Related Experiment Videos
Pharmacologic and psychologic interventions for procedural pain
A E Kazak1, B Penati, P Brophy
1Department of Pediatrics, University of Pennsylvania School of Medicine and Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Insights
A combined pharmacologic and psychologic intervention effectively reduced child distress during medical procedures for leukemia patients. Younger children experienced more distress, requiring tailored support.
Area of Science:
- Pediatric Oncology
- Child Psychology
- Pain Management
Background:
- Childhood leukemia requires frequent invasive procedures.
- Procedural distress significantly impacts children and families.
- Current interventions may not fully address distress.
Purpose of the Study:
- To evaluate a combined pharmacologic and psychologic intervention (CI) versus pharmacologic-only (PO) for child distress.
- To identify predictors of child distress during invasive procedures.
- To assess long-term outcomes of the interventions.
Main Methods:
- Randomized controlled prospective study comparing CI (n=47) and PO (n=45) interventions.
- Cross-sectional control group (n=70) of patients in remission.
- Data collected via questionnaires and ratings at 1, 6, and >12 months post-diagnosis.
Main Results:
- Combined intervention (CI) significantly lowered child and parent distress compared to pharmacologic-only (PO).
- Both CI and PO groups showed less distress than the control group.
- Younger children experienced greater distress; distress decreased over time and was linked to procedural difficulty.
Conclusions:
- Combined pharmacologic and psychologic interventions are effective in reducing procedural distress in pediatric leukemia.
- Integration of both approaches is supported.
- Younger children and procedural technical difficulty require specific attention in intervention design.
Objective:
This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required).
Methodology:
This was a randomized, controlled prospective study that compared the PO (n = 45) and CI arms (n = 47), at 1, 6, and >12 months after diagnosis. A cross-sectional control group consisted of parents of 70 patients in first remission before the prospective study. Parent questionnaires, staff and parent ratings, and data on medications administered, technical difficulty of the procedure, and needle insertions were obtained for each procedure. This article reports on the final data point for the project (>12 months).
Results:
Mothers and nurses reported lower levels of child distress in the CI than the PO group. The CI and PO groups showed lower levels of child and parent distress than the cross-sectional control group. Distress decreased throughout the time, and child age was inversely related to distress (younger children had more distress) regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with child age, but not with medications administered.
Conclusions:
The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols.