Measuring the Effects of an Animal-Assisted Intervention for Pediatric Oncology Patients and Their Parents: A Multisite Randomized Controlled Trial

Healthcare professionals' attitudes to animal assisted activity with dogs in paediatric care

BACKGROUND

Hospitalization for children often involves stress induced by fear and pain. Complementary therapies, such as Animal Assisted Activities (AAA) with dogs, can alleviate the hospital experience.

PURPOSE

The first aim of this study was to initiate the development of an instrument that measures healthcare professionals' attitudes toward complementary therapy, specifically dogs in AAA. The second aim was to elucidate the emerging effects of introducing dogs to children in healthcare settings, as reported by healthcare professionals.

MATERIALS AND METHODS

A questionnaire covering demographics, rating attitudes, and allergy and hygiene risks, followed by open-ended questions, was completed by 61 healthcare professionals (HCPs). Quantitative data were analysed statistically, while qualitative data underwent content analysis.

RESULTS

The Attitude Instrument of Complementary Therapy (AICT) included 7 items and was evaluated using exploratory factor analysis. Healthcare professionals had a median score of 25 (range 18-28), high scores indicating a more positive attitude. However, 36 % of the HCPs perceived a risk of allergies, and this group had a significantly lower median score, 22 versus 26. Open-ended answers were analysed into four categories: "Dogs could positively affect children in hospital", "Dogs may pose a risk of allergies in children", "Dogs might be frightening for children" and "Dogs can affect healthcare professionals' working situation".

CONCLUSION

The AICT can serve as a valuable tool for investigating HCPs' attitudes to dogs in AAA as complementary therapies. Professionals view dogs as beneficial for hospitalized children, but attitudes toward dogs working in paediatric care can be influenced by concerns about risks such as allergies.

Systematic review and meta-analysis of the effect of psychological interventions on anxiety in children and youth with chronic medical conditions

OBJECTIVES

Anxiety disorders affect 20%-50% of youth with chronic medical conditions (CMCs) and can interfere with medical care and treatment outcomes. Psychological therapies are typically designed for youth without CMCs; thus, this systematic review (Open Science Framework preregistration osf.io/a52nd/) assesses the effect of psychological therapies on anxiety, functional impairment and health-related quality of life (HRQOL) in this unique population.

METHODS

We included randomized controlled trials of psychological therapies vs. any comparator for youth (ages 24 and younger) with CMCs that assessed child anxiety. We excluded studies of adults and those not in English. Medline, Embase, PsycInfo, and CENTRAL databases were searched, studies were screened using COVIDENCE software, and meta-analysis was undertaken in R. Study quality was assessed using the Cochrane Risk of Bias tool, version 2. Quality of evidence was assessed using the GRADE system.

RESULTS

Thirty-three studies with 2676 participants (ages 5-21 years) were included in the meta-analysis. Nearly all had at least some risk of bias. Overall, psychological interventions resulted in lower anxiety (Hedges' g = -0.48 [-0.71; -0.25]), but did not have a significant effect on functional impairment or HRQOL. Based on the GRADE criteria, we have moderate confidence in these results. Treatments with higher risk of bias and those with live therapist components had greater effects on anxiety.

CONCLUSIONS

Psychological interventions may be effective for improving anxiety for children and youth with CMCs, particularly those with a live therapist. More high-quality studies are needed to understand what components produce the best outcomes for patients.

The feasibility and acceptability of integrating dogs into inpatient rehabilitation therapy with children with acquired brain injury

INTRODUCTION

Children with acquired brain injury (ABI) are at risk for poor therapeutic engagement due to cognitive impairment, affect lability, pain, and fatigue. Animal-assisted therapy (AAT) has the potential to improve patient engagement in rehabilitation therapies; however, the feasibility of integrating AAT into the rigorous therapy schedule of inpatient clinical care or its reception by patients, families, and staff is unknown.

OBJECTIVE

To examine the feasibility and acceptability of incorporating dogs into physical therapy and occupational therapy sessions with pediatric patients being treated on an inpatient rehabilitation unit for acquired brain injury.

DESIGN

A feasibility study of AAT within the context of a within-subjects crossover study.

SETTING

Pediatric inpatient rehabilitation unit.

PARTICIPANTS

Sixteen patients, aged 7-28 years (mean = 13.6 years, standard deviation [SD] = 5.2 years; 50% male), being treated on the inpatient rehabilitation unit following ABI.

INTERVENTION

AAT - the integration of dogs into inpatient physical therapy and occupational therapy sessions.

MAIN OUTCOME MEASURES

Feasibility measures: enrollment rate, the proportion of AAT sessions a dog attended, adverse events, instances where therapist or handler ended session early, patient animal closeness, and utilization of dog in session. Satisfaction measures: parent satisfaction questionnaires and therapist feedback.

RESULTS

Feasibility was supported by high enrollment rate (88.9%) and dog attendance rate of 93%-95%; 84.3% of sessions used the dog in multiple ways and patients reported a high level of closeness with the dog in session, indicating that the dogs were integrated in meaningful ways. No adverse events were noted, therapists reported that intervention was convenient, and clinical care was not negatively impacted. A high level of satisfaction was reported by families and therapists.

CONCLUSIONS

Findings suggest that AAT is feasible and acceptable, and it may be a valuable tool for therapists working with patients with ABI on an inpatient rehabilitation unit.

Feasibility, efficacy, and safety of animal-assisted activities with visiting dogs in inpatient pediatric oncology

BACKGROUND

Childhood cancer entails a heavy burden for patients and their families. Recent advances in overall survival rates have increasingly brought long-term quality of life into focus. Animal-assisted activities (AAAs) have long been hypothesized to alleviate the burden on pediatric patients and their peers in the hospital setting. However, their use in inpatient pediatric oncology has been a sensitive issue mainly due to the fear of infections, resulting in a lack of studies. This study presents data on the feasibility, safety, and efficacy of AAAs from a single German center.

