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Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes
Gwyneth A Sullivan1,2, Yao Tian3, Willemijn L A Schäfer3
1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Biobehavioral interventions may reduce postoperative nervousness in pediatric surgical patients. Integrating these techniques into clinical practice requires improved workflows and clinician training for optimal patient outcomes.
Area of Science:
- Pediatric Surgery
- Behavioral Medicine
- Clinical Psychology
Background:
- Biobehavioral interventions like mindfulness and relaxation can mitigate perioperative stress, anxiety, and pain in children.
- Understanding patient exposure and utilization of these interventions is crucial for improving surgical care.
- Identifying barriers and facilitators is key to integrating these supportive practices into pediatric surgical settings.
Purpose of the Study:
- To quantify pediatric surgical patients' pre-operative exposure and post-operative use of biobehavioral interventions.
- To explore barriers and facilitators influencing the clinical integration of these interventions.
- To assess the impact of biobehavioral interventions on patient-reported outcomes.
Main Methods:
- An embedded mixed-methods study with a quantitative focus was conducted within the ENRICH-US clinical trial.
- Data collection involved surveys of pediatric surgical patients (ages 10-18) and their caregivers, alongside semi-structured interviews with providers.
- Outcomes measured included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.
Main Results:
- Over 70% of patients reported using biobehavioral interventions post-operatively, though pre-operative exposure was lower (41%).
- Key barriers to integration included lack of standardized workflows, clinician knowledge gaps, and resource limitations.
- Post-operative use of biobehavioral interventions was associated with a 70% reduction in worsened nervousness (p=0.03), but not with functional disability or HRQoL.
Conclusions:
- Biobehavioral interventions show promise in stabilizing postoperative nervousness among pediatric surgical patients.
- Clinical integration necessitates redesigning workflows and enhancing clinician training to support intervention use.
- Further research and implementation strategies are needed to optimize the role of these interventions in pediatric surgical care.
Background:
Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.
Methods:
We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10-18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.
Results:
41 % (n = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (n = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10-0.91; p = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.
Conclusions:
Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.
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