drawMD APP-aided preoperative anesthesia education reduce parents anxiety and improve satisfaction

Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication

BACKGROUND

The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety.

METHODS

For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling.

RESULTS

The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001).

CONCLUSION

The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.

An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation

BACKGROUND

Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps.

OBJECTIVE

This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers.

METHODS

Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision.

RESULTS

The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis.

CONCLUSIONS

ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.

Effect of Multimedia Teaching Tools in Parental Anxiety and Comprehension of Informed Consent Procedure in Pediatric Surgical Procedures: A Single Centre Randomized Control Trial

INTRODUCTION

Informed consent is an essential component of medical ethics. In children, the parent or legally authorized guardian must consent to any medical or surgical intervention. A number of adjuncts have been developed to supplement the consent process including multimedia tools. Unfortunately, there is little information regarding the use of Multimedia teaching tools (MMT) in pediatric settings in developing countries with diversities in language, socioeconomic and educational status.

OBJECTIVES

The objectives of the study were to compare the parental comprehension of the surgery through the informed consent obtained either by conventional method or by multimedia tool and the effect of MMT in alleviating parental anxiety against the conventional method and to assess their overall satisfaction.

METHODS

A randomized control trial was conducted between 2018 and 2020, including MMT and conventional groups. A novel Multimedia tool with a Microsoft PowerPoint presentation was created. A 5-Question knowledge-based test, State-Trait Anxiety Inventory (STAI) tool, and a Likert-based questionnaire were used to assess the comprehension, anxiety, and satisfaction of parents.

RESULTS

Among 122 randomized cohorts, the mean value of percentage fall in anxiety STAI score in the MMT group was 44.64 ± 10.14 whereas in the Conventional group it was 26.6 ± 11.91 (p < 0.05). MMT cohort scored higher in the knowledge-based test (p < 0.05) and recorded higher parental satisfaction.

CONCLUSION

The Multimedia tool aided consent procedure is effective in reducing parental anxiety and improving their comprehension and overall satisfaction. Thus, they can be used as an effective supplement in preoperative surgical education and consent procedure.

LEVEL OF EVIDENCE

Level I.

Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery

Video propaganda is reported effectively improving patients' understanding of operation. However, whether a video introducing patients' most concerns can reduce preoperative anxiety and promote recovery stays unsealed. In this study, we investigated the effects of complementary therapy of educational video during preoperative visit. The results showed that thirty-five (23.2%) parents in Group Control were diagnosed as anxiety according to SAS, and nineteen (12.3%) patients were diagnosed after video intervention. The APAIs anxiety score and APAIs information score in Group Video were lower than those in Group Control. Compared with Group Control, video visit helped to increase the first-attempt pass rate of the knowledge retention exam and solve the patient's most worried concerns, and decrease incidence of emergence agitation, total cost of hospitalization and length of hospital stay. Moreover, video visit improved satisfaction degrees of patients and their main family members. Briefly, our study demonstrated video visit can improve patients' knowledge of anesthesia and decrease their preoperative anxiety, which may represent an important complementary therapy to routine preoperative visits.

The effect of web-based preoperative information on parents of children who are going through elective ambulatory surgery: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of preoperative web-based information to parents of children undergoing elective ambulatory surgery performed with anesthesia. Outcome measures were parental anxiety, knowledge, and satisfaction.

METHOD

The review followed the PRISMA statement. A systematic search of six databases was conducted. Randomized controlled trials, cluster-randomized trials and quasi-randomized controlled trials were eligible for inclusion.

RESULT

Eight studies were included. An effect in favour of web-based information compared to standard information was observed for parental anxiety measured before separation from child (SMD=-0.66, 95% CI=-0.92 to -0.40) and after surgery (SMD=-0.55, 95% CI=-0.95 to -0.16), for parental knowledge measured in-hospital (SMD=1.10, Cl 95%=0.37-1.82), and parental satisfaction after discharge (SMD=1.03, 95% Cl=0.41-1.65). No effect was observed for anxiety at separation, and for satisfaction in-hospital. The certainty of the evidence varied from very low to moderate.