METHODS

Between 2018 and 2022, 60 patients (median age = 10.3 years) diagnosed with malignancy and undergoing treatment were visited by an intervention dog (total visits = 100). Patients were screened for infections as per hospital policy, with additional microbiological testing performed based on symptoms. The dog was screened for human pathogens and zoonoses. Microbial data and hospitalizations were analyzed from two months prior to the first visit until two months after the last visit. Acceptance of being in the hospital, both with and without planned animal-assisted interventions and pre- and post-intervention state stress, were measured using a validated visual analogue scale (0-10).

RESULTS

Patients benefited from AAAs, showing increased acceptance of being in the hospital (median: 7.25 vs. 4.50, P < 0.001) and decreased median state stress ratings one hour after the visit compared to one hour before the visit (1.00 vs. 4.25, P < 0.001). The intervention did not result in an increased number of infections or unplanned hospitalizations, and no zoonoses were detected. All microbial screening tests of the dog were negative.

CONCLUSIONS

AAAs with visiting dogs in inpatient pediatric oncology are feasible and safe. Although they hold promise for enhancing patients' well-being, further prospective studies are needed. Supplementary file 2 (MP4 240076 KB).

A Randomized Controlled Trial of Animal-assisted Activities for Pediatric Oncology Patients: Psychosocial and Microbial Outcomes

INTRODUCTION

Evidence about the effectiveness and safety of dog visits in pediatric oncology is limited.

METHOD

We conducted a randomized controlled trial (n=26) of dog visits versus usual care among pediatric oncology inpatients. Psychological functioning and microbial load from hand wash samples were evaluated. Parental anxiety was a secondary outcome.

RESULTS

We did not observe a difference in the adjusted mean present functioning score (-3.0; 95% confidence interval [CI], -12.4 to 6.4). The difference in microbial load on intervention versus control hands was -0.04 (95% CI, -0.60 to 0.52) log10 CFU/mL, with an upper 95% CI limit below the prespecified noninferiority margin. Anxiety was lower in parents of intervention versus control patients.

DISCUSSION

We did not detect an effect of dog visits on functioning; however, our study was underpowered by low recruitment. Visits improved parental anxiety. With hand sanitization, visits did not increase hand microbial levels.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov NCT03471221.

The Role of Animal-Assisted Therapy in Enhancing Patients' Well-Being: Systematic Study of the Qualitative and Quantitative Evidence

Background

Animal-assisted therapy, also known as pet therapy, is a therapeutic intervention that involves animals to enhance the well-being of individuals across various populations and settings.

Objective

This systematic study aims to assess the outcomes of animal-assisted therapy interventions and explore the associated policies.

Methods

A total of 16 papers published between 2015 and 2023 were selected for analysis. These papers were chosen based on their relevance to the research topic of animal-assisted therapy and their availability in scholarly databases. Thematic synthesis and meta-analysis were used to synthesize the qualitative and quantitative data extracted from the selected papers.

Results

The analysis included 16 studies that met the inclusion criteria and were deemed to be of moderate or higher quality. Among these studies, 4 demonstrated positive results for therapeutic mediation and one for supportive mediation in psychiatric disorders. Additionally, all studies showed positive outcomes for depression and neurological disorders. Regarding stress and anxiety, 3 studies indicated supportive mediation, while 2 studies showed activating mediation.

Conclusions

The overall assessment of animal-assisted therapy shows promise as an effective intervention in promoting well-being among diverse populations. Further research and the establishment of standardized outcome assessment measures and comprehensive policies are essential for advancing the field and maximizing the benefits of animal-assisted therapy.

Impact of Animal-Assisted Interaction on Anxiety in Children With Advanced Cancer and Their Caregivers

Background: Pediatric patients with advanced cancer and their caregivers have unique psychosocial needs. Anxiety often worsens throughout treatment for both patients and parents, and, if undertreated, can cause suffering. Animal-assisted interaction (AAI) incorporates animals into patient care in a structured manner for the purpose of therapeutic benefit. Objective: To evaluate feasibility of incorporating AAI into patient care and to assess AAI effectiveness in decreasing patient and caregiver anxiety in pediatric patients with advanced cancer, defined by relapsed or refractory disease. Design: Randomized controlled study. Setting/Subjects: Participants were children (n = 19) and parents (n = 21) who were randomized to AAI group or usual care (UC) group. Measures: Participants completed weekly measures to assess anxiety, including the 20-question State-Trait Anxiety Inventory (STAI). Results: Our results demonstrated feasibility of the use of AAI in children with advanced cancer. While they did not reveal a significant difference in anxiety scores over the four sessions in either group, parents randomized to the AAI group had lower STAI State subscores at initial visit in comparison to the UC group. The difference in initial STAI State anxiety scores for caregivers may indicate a positive effect of AAI in reducing anxiety surrounding appointments through anticipation of seeing a therapy dog. Conclusion: Further research is needed to determine the effectiveness of AAI in pediatric patients with advanced cancer and their caregivers, but results are promising that participation in AAI may lessen caregiver anxiety. Clinical Trial Registration Number is: NCT03765099.

