Abstract
Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to compare the Internet-delivered, preoperative program (I-PPP) in alleviating anxiety in children undergoing outpatient surgery delivered alone (I-PPP) and in conjunction with parental presence (I-PPP + parent) to treatment as usual (TAU). 104 children undergoing day surgery procedures at a local hospital and their parents/guardians participated. Primary outcome measures: (a) observer-rated child anxiety and (b) induction compliance. Results demonstrated an interaction between the I-PPP and TAU groups over time, F(1, 64) = 5.11, p = .027, partial η 2p = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η 2p = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η 2p = .07. Our findings demonstrate that the I-PPP is an efficacious preoperative preparation intervention for children. The ‘real-world’ uptake and integration of the I-PPP into pediatric preoperative settings require exploration going forward. Trial retrospectively registered March 2019 (Open Science Registration https://doi.org/10.17605/osf.io/2x8rg).
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References
Buss, A. H., & Plomin, R. (1984). Temperament: Early developing personality traits. Hillsdale, NJ: Lawrence Erlbaum Associates.
Caldwell-Andrews, A. A., Blount, R. L., Mayes, L. C., & Kain, Z. N. (2005). Behavioral interactions in the perioperative environment: A new conceptual framework and the development of the Perioperative Child-Adult Medical Procedure Interaction Scale. Anesthesiology, 103, 1130–1135. https://doi.org/10.1097/00000542-200512000-00005.
Davidson, A., & McKenzie, I. (2011). Distress at induction: Prevention and consequences. Current Opinion in Anesthesiology, 24, 301–306. https://doi.org/10.1097/ACO.0b013e3283466b27.
De Wilde, E. F., & Hendriks, V. M. (2005). The Client Satisfaction Questionnaire: Psychometric properties in a Dutch addict population. European Addiction Research, 11, 157–162. https://doi.org/10.1159/000086396.
Finley, G. A., Stewart, S. H., Buffett-Jerrott, S., Wright, K. D., & Millington, D. (2006). High levels of impulsivity may contraindicate midazolam premedication in children. Canadian Journal of Anesthesia, 53, 73–78. https://doi.org/10.1007/bf03021530.
Fortier, M. A., Bunzli, E., Walthall, J., Olshansky, E., Saadat, H., Santistevan, R., … Kain, Z. N. (2015). Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): Formative evaluation and randomized controlled trial. Anesthesia and Analgesia, 120, 915–922. https://doi.org/10.1213/ANE.0000000000000632.
Kain, Z. N., Caldwell-Andrews, A. A., Krivutza, D. M., Weinberg, M. E., Wang, S.-M., & Gaal, D. (2004). Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedation premedication in the United States, 1995-2000: Results of a follow-up national survey. Anesthesia and Analgesia, 98, 1252–1259. https://doi.org/10.1213/01.ANE.0000111183.38618.D8.
Kain, Z. N., Caldwell-Andrews, A. A., Mayes, L. C., Weinberg, M. E., Wang, S.-M., MacLaren, J. E., & Blount, R. L. (2007). Family-centered preparation for surgery improves perioperative outcomes in children: A randomized controlled trial. Anesthesiology, 106, 65–74. https://doi.org/10.1097/00000542-200701000-00013.
Kain, Z. N., MacLaren, J. E., Wang, S.-M., Caldwell-Andrews, A. A., Zisk, R. Y., & Mayes, L. C. (2006). Pre-surgical preparation programs for children undergoing outpatient surgery: Current status. Anesthesiology, 105, A955.
Kain, Z. N., Mayes, L. C., Cicchetti, D. V., Bagnall, A. L., Finley, J. D., & Hofstadter, M. B. (1997). The Yale Preoperative Anxiety Scale: How does it compare with a “gold standard”? Pediatric Anesthesia, 85, 783–787. https://doi.org/10.1097/00000539-199710000-00012.
Kain, Z. N., Mayes, L. C., Wang, S.-M., Caramico, L. A., Krivutza, M. A., & Hofstadter, M. B. (2000a). Parental presence and a sedative premedication for children undergoing surgery: A hierarchical study. Anesthesiology, 92, 939–945. https://doi.org/10.1097/00000542-200004000-00010.
Kain, Z. N., Mayes, L. C., Weisman, S. J., & Hofstadter, M. B. (2000b). Social adaptability, cognitive abilities, and other predictors for children’s reactions to surgery. Journal of Clinical Anesthesia, 12, 549–554. https://doi.org/10.1016/S0952-8180(00)00214-2.
Kim, J., Chiesa, N., Wright, K. D., & Raazi, M. (2019). A systematic review of technology-based preoperative preparation interventions for child and parent anxiety. Canadian Journal of Anesthesia, 66, 966–986. https://doi.org/10.1007/s12630-019-01387-8.
Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197–207. https://doi.org/10.1016/0149-7189(79)90094-6.
LeVois, M., Nguyen, T. D., & Attkisson, C. C. (1981). Artifact in client satisfaction assessment: Experience in community mental health settings. Evaluation and Program Planning, 4, 139–150. https://doi.org/10.1016/0149-7189(81)90004-5.