CONCLUSION

Depending on the timing of assessment, web-based information before pediatric surgery may reduce the level of parental anxiety and increase the level of parental knowledge and satisfaction more than standard care.

PRACTICE IMPLICATIONS

Web-based routines can be used to convey pre-operative information to parents before paediatric ambulatory surgery. Still, standardized research that enables further comparison across studies is needed.

The effect of a video-assisted operating room promotion program on the anxiety levels of parents and their children: A randomized controlled trial protocol

PURPOSE

Anxiety experienced by parents is an important predictor of anxiety experienced by children. Different interventions are used to reduce the anxiety levels of children and their parents during the preoperative period. Apart from conventional training methods, watching videos about real-life operating rooms can reduce parents' and their children's anxiety levels. Children scheduled for surgery are likely to experience less anxiety if their parents experience less anxiety. A video-assisted operating room promotion program will develop for parents. This study will be aimed to evaluate the effect of the program on the anxiety levels of parents and children.

DESIGN AND METHODS

This study protocol is a single-center, single-blind, pre-test, post-test, follow-up parallel group randomized controlled trial. This study protocol was prepared with the Standard Protocol Items: Recommendations for Interventional Trials guidelines and will adhere to the Consolidated Standards of Reporting Trials Non-Pharmacologic Treatment Interventions checklist. A total of 100 eligible participants will be randomized into intervention and control groups. The intervention group will attend the program and receive standard care.

CONCLUSION

If we obtain the expected results, we think that they will help healthcare professionals develop methods and strategies to reduce the anxiety levels of parents and children through content covering the pre-, peri-, and post-surgical processes.

PRACTICE IMPLICATIONS

The results will assist healthcare professionals in the management of pain and guide them in developing technology-based nursing interventions. Trial registration It was registered at ClinicalTrials.gov in January 2022 (NCT05186766).

Implementation of a Personalized Digital Application for Pediatric Pre-Anesthesia Evaluation and Education: An Ongoing Usability Analysis and Dynamic Improvement Scheme

BACKGROUND

Pre-anesthesia evaluation session is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plan per patient, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last two decades, electronic health (eHealth) and mobile health (mHealth) settings gradually replaced part of the face-to-face encounters as the platform for pre-anesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Yet, there is a lack of studies examining the effectiveness of surgical mHealth applications focusing on the pediatric preanesthetic setting and addressing their usability among families.

OBJECTIVE

This study describes a dynamic approach for the development process of GistMD's pre-anesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting.

METHODS

The study was conducted in four departments in a 1500-beds quaternary, academic medical center in Tel Aviv, Israel. During the study period, pre-anesthesia system was sent via text message to families whose children were about to undergo surgery. The system included pre-anesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Ongoing collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period.

RESULTS

In a period of 141 days of implementation, GistMD pre-anesthesia management system was sent to 769 families. Three product fit actions were applied during this term: (1) Change of text message scheduling, aimed at addressing learnability and accessibility, resulted in a significant increase of 27% (χ2 [1] = 12.65, P<.001) in view rates and 27.4% (χ2 [1] = 30.01, P<.001) in satisfaction rates; (2) Reduce the number of screens, aimed at increasing efficiency and operability, resulted in a significant decrease of 8.6% of cases in which users did not perform any activity on the system after logging in (χ2 [1] = 6.18, P=.02); (3) Patient-focused campaign in two departments aimed at addressing memorability, resulted in significant increases in eight of twelve usability indicators.

CONCLUSIONS

Our results indicate that mHealth product-fit decisions derived from theory-based approach and ongoing usability data analysis allow tailoring of most appropriate responses for usability gaps, as reflected in increasing use rates and satisfaction. In the case of the pre-anesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains.