Characteristics of Animal-assisted Interventions in the state of Lower Saxony, Germany, with a focus on hygiene in health care facilities

Animal-assisted Interventions (AAIs) are becoming increasingly popular. To date, information on the extent of AAIs in Germany is limited. With a focus on infection control measures in health care facilities (HCFs), two studies were conducted in Lower Saxony to gain knowledge about the structure, characteristics and frequency of AAIs. An online survey among AAI providers identified dogs as the most important animal species in AAI, which mainly operated in educational facilities (53%) and/or on own property (46%). Twenty-nine percent offered their services in HCFs. The majority (55%) of the animal handlers was highly trained in AAI, but their awareness of hygiene and infection control measures to prevent zoonotic disease transmission was limited. Nineteen percent of animal handlers dewormed dogs only when faecal examinations were positive and 13% of dogs received ectoparasiticides only when infestations were present. Raw meat diets were frequent (82%). There was little awareness among animal handlers about the possibility of a zoonotic transmission from the client to the animal. Thus, handling of therapy dogs often reflected that of a "normal" pet ownership and did not always account for the special situation in HCFs. A telephone survey in 148 hospitals showed that 28% of the hospitals had experiences with animal-assisted therapies or animal visits, but 22% of these were lacking regulations on handling these animal contacts. While 28% of all hospitals had regulations for assistance dogs only 5% were aware of a new law that grants people accompanied by an assistance dog broad admission rights to public spaces, including HCFs. With an expected further increase in popularity of AAIs high quality standards which include infection control measures and animal welfare should be adopted by all AAI providers and recipients. This will ensure a safe implementation of this complementary medicine, where both sides - the human and the animal - can benefit.

Psychoneuroimmunological Markers of Psychological Intervention in Pediatric Cancer: A Systematic Review and New Integrative Model

PURPOSE

Pediatric cancer is a serious problem and still becomes a global challenge today. Various complex stressors due to diagnosis, disease symptoms, and various side-effects from the treatment that children with cancer undergo will cause problems in the child's psychoneuroimmunological aspects. Psychological interventions designed to modulate the stress response include psychoneuroimmunological markers. Unfortunately, there is little evidence to support the effect of psychological interventions on psychoneuroimmunological markers. This systematic review aims to assess the effectiveness of psychological interventions on psychoneuroimmunological markers in children with cancer and to provide a new integrative model for further research.

METHODS

This systematic review uses four main databases (Scopus, PubMed, ScienceDirect, and ProQuest). The guideline used Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Selecting articles used the Rayyan application. The quality study was conducted using Joanna Briggs Institute (JBI)'s critical appraisal tools. The data were analyzed using the population, intervention, comparison, outcome, and study design (PICO) Synthesis based on similarities and differences in study characteristics to interpret the results.

RESULTS

The search results in this systematic review found 1653 articles, 21 of which matched the predetermined inclusion and exclusion criteria. Most of the designs used were randomized controlled trials (57.1%). Massage therapy was the most common type of psychological intervention (14.2%). Almost half of the studies measured psychological responses (38.0%), and psycho-physiological responses (42.9%), and only a small proportion assessed the effectiveness of psychological interventions on neuroimmunological markers in pediatric cancer.

CONCLUSIONS

We recommend the use of psychological interventions as an additional intervention in managing psychoneuroimmunological markers of pediatric cancer. This study offers a new integrative model demonstrating the interaction between stress and psychological intervention involving neuroendocrine and immune mechanisms. However, future researchers need to test all domains of these new integrative models. This will reveal the complex interactions among these components and understand their relevance to health outcomes.

The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review

Background

Hospitalized children face pain and anxiety associated with the environment and procedures.

Objective

This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible.

Methods

Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies.

Results

A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety.

Conclusion

Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.

Exploring the benefits of full-time hospital facility dogs working with nurse handlers in a children's hospital

OBJECTIVE

To examine the benefits of full-time hospital facility dogs (HFDs) working with qualified nurse handlers for inpatients in a pediatric medical facility.

METHODS

A questionnaire survey on the evaluation of HFD activities was conducted in a hospital that had introduced HFDs for the first time in Japan and has been using them for 9 years. Of the 626 full-time medical staff, 431 responded, of which 270 who observed HFD activities were included in the analysis. The Questionnaire contained 20 questions, and nine questions were selected for presentation in this paper because they focused on the situations in which HFD activities were thought to have a strong impact on inpatients. A comparison of the respondents' evaluations for each question was made, and differences in the respondents' attributes (such as profession, length of clinical experience and experience of dog ownership) for those items were examined.

RESULTS

The impact of HFDs in terminal care was ranked highest among the respondents. Similarly, HFDs increased patient cooperation for clinical procedures. The responses to these two items did not differ statistically depending on the respondents' attributes. The results imply that patients were more cooperative even for highly invasive examinations and procedures with the support of HFD activities.

CONCLUSIONS

Healthcare providers considered that HFDs were useful, especially for providing support during the terminal phase and for gaining patients' cooperation for procedures. The fact that the handler was a nurse and the HFD team worked full-time may have enhanced the effectiveness of the program.

Consensus Statement on Animals' Relationship with Pediatric Oncohematological Patients, on Behalf of Infectious Diseases and Nurse Working Groups of the Italian Association of Pediatric Hematology-Oncology

Contact with animals in pediatric oncohematologic patients is associated with many benefits, but the risk of contracting zoonoses, even if low, must be considered by clinicians. In order to assess the awareness about this topic, we surveyed the Italian pediatric oncohematology centers, which resulted in heterogeneous responses. The Infectious Diseases Working Group and the Nurse Working Group of the Italian Association of Pediatric Hematology-Oncology, together with veterinarians from the National Federation of Italian Veterinarians, drew up a consensus document to unify the indications to be given to families with the aim of guaranteeing a safe interaction between patients and animals and improving the collaboration of clinicians with veterinarians and families.

Effects of the COVID-19 Pandemic on Animal-Assisted Activities in Pediatric Hospitals

INTRODUCTION

The goal of this study was to document current hospital-based animal-assisted activities (AAA) practices.

METHOD

We contacted 20 hospitals and asked about their AAA programs, including COVID-19 precautions.

