Cognitive behavioral pain and anxiety interventions in pediatric oncology centers and bone marrow transplant units

Although research conducted on the treatment of pain and anxiety in children has found a number of cognitive behavioral interventions to be effective, it is not known to what extent this research has been put into practice. The purpose of this project was to obtain information on the use of cognitive behavioral interventions to help children and families cope with the pain and anxiety experienced during lumbar punctures and bone marrow aspirations. In this descriptive study, 15 Pediatric Bone Marrow Transplant Units and 32 Pediatric Hematology/Oncology Centers from across the country were surveyed using a questionnaire developed to obtain information on the use and effectiveness of cognitive behavioral interventions and the availability of support services. This survey indicates that most centers use a number of cognitive behavioral interventions to help children cope with painful procedures. However, some interventions, such as providing information before procedures and positive reinforcement after procedures, are used more frequently than interventions, such as rhythmic breathing, distraction, and imagery, that require more time and training. A variety of support services were available, although psychological services were primarily available on an as needed basis and support groups were not usually offered on an ongoing basis. In general, nurses are the major providers of these interventions, with other professionals providing interventions specific to their training. Nurses need to continue to study appropriate ways to incorporate use of effective cognitive behavioral interventions into the routine care of children with cancer.