Aromatherapy to Address Psychological Distress in Emergency Department Patients.

Stress and anxiety are frequently experienced by patients during emergency department (ED) visits, often due to diagnostic uncertainty, prolonged wait times, and environmental factors such as noise and bright lighting. These psychological stressors can trigger physiological responses, including elevated cortisol levels, increased blood pressure, and disrupted sleep, which may negatively impact patients' experiences and overall health outcomes. Aromatherapy has emerged as a promising non-pharmacologic intervention for reducing stress and anxiety in various settings.

This pilot randomized controlled trial will be conducted to assess the feasibility and acceptability of a brief aromatherapy session for ED patients. Research staff will pre-screen potential participants admitted to the ED Observation Unit at Brigham and Women's Hospital (BWH) using information from the electronic medical record. After obtaining approval from the treating medical team, staff will approach and invite potential participants to participate in the study. Once consented and screened eligible, participants will complete a baseline assessment and be randomized in a 1:1 ratio to either the aromatherapy group or the control group. Participants in the aromatherapy group will receive a lavender-scented tube and be instructed to inhale it for about 5 minutes. Participants in the control group will receive an unscented tube and follow the same instructions. After the session, participants will complete a post-experiment assessment.

Inclusion criteria

• Adults ≥18 years of age
• Admitted to the BWH Emergency Department (ED) Observation Unit
• Able to provide written informed consent
• Willing to participate in a 1-hour aromatherapy session

Exclusion criteria

• Acutely ill and unable to be approached for research, as determined by the treating medical team and/or physician investigator
• Active gastrointestinal problems at the time of enrollment (e.g., nausea, vomiting, abdominal cramping, diarrhea), as determined by the treating team and/or physician investigator.
• Pregnancy or breastfeeding
• Current or planned treatment using sedating medications
• History of, or current presentation with, significant cognitive impairment or acute delirium that would preclude informed consent or participation
• Currently receiving supplemental oxygen
• Acute exacerbation of asthma or COPD
• Admission for an acute upper or lower respiratory tract illness (e.g., pneumonia, bronchitis, influenza, COVID-19)
• Known allergy or sensitivity to lavender
• Documented history of anosmia (loss of smell)
• Documented hypotension during current ED presentation, defined as systolic blood pressure <90 mmHg
• Assigned clinical staff (physician, nurse, or other healthcare provider) with fragrance sensitivity prior to consent
• Concurrent enrollment in another interventional drug or behavioral trial
• Any condition that, in the judgment of the treating team or physician investigator, would make study participation unsafe or inappropriate.