RESULTS

Eighteen of 20 hospitals responded. Before 2020, all offered either in-person only (n = 17) or both in-person and virtual AAA visits (n = 1). In early 2022, 13 provided in-person visits; the five hospitals that had not resumed in-person visits planned to restart. Most hospitals stopped group visits. Most required that patients and handlers be free of COVID-19 symptoms and that handlers be vaccinated and wear masks and eye protection. Most did not require COVID-19 vaccination for patients. None required handlers to test negative for COVID-19.

DISCUSSION

The COVID-19 pandemic impacted hospital-based pediatric AAA. Future studies should assess the effectiveness of virtual AAA and of precautions to prevent COVID-19 transmission between patients and AAA volunteers.

Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review

While the symbiotic nature of human-dog relationships and perceived benefits to human health have attracted much scientific interest, the mechanisms through which human-dog interactions may confer health benefits to humans are still poorly understood. The aim of this systematic literature review was to synthesize evidence of physiological changes associated with human-dog interactions with relevance to human health. Electronic databases were systematically searched (PubMed, MEDLINE with full text, Scopus, PsycINFO, CINAHL Plus with Full Text, and Web of Science Core Collection) for relevant studies. Of the 13,072 studies identified, 129 met the inclusion criteria, with approximately half being randomized trials (Level 2) based on the Oxford Centre for Evidence Based Medicine level system. Measures employed to study human physiological changes associated with human-dog interactions most commonly involved cardiac parameters and hormones, with negligible research of brain activity. The main positive findings were increases in heart rate variability and oxytocin, and decreases in cortisol with human-dog interactions. These physiological indicators are consistent with activation of the parasympathetic nervous system (PNS) and oxytocinergic system (OTS), and down-regulation of hypothalamic-pituitary-adrenal (HPA) axis activity. These results provide evidence of specific pathways through which human-dog contact may confer health benefits, likely through relaxation, bonding, and stress reduction. However, these findings should be interpreted contextually due to limitations and methodological differences. Previous research using other biological variables was limited in quantity and quality, thus impeding firm conclusions on other possible mechanisms. Further research is needed in some psychophysiological domains, particularly electroencephalography, to better understand central nervous system (CNS) effects. The findings of this review have implications for human-dog interactions to positively affect several stress-sensitive physiological pathways and thus confer health benefits. This supports their incorporation in various clinical, non-clinical, and research settings to develop evidence-based interventions and practices for cost-effective and efficacious ways to improve human health.

Ethical Considerations in Oncology and Palliative Care Research During COVID-19

Background: Researchers and clinicians must collaborate to consider alternative approaches to conduct standard protocol activities and deliver interventions during the pandemic. The COVID-19 pandemic has required researchers at many institutions to modify traditional in-person research to virtually delivered activities and still adhere to healthcare ethical principles of beneficence, justice, and respect for persons. Our objective is to describe ethical considerations faced by nurse investigators who modified research conducted in pediatric oncology during the COVID-19 pandemic. Methods Review of research case examples. Results Two research study case examples are presented, including remote-participant recruitment via Facebook advertising and a virtually delivered web-based legacy intervention in a pediatric oncology randomized clinical trial. Challenges to modifying in-person approaches to remote strategies are also discussed, with examples of advantages and disadvantages presented from a study testing a human-animal interaction intervention for children with cancer. Discussion Our case information may assist other investigators in planning virtually delivered behavioral strategies for populations that may prefer the convenience of remote participation in research studies because of multiple family responsibilities in the care of a family member, during the pandemic and after. As researchers understand more about subjects' preferences to receive protocol activities (i.e., virtual vs. in-person delivery), they may be able to reduce risks of being unable to collect data because eligible subjects declined or withdrew from a study due to multiple-home responsibilities during the care of a family member with a serious or life-limiting condition.

Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.

Improving the Emotional Distress and the Experience of Hospitalization in Children and Adolescent Patients Through Animal Assisted Interventions: A Systematic Review

Introduction

Animal Assisted Interventions (AAIs) are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.

Objectives

The aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.

Methods

All published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.

Results

Of the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.

Conclusion

Although further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993].

Perspectives on facility dogs from pediatric hospital personnel: A qualitative content analysis of patient, family, and staff outcomes

An increasing number of children's hospitals feature full-time resident facility dogs, which are specially trained to work alongside pediatric healthcare professionals to improve the patient experience. This qualitative study aimed to describe the role that facility dogs play in the lives of patients, families, and hospital staff. A total of N = 73 pediatric healthcare professionals that worked with 46 facility dogs across 17 children's hospitals in the US completed a set of open-ended questions in an online survey. Responses were analyzed via a conventional thematic analysis and organized into themes and sub-themes. Facility dogs were described to benefit pediatric healthcare professionals' daily lives through improving stress and wellbeing, staff relationships, and job-related morale. Negative impacts included increased burdens and responsibilities in the workplace. Facility dogs were also described to benefit patients and families by helping build rapport, providing a comforting presence and positive resource, and normalizing the hospital environment. In conclusion, facility dog programs were found to be a promising complementary intervention to benefit both staff as well as and patients and families. Future research is warranted to examine short-term and long-term implications of facility dog programs for staff, patient, and family wellbeing.

A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes

Parents of children with cancer are prone to psychosocial distress, yet little is known about intervention response among diverse parents. Our systematic review and meta-analysis evaluated the efficacy of psychosocial interventions on anxiety and depression among parents of children with cancer and explored race and/or ethnicity differences in the efficacy of these interventions. Twenty articles met inclusion. The aggregate effect size on anxiety (-0.01, 95% CI: -0.95, 0.93, p = .97) and depression (-0.56, 95% CI: -1.65, 0.54, p = .32) showed micro to medium effects, with larger negative effect sizes indicating that anxiety and depression scores after treatment were lower for parents in intervention group as compared to control group. Neither aggregate effect size was statistically significantly different from zero. Due to underrepresentation of minorities, we could not perform subgroup or moderator analyses. Several efficacious psychosocial interventions were found to reduce parental anxiety. Future studies to examine psychosocial interventions in minority parents are warranted.

