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Ruskin D, Szczech K, Tyrrell J, Isaac L. Innovative Program to Prevent Pediatric Chronic Postsurgical Pain: Patient Partner Feedback on Intervention Development. Healthcare (Basel) 2024; 12:360. [PMID: 38338245 PMCID: PMC10855720 DOI: 10.3390/healthcare12030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain. METHODS Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP. RESULTS Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials. CONCLUSIONS The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve.
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Affiliation(s)
- Danielle Ruskin
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada
| | - Klaudia Szczech
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Jennifer Tyrrell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Lisa Isaac
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Sullivan V, Sullivan DH, Weatherspoon D. Parental and Child Anxiety Perioperatively: Relationship, Repercussions, and Recommendations. J Perianesth Nurs 2021; 36:305-309. [PMID: 33653615 DOI: 10.1016/j.jopan.2020.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Elective surgical procedures predictably cause stress and anxiety for children and their parents. This can have a negative effect on the child's short-term and long-term psychological and physiological outcomes. This narrative review examines perioperative child anxiety and existing interventions to reduce child and parent perioperative anxiety. The aim was to identify a need and gaps in knowledge for future study. DESIGN Peer-reviewed articles were examined to identify themes in the literature on interventions in place to reduce child and parent perioperative anxiety and to identify any gaps in knowledge for future study. METHODS A narrative review of 62 peer-reviewed articles was conducted. FINDINGS Evidence of themes aimed at lowering perioperative child anxiety using medication, cognitive educational, and play therapy approaches emerged through the literature search. A relationship between parental anxiety and the effect on the child's anxiety was supported, yet interventions that target the parent were limited cognitive education interventions and were found to be implemented only in a small number of hospitals. CONCLUSIONS A clear gap is the lack of research on the effects of parental interventions on the short-term and long-term negative behavioral and physiological outcomes of child perioperative anxiety. Research is needed to further explore the effect of a preoperative psychotherapeutic intervention to allow parents to express anxieties and discuss them with a trained professional in the absence of children. A systematic review or further research would help determine if a psychotherapeutic intervention for the parents would lower child anxiety perioperatively.
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Affiliation(s)
- Virginia Sullivan
- Department of Psychology, The New School for Social Research, New York, NY.
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Psychological preparation reduces preoperative anxiety in children. Randomized and double‐blind trial. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Meletti DP, Meletti JFA, Camargo RPS, Silva LM, Módolo NSP. Psychological preparation reduces preoperative anxiety in children. Randomized and double-blind trial. J Pediatr (Rio J) 2019; 95:545-551. [PMID: 31340899 DOI: 10.1016/j.jped.2018.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety. METHOD After the approval of the institutional Research Ethics Committee and written consent of the children's parents or guardians, 118 children of both genders were prospectively selected, aged between 2 and 8 years, physical condition classification ASA I, who were treated in the pre-anesthetic evaluation ambulatory of the University Hospital and who underwent ambulatory surgeries at the same hospital. Two controlled groups of 59 children were randomized: control group basic preparation and psychological preparation group. On the day of surgery, all selected children were evaluated regarding their level of anxiety using the modified Yale Preoperative Anxiety Scale and their parents were evaluated regarding their level of anxiety through the Visual Analog Scale. The evaluator was blinded to which study group the child and family member belonged to. RESULTS Nine children and their family members were excluded per group when the results were analyzed. Children from the prepared group showed significant reductions in their level of anxiety in relation to the control group (p=0.04). There was no correlation between the level of anxiety of children and their parents' levels (p=0.78). CONCLUSION The psychological preparation was effective in reducing the level of anxiety of children. However, there was no relation between the level of anxiety of children and their parents' level.
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Affiliation(s)
- Dânia P Meletti
- Faculdade de Medicina de Jundiaí, Departamento de Ciências da Saúde, São Paulo, SP, Brazil.
| | | | - Rodrigo P S Camargo
- Faculdade de Medicina de Jundiaí, Departamento de Ginecologia e Obstetrícia, São Paulo, SP, Brazil
| | - Leopoldo M Silva
- Universidade Estadual Paulista (Unesp), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Norma S P Módolo
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil
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La Foresta S, Faraone C, Sframeli M, Vita GL, Russo M, Profazio C, Rulli I, Gitto E, Versaci A, Messina S, Vita G. Intrathecal administration of Nusinersen in type 1 SMA: successful psychological program in a single Italian center. Neurol Sci 2018; 39:1961-1964. [PMID: 30043247 DOI: 10.1007/s10072-018-3506-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022]
Abstract
Nusinersen is the first approved drug to treat spinal muscular atrophy (SMA). Its periodic intrathecal delivery may cause psychological burden in infants and in their parents. We report our experience during expanded access program (EAP) for type 1 SMA in a single Italian center. Because of the occurrence of stress emotional states, anxious reactions and fear before, during, and after lumbar puncture (LP), a specific psychological intervention was implemented based on regulation of emotions, anticipatory expectations, and post-event attributions. Activities included the use of fairy tales, distraction, music play through listening preferred cartoon themes in the youngest children, and contextual games and solution of fun riddle quizzes in the oldest ones. State anxiety greatly reduced in children and their parents. Treatment of psychological aspects should therefore become an integral part of health care in SMA infants and children during Nusinersen treatment.
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Affiliation(s)
| | | | | | | | | | | | - Immacolata Rulli
- Department of Human Pathology in Adult and Developmental Age, Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age, Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Antonio Versaci
- Department of Human Pathology in Adult and Developmental Age, Intensive Care Unit, University of Messina, Messina, Italy
| | - Sonia Messina
- Centro Clinico Nemo Sud, Messina, Italy
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Centro Clinico Nemo Sud, Messina, Italy.