CLINICALTRIAL

Smartphone Interventions Effect in Pediatric Subjects on the Day of Surgery: A Meta-Analysis

Background: A meta-analysis was performed to evaluate the effect of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or standard care as control. Methods: A systematic literature search up to June 2021 was performed and nine studies selected 785 pediatric subjects on the day of surgery at the start of the study; 390 of them were using smartphone interventions, 192 were control, and 203 were using oral midazolam. They were reporting relationships between the effects of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or control. The mean difference (MD) with its 95% CIs was calculated to assess the effect of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or control using the continuous method with a fixed or a random-effects model. Results: Smartphone interventions in pediatric subjects were significantly related to lower anxiety at induction on the day of surgery (MD, -19.74; 95% CI, -29.87 to -9.61, p < 0.001) compared to control and significantly related to lower anxiety at induction on the day of surgery (MD, -7.81; 95% CI, -14.49 to -1.14, p = 0.02) compared to oral midazolam. Conclusion: Smartphone interventions in pediatric subjects on the day of surgery may have lower anxiety at induction compared to control and oral midazolam. Further studies are needed to confirm these findings.

Importance of non-technical skills in anaesthesia education

Rising concern about patient safety has resulted in growing interest in non-technical skills (NTS) among anaesthesiologists. Growing evidence suggesting the use of good NTS training in patient safety in simulated as well as real-world environment made them important in medical education. Both technical skills (TS) and NTS are interdependent. Successful task performance depends on effective integration of both TS and NTS for any given situation. Development of tools for assessing the NTS of an anaesthesiologist in improving health care outcomes is challenging. Teaching, understanding and evaluating NTS among anaesthesiologists in improving health care outcomes is a domain which is supposed to be a rich seam for future studies.

Interventions for Parental Anxiety in Preparation for Pediatric Surgery: A Narrative Review

The preoperative experience can cause significant anxiety for both pediatric patients and their parents in the lead up to a surgical procedure. Pediatric anxiety in a preoperative setting has been shown to have significant negative downstream effects on the clinical outcomes of children and the healthcare system as a whole. Studies have found that preoperative parental anxiety has significant negative effects on children, regarding anxiety and emotional response. Therefore, interventions for parental preoperative anxiety are important to reduce the child’s anxiety. This review provides a brief overview of a broad range of strategies used to alleviate parental anxiety in a preoperative setting. Preoperative education, play-based interventions, music therapy, the presence of parents at induction of anesthesia, and integrative preoperative preparation programs have all demonstrated some evidence for reducing parental preoperative anxiety. The ultimate goal of using interventions for parental preoperative anxiety is to equip healthcare systems to better support families and optimize the perioperative outcomes of children.

Efficacy of Scenario Simulation-Based Education in Relieving Parental Anxiety about Fever in Children

PURPOSE

This study was designed to evaluate the short- and long-term effects of a scenario simulation-based education intervention on parental anxiety about fever in their children.

DESIGN AND METHODS

This experimental research was conducted using a two-group pretest-posttest design. One hundred and sixty parents of 3-month to 5-year-old children enrolled in preschools and kindergartens with childcare services were recruited as participants using cluster random sampling. The participants were divided randomly into an experimental group (80) and a control group (80). The former participated in a scenario simulation-based education intervention and received a fever education booklet. The latter received the booklet only. Data were collected using the Children's Fever Anxiety Inventory at three time points: before the intervention (pretest, T1) and at six-month (T2) and 12-month (T3) posttests.

RESULTS

Significant intergroup differences in fever anxiety were found at both T2 and T3 (p < .001). For both groups, the scores at T2 and T3 were significantly lower than at T1 (p < .001) and the difference between T2 and T3 did not attain statistical significance (p > .05). Although both groups experienced reduced fever anxiety over time, this reduction was significantly greater in the experimental group than in the control group (p < .001).

CONCLUSION

Simulation-based education may be used in conjunction with the traditional fever education booklet to further reduce parent fever anxiety over time.

PRACTICE IMPLICATIONS

This simulation-based education approach significantly and positively impacts parental anxiety about fever in their children. Furthermore, the approach may be generalizable to other childhood healthcare settings.