Animal-Assisted Interventions for Children with Advanced Cancer: Child and Parent Perceptions

Background: The burden of relapsed/refractory childhood cancer takes an immense toll on ill children and their caregivers, jeopardizing quality of life. Animal-assisted interventions (AAIs) have shown promising benefits for children with chronic conditions and their families. Little is known about child and caregiver perspectives on AAI participation for children with advanced cancer. Objective: To explore perspectives of children with advanced cancer and their caregivers on experiences with AAIs. Design: Cross-sectional qualitative design. Setting/Subjects: Participants were children (n = 9) aged 5 to 17 years with relapsed or refractory cancer and their parents (n = 12) from one academic children's hospital in the southeastern United States. Participants completed approximately weekly 15-minute AAI sessions with a trained dog and handler during oncology clinic visits or hospitalizations for up to 12 weeks. Measures: Semistructured interviews were carried out after completion of each family's final AAI session to assess child and parent perceptions of AAIs. Qualitative content analysis identified themes. Results: Five themes emerged: (1) positive aspects, (2) negative aspects, (3) preferred changes, (4) pet ownership, and (5) value of the study. Twenty (95%) participants shared positive aspects of AAIs. The only negative aspect reported was too little time with the dog. Conclusion: Children with advanced cancer and their parents perceive AAIs as desirable with few requested changes. Further studies are needed to fully evaluate impact of AAIs. ClinicalTrials.gov Identifier: NCT03765099.

Impact of equine assisted therapy on the cardiovascular parameters of the elderly

Introduction: Physical activity programs in the elderly aim to prevent and/or reduce the functional decline resulting from the senescence process. Several studies provide evidence that Equine Assisted Therapy (EAT) is an effective means of improving health. However, studies addressing the effects of EATon the cardiovascular system are scarce. Objective: To evaluate the effect of Equine Assisted Therapyon the cardiovascular responses of participants divided into two groups: normotensive and hypertensive. Methods: Twenty individuals participated, aged between 60 and 79 years, divided into three groups: Normotensive Group (n=14), Hypertensive Group (n=6) and all participants, Total Group (n=20). The Omron® HEM 742 blood pressure monitor was used to measure blood pressure and the Gerathem® portable finger oximeter to measure heart rate and blood oxygen saturation. Ten visits were made once a week, lasting 30 minutes. Results: Between the first and tenth interventions, there was a reduction in blood pressure and heart rate, with statistical significance of systolic blood pressure for the Hypertensive Group (p=0.0478), the Total Group (p=0.0201) and diastolic pressure for the Total Group (p=0.0421). There was also a statistically significant difference in systolic blood pressure and heart rate during some visits. Blood oxygen saturation increased after the intervention, but without statistical significance. Conclusion: Equine Assisted Therapy can promote a reduction in blood pressure in the elderly, especially hypertensive individuals.

An Evaluation of Natural Environment Interventions for Informal Cancer Caregivers in the Community

Home-based informal caregiving by friends and family members of patients with cancer is be-coming increasingly common globally with rates continuing to rise. Such caregiving is often emo-tionally and cognitively demanding, resulting in mental exhaustion and high perceived burden. Support for caregivers may be fostered by engagement with the natural environment. Interaction with nature is associated with mental health benefits such as stress reduction and improved well-being. The purpose of this paper was to evaluate the state of the science regarding the use of nat-ural environment interventions to support caregivers of cancer patients in the community. A comprehensive scoping review using the Arksey and O’Malley framework and the Preferred Re-porting Items for Systematic Reviews and Meta-analyses assessed natural environment therapies and mental health outcomes among cancer caregivers. Databases searched included CINAHL, PubMed, Scopus, Cochrane, and Alt HealthWatch. Findings recovered a total of five studies over a 10-year period that met criteria, demonstrating a lack of empirical evidence addressing this po-tential resource to support caregivers. Often, study appraisal was not on nature exposure, but ra-ther other aspects of the projects such as program evaluation, exercise, or complementary thera-pies. Both qualitative and quantitative designs were used but sample sizes were small. Caregivers experienced beneficial results across the various studies and future work could enhance these findings.

Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part I): Methods and Results

Animal-assisted interventions (AAIs) use human-animal interactions to positive effect in various contexts including cancer care. As the first installment of a 2-part series, this systematic literature review focuses on the research methods and quantitative results of AAI studies in oncology. We find methodological consistency in the use of canines as therapy animals, in the types of high-risk patients excluded from studies, and in the infection precautions taken with therapy animals throughout cancer wards. The investigated patient endpoints are not significantly affected by AAI, with the exceptions of improvements in oxygen consumption, quality of life, depression, mood, and satisfaction with therapy. The AAI field in oncology has progressed significantly since its inception and has great potential to positively affect future patient outcomes. To advance the field, future research should consistently improve the methodological design of studies, report data more completely, and focus more on the therapy animal’s well-being.

The New Era of Canine Science: Reshaping Our Relationships With Dogs

Canine science is rapidly maturing into an interdisciplinary and highly impactful field with great potential for both basic and translational research. The articles in this Frontiers Research Topic, Our Canine Connection: The History, Benefits and Future of Human-Dog Interactions, arise from two meetings sponsored by the Wallis Annenberg PetSpace Leadership Institute, which convened experts from diverse areas of canine science to assess the state of the field and challenges and opportunities for its future. In this final Perspective paper, we identify a set of overarching themes that will be critical for a productive and sustainable future in canine science. We explore the roles of dog welfare, science communication, and research funding, with an emphasis on developing approaches that benefit people and dogs, alike.

