patients didn’t feel that it interfered with the nurse’s ability to provide care. The nurses likewise also commented in their questionnaire that it was very easy to apply [and] they also felt that when the patients had the blanket on it did not impact their ability to access any IVs or provide therapy to the patient while they were in the infusion chair.
Overall, we found that using the weighted blanket was an easy strategy for the nurses to use in helping patients to decrease anxiety. We found that in the clinic it was very easy to operationalize amongst our team and it was something simple that we could have control over to help patients have a better experience.
What are any next steps for the research?
Corbett: We are looking to implement the use of weighted blankets across Dana-Farber Cancer Institute [and] not only are we sharing our weighted blankets, we are also sharing our implementation plan. We are going from meeting to meeting and committee to committee to share our work and support the teams who are looking to have weighted blankets in their infusion clinics as well.
We learned [and saw] only positive patient and nurse validated results from this study, so we want to expand the use of weighted blankets in oncology nursing care. We would love to say weighted blankets are part of standard of care in oncology nursing practice, and that every infusion clinic has access to weighted blankets and [that] patients are able to use them freely.
Corbett M, Hermann C, Chicko L, Cole V, Arcieri C. Evaluating the use of weighted blankets as an anxiety reduction tool during cancer treatment. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed May 10, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12939