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, University of Messina, Messina, Italy.
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Kassai B, Rabilloud M, Dantony E, Grousson S, Revol O, Malik S, Ginhoux T, Touil N, Chassard D, Pereira de Souza Neto E. Introduction of a paediatric anaesthesia comic information leaflet reduced preoperative anxiety in children. Br J Anaesth 2018; 117:95-102. [PMID: 27317708 DOI: 10.1093/bja/aew154] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the study was to determine whether the introduction of a paediatric anaesthesia comic information leaflet reduced preoperative anxiety levels of children undergoing major surgery. Secondary objectives were to determine whether the level of understanding of participants and other risk factors influence STAIC-S (State-Trait Anxiety Inventory for Children-State subscale) score in children. METHODS We performed a randomized controlled parallel-group trial comparing preoperative anxiety between two groups of children aged >6 and <17 yr. Before surgery, the intervention group received a comic information leaflet at home in addition to routine information given by the anaesthetist at least 1 day before surgery. The control group received the routine information only. The outcome measure was the difference between STAIC-S scores measured before any intervention and after the anaesthetist's visit. A multiple regression analysis was performed to explore the influence of the level of education, the anxiety of parents, and the childrens' intelligence quotient on STAIC-S scores. RESULTS One hundred and fifteen children were randomized between April 2009 and April 2013. An intention-to-treat analysis on data from 111 patients showed a significant reduction (P=0.002) in STAIC-S in the intervention group (n=54, mean=-2.2) compared with the control group (n=57, mean=0.90). The multiple regression analysis did not show any influence on STAIC-S scores of the level of education, parental anxiety, or the intelligence quotient of the children. CONCLUSIONS A paediatric anaesthesia comic information leaflet was a cheap and effective means of reducing preoperative anxiety, measured by STAIC-S, in children. CLINICAL TRIALS REGISTRATION NCT 00841022.
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Affiliation(s)
- B Kassai
- Service de Pharmacologie Clinique, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677 Bron, France Université de Lyon, F-69000 Lyon, France Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR 5558, F-69622 Villeurbanne, France
| | - M Rabilloud
- Université de Lyon, F-69000 Lyon, France Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR 5558, F-69622 Villeurbanne, France Service de Biostatistique, Hospices Civils de Lyon, F-69324 Lyon, France
| | - E Dantony
- Université de Lyon, F-69000 Lyon, France Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR 5558, F-69622 Villeurbanne, France Service de Biostatistique, Hospices Civils de Lyon, F-69324 Lyon, France
| | - S Grousson
- Department of Anaesthesioloy, Hôpital Neurologique Pierre Wertheimer, F-69677 Bron, France
| | - O Revol
- Department of Child and Adolescent Psychiatry
| | - S Malik
- Service de Pharmacologie Clinique, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677 Bron, France Université de Lyon, F-69000 Lyon, France
| | - T Ginhoux
- Service de Pharmacologie Clinique, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677 Bron, France
| | - N Touil
- Service de Pharmacologie Clinique, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677 Bron, France
| | - D Chassard
- Department of Anaesthesioloy, Hôpital Femme-Mère-Enfant, F-69677 Bron, France
| | - E Pereira de Souza Neto
- Centre Hospitalier de Montauban, 100 rue Léon Cladel, 82013 Montauban, France Universidade do Oeste Paulista (UNOESTE), rua José Bongiovani, 700, 19050-920, Presidente Prudente, São Paulo, Brazil CNRS, Laboratoire de Physique, École Normale Supérieure de Lyon, 46, allée d'Italie, Cedex 07, Lyon 69364, France Department of Pediatric Anesthesia, Hôpital Sainte Justine, Montréal, QC, Canada
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Naldan ME, Karayagmurlu A, Ahıskalıoglu EO, Cevizci MN, Aydin P, Kara D. Is surgery a risk factor for separation anxiety in children? Pediatr Surg Int 2018; 34:763-767. [PMID: 29728760 DOI: 10.1007/s00383-018-4273-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Postoperative anxiety symptoms are distressing for both family and child. The aim of this study was to examine the prevalence of postoperative anxiety symptoms in children. METHODS 60 children aged 6-12 undergoing surgery were included in the study group. The study group was assessed three times in terms of separation anxiety disorder (SAD), at the time of presentation, 1 and 3 months postoperatively. A personal information form and the SAD section of the K-SADS-PL on the basis of DSM-IV diagnostic criteria for screening SAD symptoms were used. RESULTS Study group consisted of 19 girls (31.7%) and 41 boys (68.3%) (mean age 8.9 ± 2.3). Four (6.6%) of the cases at the time of presentation and 13 (21.6%) in the study group met SAD diagnostic criteria in 1 month and 21 (35.0%) in 3 months. Anxiety disorder symptoms were significantly higher in the study group at 3 months postoperatively (p < 0.05). There is significant correlation between both SAD symptoms and duration of hospitalization. There was also a positive correlation between duration of hospitalization and parental education and SAD symptoms. CONCLUSION Greater SAD was observed in children undergoing surgical procedures. It will be useful to physicians to consider SAD after surgery in pediatric patients especially when the level of parental education and duration of hospitalization increase. Since SAD may persist long after surgery, it may cause constant fear in personality disorders and lead to psychological problems by significantly lowering quality of life.
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Affiliation(s)
- Muhammet Emin Naldan
- Department of Anesthesia and Reanimation, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey.
| | - Ali Karayagmurlu
- Department of Child and Adolescent Psychiatry, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Elif Oral Ahıskalıoglu
- Department of Anesthesia and Reanimation, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | | | - Pelin Aydin
- Department of Anesthesia and Reanimation, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Duygu Kara
- Department of Anesthesia and Reanimation, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
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