Preoperative communication with anesthetists via anesthesia service platform (ASP) helps alleviate patients' preoperative anxiety

Female gender has been identified as one of the risk factors closely linked to perioperative anxiety and a lower level of satisfaction. A successful preoperative anesthesia education may improve such negative outcomes. The aim of this study was to investigate whether preoperative anesthesia education via an Anesthesia Service Platform (ASP) could reduce the anxiety levels in female patients scheduled for laparoscopic cholecystectomy under general anesthesia, and accelerate rehabilitation. A total of 222 patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to the control group and the ASP group. Patients’ baseline and post-intervention psychological status was measured by the State-Trait Anxiety Inventory and General Well-Being Schedule. Pain management and recovery were assessed by VAS every 12 h for 48 h after surgery; length of stay (LOS) and postoperative analgesic consumption were also assessed. Patients in the control group experienced higher anxiety levels before surgery and had longer LOS than those in the ASP group. Patients in the ASP group had a higher general well-being score; however, they suffered more pain and consumed more analgesics after surgery. ASP is effective for preventing anxiety in female patients before laparoscopic cholecystectomy, improving patients’ general well-being levels, and shortening their LOS, but negatively influences patients’ postoperative pain levels.

How Hospital Tours Affect Preoperative Anxiety in Mothers with Children Undergoing Open-Heart Surgery in Iran: A Quasi-Experimental Study

Background:

Parents tend to experience considerable amounts of anxiety before their children undergo open heart surgery. This study was conducted to assess the effects of taking a hospital tour on preoperative anxiety in the mothers of children undergoing open heart surgery.

Methods:

In this quasi-experimental study, 96 mothers from Shahid Modarres Hospital in Tehran, Iran, during April to December 2018, were selected through convenience sampling and were assigned to three groups using simple randomization. The oral instruction group (N=32) attended two oral instruction sessions; the hospital tour group (N=32) participated in tours of the operation room and intensive care unit; the control group (N=32) was prepared according to the ward’s routine. Preoperative anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale and the State Trait Anxiety Inventory. Data were analyzed in SPSS-20. The ANOVA, paired t-test and Tukey’s test were used for the data analysis. The level of statistical significance was set at P<0.05.

Results:

The mothers’ anxiety about surgery (F=30.99, P≤0.001) and their scores of state anxiety (F=6.02, P<0.001) differed significantly among the three groups after the intervention. A significant difference was observed between the oral instruction and control groups (P<0.001) and the hospital tour and control groups (P<0.001) regarding the surgery-related anxiety scores. A significant difference was also observed between the oral instruction and control groups (P=0.002) regarding the mothers’ state anxiety scores.

Conclusions:

The results suggest the greater efficiency of oral instructions versus hospital tours. Nurses can use oral instructions for reducing surgery-related anxiety and state anxiety of mothers before their toddlers’ open heart surgery.

Trial Registration Number: IRCT20180904040944N1.

The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials

AIMS

To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents' anxiety and satisfaction with entire course of the day surgery.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018).

REVIEW METHODS

Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed.

RESULTS

Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N = 560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction.

CONCLUSION

Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions.

IMPACT

Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.

The role of smartphone applications in clinical practice: a review

OBJECTIVE

The number of medical mobile phone applications continues to grow. Although otorhinolaryngology-specific applications represent a small proportion, there are exciting innovations emerging for the specialty. This article will assess the number of applications available and review how they may be used in clinical practice.

METHOD

The application stores of the two most popular mobile phone platforms, Apple and android, were searched using multiple search terms.

RESULTS

A total of 107 ENT applications were identified and categorised according to intended use. Eight applications were reviewed in more detail and assessed on whether a doctor or allied health professional was involved in their design and if they were evidence-based.

CONCLUSION

There are a number of ENT-specific smartphone applications currently available. As the technology progresses, their scope has extended beyond being purely for reference. Nevertheless, it remains difficult to assess the validity and security of these applications.