Feasibility and Acceptability of a Reiki Intervention With Very Young Children Receiving Palliative Care

BACKGROUND

Very little research has been reported examining nonpharmacologic symptom management strategies for very young, hospitalized children receiving palliative care, and none has involved Reiki-a light touch therapy.

OBJECTIVES

To determine if completing a Reiki intervention with hospitalized 1- to 5-year-old children with chronic, life-limiting conditions receiving palliative care was feasible and acceptable.

METHODS

Children ages 1 to 5 years receiving palliative care who were expected to be hospitalized for at least 3 weeks were recruited for a single-arm, mixed-methods, quasi-experimental pre/poststudy. Six protocolized Reiki sessions were conducted over 3 weeks. We calculated feasibility by the percentage of families enrolled in the study and acceptability by the percentage of families who completed all measures and 5 out of 6 Reiki sessions. Measures were collected at baseline, the end of the intervention period, and three weeks later. At the final follow-up visit, parents were verbally asked questions relating to the acceptability of the intervention in a short structured interview.

RESULTS

We screened 90 families, approached 31 families, and recruited 16 families while 15 families declined. Reasons for not participating included that the child had "a lot going on," would be discharged soon, and families were overwhelmed. Of those enrolled, most completed all measures at three time points and 5 out of 6 Reiki sessions. We completed nearly all scheduled Reiki sessions for families that finished the study. All parents reported that they would continue the Reiki if they could, and almost all said they would participate in the study again; only one parent was unsure.

DISCUSSION

Young children and their parents found Reiki acceptable; these results are comparable to an earlier study of children 7-16 years receiving palliative care at home and a study of massage for symptom management for hospitalized children with cancer. These findings add to the literature and support further investigation of Reiki's efficacy as a nonpharmacologic symptom management intervention.

Association between Early Life Child Development and Family Dog Ownership: A Prospective Birth Cohort Study of the Japan Environment and Children's Study

Pets may play a role in the social-emotional development of children. In particular, some studies have suggested that family dog ownership is associated with better health outcomes. To date, no study has assessed child development in association with dog ownership of different time points. The purpose of the current study was primary to investigate whether “ever” family dog ownership was associated with early child development, and secondary to further examine whether associations between family dog ownership and early child development differ among family dog ownership of status, including “past only”, “current only”, and “always” groups, using the data of family dog ownership obtained at multiple time points. Associations between family dog ownership and infant development at 3 years of age were examined using data from a nationwide prospective birth cohort study, the Japan Environment and Children’s Study (n = 78,941). “Ever” family dog ownership was categorized to “past only”, “current only”, and “always”. We observed that children with “ever” family dog ownership showed a significantly decreased risk of developmental delay in the communication (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.78, 0.96), gross motor (OR = 0.83; 95% CI: 0.76, 0.92), problem-solving (OR = 0.89; 95% CI: 0.83, 0.96) and personal-social (OR = 0.86; 95% CI: 0.72, 0.92) domains compared to children with “never” family dog ownership. Furthermore, a significantly decreased risk of developmental delay in gross motor function was observed in association with living with dogs in the “past only” (OR = 0.83; 95% CI: 0.73, 0.95) and “always” (OR = 0.86; 95% CI: 0.75, 0.98). In addition, a decreased risk of developmental delay in the problem-solving domain was associated with “past” family dog ownership (OR = 0.87; 95% CI: 0.79, 0.97) and in the personal-social domain was associated with “always” family dog ownership (OR = 0.81; 95% CI = 0.68, 0.95). Given the possible positive association between early life child development and family dog ownership, living with dogs may be an important factor to be considered when assessing child development.

Associations of Age, Gender, and Family Income with Quality of Life in Children With Advanced Cancer

Background: Children with cancer often experience decreased quality of life (QOL) throughout the illness trajectory. The purpose of this study was to explore the associations of demographic characteristics with QOL in children with advanced cancer. Methods: This secondary analysis was part of a larger randomized clinical trial that evaluated the efficacy of a legacy intervention for children (7-17 years) with relapsed/refractory cancer and their primary parent caregivers. Assessments included child self-reports on the Pediatric Quality of Life Inventory (PedsQL) Cancer Module. Researchers used descriptive and linear regression statistical methods. Results: Children (n = 128) averaged 10.9 years (SD = 3.0). The majority were female (n = 68, 53%), white (n = 107, 84%), had a hematologic malignancy (n = 67, 52%), with family incomes of $50,000 or less (n = 81, 63.3%). Statistically significant positive associations of both age and income level with PedsQL scores were observed (p < .05) but not gender (p > .05). The strongest correlations for age were with the procedural anxiety (beta = 0.42), treatment anxiety (beta = 0.26), and total (beta = 0.28) scores (all p < .01). In general, there was a positive correlation between family income levels and PedsQL scores (p < .05). The strongest correlations for income were with nausea (R = 0.49), appearance (R = 0.44), pain, and treatment anxiety (both R = 0.42) (all p < .01). Associations adjusted for age remained essentially the same (all p < .01). Discussion: Children with advanced cancer with lower family income and younger age are at high risk for poorer QOL. Oncology nurses should seek to identify families who may benefit from additional resources to promote QOL.

Animal assisted intervention for oncology and palliative care patients: A systematic review

INTRODUCTION

Animal assisted interventions (AAI) have been used in different contexts including oncology/palliative care and can improve mood, quality of life and wellness. The goal of this review was to evaluate studies about AAI and its effects on oncological/palliative care patients.

METHODS

The search was conducted on PubMed, Scopus and Lilacs databases. The inclusion criteria were original articles that measured quantitatively the health-related outcomes of an AAI on oncological/palliative care patients.

RESULTS

Ten studies fulfilled the inclusion criteria. Benefits related to the AAI were described. Mood, pain perception and quality of life seemed to be the variables that had improvement with the intervention. Due to the small sample sizes/heterogeneous methodologies, additional analyses could not be performed.

