A biopsy—the surgical extraction and examination of a living tissue sample to determine the presence, cause, or extent of a disease—can be scary and sometimes painful. How healthcare staff approach patient education and communication before, during, and after the procedure can make a huge impact on the overall experience for both patients and their caregivers. 

Few studies have been done to gauge patient and caregiver experiences when it comes to renal biopsy. There are studies, however, concerning other types of biopsies that can inform medical teams’ approaches and suggest further research concerning communication, patient education, psychosocial support, and self-management. 

A non-profit organization, Kidney Health Australia, shares an overview of the studies on which they based their guidelines for best practices on biopsy information and education for patients and caregivers.*

What does a renal biopsy entail?

Percutaneous renal biopsy—or the extraction of a tissue sample from the kidney via needle—is considered the most reliable way to explore the causes of kidney disease. 

A renal biopsy is a day-long process that consists of three main steps:

1. Pre-admission consultation: During this consultation, blood tests are arranged, the benefits and risks of a biopsy are explained, and a consent form for the procedure is signed by the patient.
2. Biopsy: The procedure lasts approximately an hour, during which you will be awake and typically laying on either your back or side. A local anesthetic is applied to the area. If you have additional pain, your doctor may give you medication through an IV during the procedure. A renal biopsy is a safe procedure, with a few minor possible risks.
3. Post-procedure observation: You’ll head to a recovery room to rest, where you’ll be monitored (blood pressure, pulse, and breathing)—typically for about six hours. You’ll be given a urinalysis and a complete blood count test before you’re released. You may feel some soreness at the biopsy site, for which you’ll be given pain medications.

What they did

The research team used multiple studies to acquire data about biopsy information and education for patients and caregivers. Of the studies used, two studies involved prostate biopsies, and seven studies involved breast biopsies.

From the prostate biopsy studies

In the studies where men had undergone transrectal prostate biopsies, they found the following information:

In the first study, which surveyed 85 men:

• 25% of participants felt ill-prepared for possible complications, such as blood loss, pain, and infection. 
• Anxiety ran highest when actual experiences differed from expectations resulting from the information provided
  

In the second study, which included 30 men:

• 90% of participants experienced increased pain and anxiety as each sample was taken.
• All participants felt anxious while awaiting both their screening test results and their biopsy results.

From the breast biopsy studies

Data gleaned from the seven breast biopsy studies demonstrated that the participants:

• were primarily concerned about the biopsy procedure and the biopsy results;
• didn’t want to hear about treatment options prior to undergoing the biopsy or receiving their results;
• preferred to receive information about the procedure directly from their trusted physician;
• desired reassurance, understanding, and emotional support from their healthcare team;
• felt better prepared when receiving information in simple, easy-to-understand language; 
• preferred receiving information in multiple forms (in-person, via phone, written brochures, graphic flip charts, etc.);
• wanted to shorten the time between detection and biopsy to reduce physical and psychological symptoms of anxiety; and
• felt most anxious while anticipating the results of their biopsies, regardless of how much information they received beforehand or how effectively it was communicated.

Moreover, caregivers desired more information about the procedure, diagnosis, treatment options, and side effects. 

What they found

Upon analyzing these biopsy studies, the researchers gained significant insight from one study in particular, which offered possible modeling for best practices. The study surveyed women, ranging in age from 24 to 92, who had undergone breast biopsies in a rural cancer center that focuses on effective patient communication and education. 

The study showed that the center:

• conveys diagnostic information to patients using direct and specific language;
• streamlines follow-up by reviewing results with doctors before contacting patients; and
• gives patients the opportunity to contact the physician for further clarification if needed. 

More than 95% of the women surveyed agreed that:

• the biopsy procedure was explained to them in appropriate, simplified terminology; 
• the reason for the biopsy was satisfactorily explained; and
• they felt the surgical team cared about their emotional and physical comfort, as well as kept them sufficiently informed throughout the process.

What this means

Biopsies can be extremely stressful, given their potentially life-altering results. The evidence suggests that many patients’ psychosocial needs are not being adequately addressed in a widespread, compassionate, constructive way before, during, or after these procedures. 

The study demonstrates a need for medical professionals and researchers to reevaluate their patient protocols and adapt the suggestions to renal biopsies while continuing to improve the patient and caregiver experience.

*Champion de Crespigny, P., See, E., Lopez-Vargas, P., et al. (2018, July.). “Biopsy Information and Education for Patients and Caregivers.” Kidney Health Australia.