MANAGING PREOPERATIVE ANXIETY IN CHILDREN UNDERGOING SURGERY

Abstract

Objectives: 1) To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety (PA) and its associated outcomes in children undergoing surgery; 2) To assess the psychometric properties of a new scale, the Children’s Perioperative Multidimensional Anxiety Scale (CPMAS); 3) To examine the feasibility and acceptability of a novel tablet-based intervention, Story-Telling Medicine (STM), for reducing children’s PA; 4) To examine the relation between temperament and PA in the surgical context. Methods: A systematic review of studies where the primary outcome was children’s PA was conducted (Study 1). A study of the reliability and validity of the CPMAS were assessed at preoperative assessment (T1), on the day of surgery (T2), and 1 month postoperatively (T3) was also undertaken (Study 2). The feasibility and acceptability of STM were then examined and compared its effect to Usual Care (UC) (Study 3). Finally, children’s temperament was examined using the Colorado Childhood Temperament Inventory at T1 along with the CPMAS assessed at T1 and T2 (Study 4). Results: Fourteen of the 18 studies led to reductions in children’s PA (Study 1). The CPMAS demonstrated good internal consistency, stability and convergent validity across all visits (Study 2). The participant recruitment and study procedures were shown to be feasible and children in the STM group demonstrated greater reductions in CPMAS compared to the UC group (Study 3). Shyness predicted lower PA at T1, while sociability predicted higher PA at T1 and T2 (Study 4). Conclusions: AV interventions appear useful but full-scale RCTs of these treatments are required to pinpoint those that are most effective. The CPMAS is a promising tool for evaluating children’s PA and preliminary evidence suggests that STM is a feasible intervention for reducing children's PA. Finally, our findings highlight the importance of considering individual differences in predicting anxiety in the surgical setting.