CONCLUSIONS

AAI can be an important tool for improving psychosocial/physiological parameters in cancer/palliative care patients. Further well designed studies are needed to provide a better knowledge of the AAI benefits in this setting.

Variability in Human-Animal Interaction Research

The field of Human-Animal Interaction (HAI) is plagued with mixed results. Some findings appear to indicate that interacting with a companion animal is beneficial for some aspect of human health and well-being, while other research outcomes are inconclusive or even indicate the opposite. The purpose of this paper is to take a closer look at this variability in research outcomes and to provide plausible explanations and potential remedies. Some of the reasons for mixed results are likely due to the wide variety of methodologies implemented, intermittent use of standardized measures and manualized protocols, variability in human and animal participants, and limited quantification of human-animal interactions or definitions of pet ownership. Variability in research outcomes is not unique to HAI and is, in fact, not uncommon in many more established fields such as psychology and medicine. However, the potential reasons for the variability may be linked to the unique nature of HAI in that, in its' simplest form, it involves two complex organisms, a human and an animal, interacting in dynamic ways. We argue that this complexity makes research in this field particularly challenging and requires a broad spectrum of theoretical and methodological considerations to improve rigor while ensuring the validity and reliability of conclusions drawn from study results.

Effect of Dog-Assisted Therapy on Psychomotor Development of Children with Intellectual Disability

BACKGROUND

Although dog-assisted therapy (DAT) has been used for years, there is still a scarcity of research findings confirming efficacy of the method. The current study was designed to assess effects of DAT on psychomotor development of children with mild intellectual disabilities.

MATERIAL AND METHOD

The study involved 60 children with mild intellectual disabilities, aged 10-13 years, divided into a group participating in a 10-month DAT program, and the control group. Four tests were applied, i.e., finger identification, postural imitation, kinaesthesia, and Bourdon-Wiersma Dot Cancellation Test. The examinations were carried out before the start and at the end of the DAT, and at a two-month follow-up.

RESULTS

The results obtained by the DAT group in all the four tests, at all the three timepoints, were not the same (p < 0.001). No statistically significant differences were found in the measurement at the end of the therapy between the DAT group and the controls. On the other hand, the DAT group achieved significantly better scores (p = 0.001 and p = 0.001), compared to the control, in the follow-up measurements two months after the end of the therapy in postural imitation and finger identification tests.

CONCLUSIONS

Some of the scores achieved by the children in the DAT group improved in the measurements performed over time. Two months after the therapy ended, the children in the DAT group presented greater gains in motor planning (postural imitation test) and in the sense of touch, attention, and concentration (finger identification test), compared to the control group. Although the measurement performed immediately after the therapy did not show significant differences between the DAT group and the controls, the examination carried out at the two-month follow-up identified long-term gains in the treatment group in the domain of motor planning (postural imitation test).

Assessing the Outcomes of an Animal-Assisted Intervention in a Paediatric Day Hospital: Perceptions of Children and Parents

Simple Summary

Scientific evidence of the effects of intervention with dogs as a non-pharmacological distraction strategy in child hospital care is still small. In addition, the results of implementation of animal-assisted programmes at a paediatric day hospital are not known. Thus, in this pilot study, we conducted preliminary research on the efficacy of an intervention based on the use of therapy dogs at a Spanish day hospital. An intra-subject quasi-experimental longitudinal design was used. The study showed that implementation of an animal-assisted programme at a paediatric day hospital is feasible. Children and parents both gave this programme their highest satisfaction rating. The results portray a significant improvement in the child’s self-assessment of their emotional well-being. In parallel, the parents confirmed this significant improvement in the child’s mood. The research suggests that conducting an animal-assisted session just before an outpatient medical procedure is an effective approach in the promotion of emotional welfare, a compromised area for a high percentage of paediatric patients during hospitalisation periods.

Abstract

There is a growing interest in the use of animal-assisted intervention (AAI) as a non-pharmacological strategy to improve child welfare in hospitals. However, the efficacy of implementation of programmes based on activities with dogs in a paediatric day hospital is not known. An intra-subject quasi-experimental longitudinal design was used for the purpose of assessing the feasibility of such an intervention, as well as exploring the perceptions of its outcomes by children and parents/guardians. A total of 55 children in outpatient care at a paediatric day hospital participated in an AAI session. The application of this intervention was feasible. Self-assessment by the paediatric patients revealed a statistically significant improvement in their emotional state after the session, which was large in size. Parents confirmed this improvement in their child, perceiving significant changes in their mood, which were large in size. This study suggests that AAI is an effective approach when it comes to promoting the emotional welfare of children during their stay in hospital care environments. Participating in recreational occupations with dogs could contribute in a relevant and efficient way to the development of significant and gratifying experiences and to a more positive perception of healthcare centres on the part of children.

Patient Work and Their Contexts: Scoping Review

BACKGROUND

Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life.

OBJECTIVE

This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors.

METHODS

A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health-related tasks, (2) cognitive health-related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools).

RESULTS

In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support.

CONCLUSIONS

This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one's internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.

Dog-Assisted Therapy for Children and Adolescents With Fetal Alcohol Spectrum Disorders a Randomized Controlled Pilot Study

Objective

The rationale of this study was to evaluate the efficacy of dog-assisted therapy (DAT) combined with pharmacological treatment in children and adolescents with fetal alcohol spectrum disorder (FASD).

Method

We conducted a randomized, rater-blinded, controlled pilot trial in a cohort of 33 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 17) or Treatment as Usual (TAU control group) (n = 16).

Results

Of the initial 39 participants enrolled, 33 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the DAT group experienced significantly improvements on social skills (SSIS-P social skills: p = 0.02, d = 0.8), reductions on externalizing symptoms (CBCL externalizing: p = 0.03; d = 0.56), and lower scores on FASD severity (CGI-S clinician: p = 0.001, d = 0.5).

