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The effects of a psychological preparation program on anxiety in children and adolescents undergoing gastrointestinal
L Mahajan1, R Wyllie, R Steffen
1Section of Pediatric Gastroenterology and Nutrition, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Psychological preparation significantly reduces anxiety in children undergoing endoscopy. This approach also decreased the need for sedatives and improved cooperation, enhancing procedural safety.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Medical Education
Background:
- Children frequently experience anxiety during medical procedures, similar to adults.
- Endoscopy is a common procedure that can induce significant stress in pediatric patients.
- Effective strategies are needed to mitigate procedural anxiety in children.
Purpose of the Study:
- To evaluate the impact of a structured psychological preparation program on children undergoing endoscopy.
- To assess the effects of this preparation on patient anxiety, cooperation, and physiological responses.
- To determine the influence on parental anxiety and perception of the child's experience.
Main Methods:
- Sixty pediatric patients (ages 6-19) were randomized into routine preparation or psychological preparation groups.
- Psychological preparation included material demonstrations, doll models, or photo books.
- Anxiety, distress, cooperation, vital signs, and post-procedure perceptions were assessed using validated instruments and physician evaluation.
Main Results:
- Psychological preparation led to significantly lower pre-procedure anxiety (p < 0.0001).
- Patients required less meperidine (p < 0.04), showed improved cooperation (p = 0.042), and had reduced autonomic nervous system stimulation (p < 0.001).
- Both patients and parents reported significantly less anxiety post-procedure (p = 0.003 and p < 0.001, respectively).
Conclusions:
- Psychological preparation is an effective intervention for reducing pediatric anxiety during endoscopy.
- This method may allow for decreased sedative medication use, thereby improving procedural safety.
- The benefits extend to parental anxiety, suggesting a holistic approach to pediatric procedural care.
Background:
Like adults, children often experience anxiety associated with medical procedures. The purpose of this study was to investigate the effects of a program of psychological preparation for children undergoing endoscopy.
Methods:
Sixty patients aged 6 to 19 years (mean, 12.2 years) were randomized into one of two groups. Group 1 received routine preparation before endoscopy. Group 2 received psychological preparation consisting of demonstration of materials that would be encountered during the procedure, use of a doll as a model, or use of a book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State-Trait Anxiety Inventory in the clinic and just before endoscopy. The Observational Scale of Behavioral Distress was completed by a blinded observer during each procedure. The attending physician (blinded) assessed patient cooperation. Vital signs were recorded in clinic and just before endoscopy. Parents and patients completed questionnaires after endoscopy.
Results:
Analysis of the Spielberger State-Trait Anxiety Inventory showed patients in group 2 were significantly less anxious before endoscopy (p < 0.0001). They also required less meperidine (p < eq 0.04) per kilogram body weight and were more cooperative during the examination (p = 0.042). There was significantly less autonomic nervous system stimulation in those who had undergone psychological preparation (change in heart rate, p < 0.001; change in systolic blood pressure, p = 0.04). Statistically significant differences were found in the patients' response to questions after endoscopy regarding perceived anxiety during the procedure (p = 0.003) and the parents' response to questions regarding their own conditions (p = 0.026) and that of their child (p < 0.001).
Conclusion:
Psychological preparation before endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.
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