MacLaren, J. E., Thompson, C., Weinberg, M., Fortier, M. A., Morrison, D. E., Perret, D., & Kain, Z. N. (2009). Prediction of preoperative anxiety in children: Who is most accurate? Anesthesia and Analgesia, 108, 1777–1782. https://doi.org/10.1213/ane.0b013e31819e74de.
Nguyen, T. D., Attkisson, C. C., & Stegner, B. L. (1983). Assessment of patient satisfaction: Development and refinement of a service evaluation questionnaire. Evaluation and Program Planning, 6, 299–313. https://doi.org/10.1016/0149-7189(83)90010-1.
O’Conner-Von, S. (2008). Preparation of adolescents for outpatient surgery: Using an Internet program. AORN Journal, 87, 374–398. https://doi.org/10.1016/j.aorn.2007.07.024.
Spielberger, C. D., Gorsuch, R. L., Luschene, R. E., Vagg, P. R., & Jacobs, G. A. (1993). State Trait Anxiety Inventory for adults. Palo Alto, CA: Mind Garden.
Strom, S. (2012). Preoperative evaluation, premedication, and induction in infants and children. Current Opinion in Anesthesiology, 25, 321–325. https://doi.org/10.1097/ACO.0b013e3283530e0d.
Urbaniak, G. C., & Plous, S. (2016).Research randomizer. Middletown, CT [publisher unknown]. Retrieved from https://www.randomizer.org/.
Varughese, A. M., Nick, T. G., Gunter, J., Wang, Y., & Kurth, C. D. (2008). Factors predictive of poor behavioral compliance during inhaled induction in children. Anesthesia and Analgesia, 107, 413–421. https://doi.org/10.1213/ane.0b013e31817e616b.
Walker, K. L., Raazi, M., & Wright, K. D. (2018). Randomized control trial of a parent-directed presurgery shaping and exposure intervention for preoperative anxiety in children. Canadian Journal of Anesthesia, 66, 293–301. https://doi.org/10.1007/s12630-018-01274-8.
Wright, K. D., Finley, G. A., Lee, D., Raazi, M., & Sharpe, D. (2013). A snapshot: Practices of Canadian anesthesiologists in alleviating preoperative anxiety in children and adolescents. Canadian Journal of Anesthesia, 60, 1161–1162. https://doi.org/10.1007/s12630-013-0018-4.
Wright, K. D., Kim, J., Ratcliffe, C. R. D., Sharpe, D., Wilson, S., O’brien, J., & Raazi, M. (2020). Internet-Delivered, Preoperative, Preparation Program (I-PPP): The effect of the timing of delivery on anxiety in children undergoing day surgery procedures. Children’s Health Care. https://doi.org/10.1080/02739615.2020.1734459.
Wright, K. D., Raazi, M., & Walker, K. L. (2017). Internet-delivered, preoperative, preparation program (I-PPP): Development and effectiveness. Journal of Clinical Anesthesia, 39, 45–52. https://doi.org/10.1016/j.jclinane.2017.03.007.
Wright, K. D., Stewart, S. H., & Finley, G. A. (2010). Preoperative anxiety in children: When is parental presence helpful? Canadian Journal of Anesthesia, 57, 751–758. https://doi.org/10.1007/s12630-010-9333-1.
Wright, K. D., Stewart, S. H., Finley, G. A., & Buffett-Jerrott, S. E. (2007). Prevention and intervention strategies to alleviate preoperative anxiety in childhood: A review. Behavior Modification, 31, 52–79. https://doi.org/10.1177/0145445506295055.
Wright, K. D., Stewart, S. H., Finley, G. A., & Raazi, M. (2014). A sequential examination of parent-child interactions at anesthetic induction. Journal of Clinical Psychology in Medical Settings, 21, 374–385. https://doi.org/10.1007/s10880-014-9413-4.
Yip, P., Middleton, P., Cyna, A. M., & Carlyle, A. V. (2009). Non-pharmacological interventions for assisting the induction of anaesthesia in children. The Cochrane Database of Systematic Review, 4, 1–61. https://doi.org/10.1002/14651858.CD006447.pub2.
Acknowledgements
We would like to thank the children, parents, nurses, physicians, and surgical staff who helped make this project possible. We would also like to thank the Jim Pattison Children’s Hospital Foundation (JPCHF #96000024) and the Faculty of Medicine, University of Saskatchewan for providing funding for this study.
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The funding for this study was provided by the Jim Pattison Children’s Hospital Foundation (JPCHF #96000024) and the Faculty of Medicine, University of Saskatchewan.
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Kristi D. Wright, Jinsoo Kim, Chelsy R. D. Ratcliffe, Kirstie L. Walker, Donald Sharpe, Stuart Wilson, and Mateen Raazi declare no conflict of interest.
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Harmonized research ethics board (REB) approval was provided by the Universities of Regina and Saskatchewan, and the Regina Qu’Appelle Health Region (now part of the Saskatchewan Health Authority), and operational approval was provided by the Saskatoon Health Region (now part of the Saskatchewan Health Authority).
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Wright, K.D., Kim, J., Ratcliffe, C.R.D. et al. Pilot Examination of the Efficacy of the Internet-Delivered, Preoperative, Preparation Program (I-PPP). J Clin Psychol Med Settings 28, 627–636 (2021). https://doi.org/10.1007/s10880-020-09754-0
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DOI: https://doi.org/10.1007/s10880-020-09754-0