Conclusion

DAT is a promising adjunctive treatment for children and adolescents with FASD.

Clinical Trial Registration

Dog-assisted therapy for children and adolescents with fetal alcohol spectrum disorders: a randomized controlled pilot study; http://clinicaltrials.gov/, identifier NCT04038164.

The Best Medicine: Personal Pets and Therapy Animals in the Hospital Setting

Companion animals can have a positive impact on people's health and well-being. Personal pet visitation and animal-assisted interventions (AAIs) can benefit patients' pain, blood pressure, stress, depression, and anxiety, as well as increasing mobility and socialization with staff and families. Implementing personal pet visitation and/or AAI programs requires the involvement of stakeholders from multiple disciplines. AAI is generally well received by staff. Animal presence in the intensive care unit carries few risks for humans and animals but is not risk free. Programs should be designed to minimize these risks. Effective planning can create programs that support patient-centered and family-centered care.

A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part II): Theoretical Mechanisms and Frameworks

Animal-assisted interventions (AAIs) can improve patients' quality of life as complementary medical treatments. Part I of this 2-paper systematic review focused on the methods and results of cancer-related AAIs; Part II discusses the theories of the field's investigators. Researchers cite animal personality, physical touch, physical movement, distraction, and increased human interaction as sources of observed positive outcomes. These mechanisms then group under theoretical frameworks such as the social support hypothesis or the human-animal bond concept to fully explain AAI in oncology. The cognitive activation theory of stress, the science of unitary human beings, and the self-object hypothesis are additional frameworks mentioned by some researchers. We also discuss concepts of neurobiological transduction connecting mechanisms to AAI benefits. Future researchers should base study design on theories with testable hypotheses and use consistent terminology to report results. This review aids progress toward a unified theoretical framework and toward more holistic cancer treatments.

Animal assisted therapy: systematic review of literature

PURPOSE

to verify the applications of AAT in health by performing a systematic review of the literature.

RESEARCH STRATEGY

a survey was carried out in four databases with the descriptors: animal assisted therapy, horse assisted therapy, speech therapy.

SELECTION CRITERIA

article published between 2010 and 2018, in Portuguese or English, free electronic access and that mentioned the characteristics of the intervention program.

DATA ANALYSIS

criteria: casuistry, area of knowledge, program characteristic, type of research, year and language of publication, nationality, periodical and impact factor.

RESULTS

43 articles published in 30 journals, 16 with impact factor, were reviewed. Clinical studies prevailed (93.02%), 37.20% were from Medicine, the population studied had different diagnoses and ages, 55.81% with adults / elderly. AAT was used preferentially for physical rehabilitation (67.44%) and the main mediator was the dog, mentioned in 72.09% of the articles. Eight (n = 8) programs with a focus on communication intervention were described.

CONCLUSION

There is scientific evidence on the use of AAT published in the period studied, in Brazil and in the world. The programs were used by different health and education professionals. The AAT goals were specific to the profile of the participants, and consistent with the characteristics of the mediator animal and the site.

The Effect of a Pet Therapy and Comparison Intervention on Anxiety in Hospitalized Children

The purpose of this study was to evaluate the effect of a brief pet therapy visit and a comparison intervention on anxiety in hospitalized children. This quasi-experimental study compared state anxiety before and after structured research interventions in a convenience sample of children between the ages six and 17 (N = 93) in two groups. Participants were assigned to the pet therapy group or control group, based upon timing of data collection. Participants in each group received either a visit from the research assistant, therapy dog and handler, or from the research assistant for completion of a puzzle. The child's anxiety was measured using the State-Trait Anxiety Scale for Children (STAIC) S-Anxiety Scale before and after the visit and parents completed a brief background questionnaire. Intervention and comparison groups had no significant differences in key demographic factors or baseline anxiety level. While state anxiety decreased significantly in both groups, children in the pet therapy group experienced a significantly greater decrease in anxiety (p = .004). In addition, parents reported high levels of satisfaction with the pet therapy program. Study findings provide support for a brief pet therapy visit with a trained dog and handler as a tool decrease to anxiety in hospitalized children while promoting parent satisfaction. When resources for providing pet therapy visits are limited, clinicians may consider prioritizing children who are most affected by anxiety.

Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department

Objective

Test if therapy dogs reduce anxiety in emergency department (ED) patients.

Methods

In this controlled clinical trial (NCT03471429), medically stable, adult patients were approached if the physician believed that the patient had “moderate or greater anxiety.” Patients were allocated on a 1:1 ratio to either 15 min exposure to a certified therapy dog and handler (dog), or usual care (control). Patient reported anxiety, pain and depression were assessed using a 0–10 scale (10 = worst). Primary outcome was change in anxiety from baseline (T0) to 30 min and 90 min after exposure to dog or control (T1 and T2 respectively); secondary outcomes were pain, depression and frequency of pain medication.

Results

Among 93 patients willing to participate in research, 7 had aversions to dogs, leaving 86 (92%) were willing to see a dog six others met exclusion criteria, leaving 40 patients allocated to each group (dog or control). Median and mean baseline anxiety, pain and depression scores were similar between groups. With dog exposure, median anxiety decreased significantly from T0 to T1: 6 (IQR 4–9.75) to T1: 2 (0–6) compared with 6 (4–8) to 6 (2.5–8) in controls (P<0.001, for T1, Mann-Whitney U and unpaired t-test). Dog exposure was associated with significantly lower anxiety at T2 and a significant overall treatment effect on two-way repeated measures ANOVA for anxiety, pain and depression. After exposure, 1/40 in the dog group needed pain medication, versus 7/40 in controls (P = 0.056, Fisher’s exact test).

Conclusions

Exposure to therapy dogs plus handlers significantly reduced anxiety in ED patients.