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Improving the Patient Experience in Pediatric Cystometrography: A Prospective Observational Study
Assia Comella1, Amy Bodley2, Hayley Nugara2
1Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Victoria, Australia.
Insights
Pediatric cystometrography causes anxiety and distress, impacting test results. Preparing children and managing discomfort are key to improving their urodynamics experience and outcomes.
Area of Science:
- Pediatric Urology
- Urodynamics
- Child Psychology
Background:
- Cystometrography is vital for diagnosing pediatric bladder conditions, but its invasive nature can cause anxiety and affect results.
- Child behavior and procedural artifacts significantly influence cystometrography outcomes, necessitating strategies to improve patient experience.
Purpose of the Study:
- To assess anxiety and distress levels in children undergoing cystometrography.
- To evaluate the impact of child behavior on test outcomes.
- To understand the overall experience of children and their families during urodynamic studies.
Main Methods:
- A prospective observational study at Monash Children's Hospital (January 2023-January 2025).
- Utilized the Visual Analog Scale for Anxiety (VAS-A) pre-procedure and the Brief Behavioral Distress Scale (BBDS) during the procedure.
- Collected patient feedback via the Urodynamics Experience Questionnaire.
Main Results:
- Twenty pediatric patients were enrolled; 85% reported distress and 80% discomfort.
- Four patients (20%) exhibited behaviors that significantly compromised test results.
- Children using clean intermittent catheters (CICs) or undergoing catheterization under general anesthesia showed fewer disruptive behaviors.
Conclusions:
- Inadequate preparation contributes to pre-procedure anxiety in pediatric urodynamics.
- Children using CICs or having catheters placed under general anesthesia demonstrate better behavior during cystometrography.
- Multimodal preparation tailored to the child's age and stage is crucial for enhancing the pediatric urodynamics experience and improving test quality.
Introduction:
Cystometrography, despite its invasive nature, is a crucial investigation for understanding and managing the bladder in children with neurogenic, non-neurogenic and congenital bladder conditions. Results are influenced by child behaviors and artefacts, but results can be critical in developing patient-specific management plans. This study aims to assess the child's anxiety level and distress levels prior to testing, how their behaviors affect test outcomes, and the overall experience of the child and their families.
Methods:
This is a prospective observational study conducted at Monash Children's Hospital (MCH) between January 2023 and January 2025. Patients requiring cystometrography completed a Visual Analog Scale for Anxiety (VAS-A) score prior to the procedure to assess their anxiety. During the appointment, the Brief Behavioral Distress Scale (BBDS) score was completed by the attending consultant to objectively assess patients' behavior and its impact on test results. Finally, the Urodynamics Experience Questionnaire was completed by patients to provide feedback on their experience.
Results:
Twenty patients were enrolled in the study. Eight patients were under 4 years of age (seven on clean intermittent catheters prior to the study, CICs) and 12 patients were 5-17 years old (two on CICs prior to the study). The median VAS-A score was 4.3. BBDS results showed that in four patients (20%) behavior significantly compromised the test results. Notably, the four patients with catheters inserted under general anesthetic did not exhibit behaviors that interfered with the test results. The Urodynamics Experience Questionnaire found that 17 patients (85%) experienced some level of distress, with 16 (80%) reporting discomfort.
Discussion:
Most patients undergoing cystometrography are not adequately prepared, leading to higher anxiety prior to the procedure than afterward. Patients using CICs prior to the test demonstrated fewer disruptive behaviors during the test. In children not performing CIC, catheter placement under general anesthetic resulted in fewer disruptive behaviors.
Conclusion:
Enhancing the patient and family experience in pediatric urodynamics is essential. Future efforts should focus on multimodal preparation specific to the child's age and stage. Furthermore, managing anxiety and minimizing discomfort will improve the overall quality and outcomes of cystometrography in children.
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