Impact of a multimedia teaching tool on parental anxiety and knowledge during the informed consent process

PURPOSE

Before performing a surgical procedure, informed consent (IC) is obtained. Parents may exhibit anxiety and/or a desire for more knowledge during the IC process for their child. The purpose of this study was to measure the impact of a multimedia intervention (MMI) versus conventional discussion on parental understanding and anxiety during the IC process for infants undergoing surgery for hypertrophic pyloric stenosis.

METHODS

A time-interrupted series design was employed over a 9-month period. In the first phase, conventional discussion for IC was performed. In the second phase, a MMI was utilized. In both phases, anxiety scores and post-consent knowledge tests were collected.

RESULTS

31 participants were included in the study, 17 in the conventional consent and 14 in the MMI phase. Parental anxiety around the IC discussion was measured. There was a significant decrease in anxiety noted with use of the MMI (p = 0.046) but no significant difference in knowledge (p = 0.84).

CONCLUSION

The MMI significantly reduced parental anxiety during the IC process. Providers may consider applying this type of MMI to other surgical procedures. Securing IC in a manner that improves knowledge and decreases anxiety may improve long-term understanding and parental satisfaction with the health care process.

Stakeholder-Engaged Measure Development for Pediatric Obstructive Sleep-Disordered Breathing: The Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents

Importance

Parental decision making about adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is associated with decisional conflict that may be alleviated with improved knowledge about symptoms and treatments.

Objective

To develop a measure of parental knowledge about oSDB and AT.

Design, Setting, and Participants

A sequential design was used for scale development. A prototype measure containing 9 oSDB and AT themes and 85 items was administered in survey format via an online platform. Participants included 19 clinician experts (otolaryngologists and pediatricians) and 13 laymen (parents of children who snore or do not snore, and other adults). Quantitative and qualitative responses were used to modify the measure and create the knowledge scale. Content validity of the scale was established through expert feedback and evaluation. Criterion validity was established with t test comparisons of experts with laymen. Reliability of the responses was assessed with Cronbach α testing.

Main Outcomes and Measures

An 85-item prototype measure and 39-item modified measure were evaluated for consensus/approval and psychometric integrity.

Results

Of 45 potential participants, 32 individuals (71%) responded to the prototype scale. Respondents included 19 clinician experts (59%) (otolaryngologists and pediatricians) and 13 laymen (41%) (parents of children who snore [n = 8] or do not snore [n = 2] and other adults [n = 3]); demographic data were not collected. Content analysis and qualitative feedback were largely rated positively: 27 respondents (84%) stated that the measure was a good evaluation of knowledge, 30 respondents (94%) commented that the items were clear, and 31 individuals (97%) approved of its organization, although there were several suggestions for rewording and/or addition of response options. Experts identified themes most important for assessing oSDB (symptoms) and AT (experiences: risks and benefits) knowledge. These qualitative comments were used to modify the scale, and items were eliminated if more than 2 were reported as misleading or less than 85% of clinicians provided correct responses. Five themes (oSDB symptoms, treatment options, AT risks, anesthesia, and AT benefits) and 39 items composed the final scale. Experts scored higher than laymen on the oSDB and AT Knowledge Scale for Parents overall (17 [94%] vs 12 [67%]; Cohen d = 1.96; 95% CI, 1.05-2.86) and within all themes, including experiences of children with oSDB (19 [88%] vs 13 [62%]; Cohen d = 1.53; 95% CI, 0.71-2.32), treatment options (19 [97%] vs 12 [68%]; Cohen d = 1.74; 95% CI, 0.88-2.57), AT risks (17 [97%] vs 12 [59%]; Cohen d = 1.94; 95% CI, 1.03-2.83), anesthesia (17 [97%] vs 12 [79%]; Cohen d = 1.09; 95% CI, 0.29-1.88), and AT benefits (17 [95%] vs 12 [67%]; Cohen d = 1.28; 95% CI, 0.46-2.09), demonstrating criterion validity. All responses demonstrated high reliability (Cronbach α = 0.94).

Conclusions and Relevance

The oSDB and AT Knowledge Scale for Parents is psychometrically sound for use in the assessment of parental knowledge.