Effect of waiting room ambience on the stress and anxiety of patients undergoing medical treatment: A systematic review and meta-analysis

Objective: We systematically reviewed different waiting room designs and interventions during the waiting time, before medical or dental treatment. The risk of bias was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool. Data: Studies reporting on different interventions in medical waiting areas and parameters like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure DBP), respiratory rate (RR) and/or anxiety [state trait anxiety inventory (STAI), visual analogue scale (VAS)] and mood [multi-dimensional mood state questionnaire (MDBF)] were included. Two authors independently searched and extracted records. Sources: Electronic databases (PubMed, Embase, Cochrane CENTRAL, Google Scholar) were screened, and hand searches and cross-referencing performed. Study selection: 81 articles were included for qualitative (n=53) and quantitative (n=28) analyses. The metaanalysis revealed significant reduction in the patient's HR when exposed to aquariums for 20 minutes (p=0.02), animal/bird/aquarium videos (p=0.001). BP was significantly reduced by listening to music for <20 minutes (SBP: p=0.011; DBP: p=0.029). Overall subjective assessments revealed a significant reduction (p<0.001) in anxiety by music and aroma therapy (>20 minutes: p<0.001; <20 minutes: p=0.014). Conclusions: Optimal exposure time to aquariums, animal/bird/aquarium videos, aromatherapy, or listening to music may have a positive impact on the pre-treatment stress and anxiety of patients waiting to undergo a medical procedure. Clinical significance: Music, aroma and aquarium interventions in waiting areas can be recommended for clinical practice. The side effect profile is low and all three interventions show an anxiety-reducing effect, when waiting times are 20 minutes and more. Dentists could use the waiting area to reduce stress and anxiety in their patients.