Preparing Children for Surgery with Educational Pop-Up Books: From Theory to Clinical Trial Público

Abstract

Background and Objectives

Preoperative education empowers children to approach surgery with positive expectations. There is a need for effective, child-focused education resources that pediatric clinics, surgery centers, and hospitals can easily supply. The objectives of this study were to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies.

Methods

Children ages 5-12 undergoing outpatient surgery participated in a prospective, randomized controlled trial. Patients read a pop-up book about general anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction.

Results

Of 169 patients screened for eligibility, 148 completed the study. The pop-up book had a significant, large effect in reducing patients’ fear of anesthesia induction (d = 0.95; P < .001). Pop-up book patients also expected less pain than standard-care patients from the anesthesia mask and during surgery, with medium-to-large effect sizes (d = 0.61-0.79; P < .001). The book encouraged more positive views of the procedure and preoperative explanations, with medium-to-large effect sizes (d = 0.58-1.20; P < .005). Further, the book prepared patients to cope adaptively: pop-up book patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies (P < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups (P = .81). Caregivers in the pop-up book group were significantly more satisfied with each aspect of the surgical experience (P ≤ .02).

Conclusion

The educational pop-up book offers a child-focused resource that effectively alleviates children’s preoperative fears, encourages positive coping, and improves caregivers’ perceptions of the experience.

Table of Contents

Introduction......................................................................................................................... 1

Theory and Structure of the Resource..................................................................................... 2

Methods............................................................................................................................... 8

Study Design and Participants ............................................................................................... 8

Outcome Measures ............................................................................................................... 9

Data Analysis ...................................................................................................................... 11

Results ............................................................................................................................... 12

Discussion .......................................................................................................................... 22

Limitations ......................................................................................................................... 25

Future Directions ................................................................................................................ 26

Conclusion.......................................................................................................................... 27

References .......................................................................................................................... 28

Appendix A. The Children’s Fear Scale .................................................................................. 37

Appendix B. The Faces Pain Scale-Revised............................................................................. 38

Appendix C. Patient Questionnaire: Views of the Procedure and Preoperative Explanations...... 39

Appendix D. Coping Strategies Content Analysis System ........................................................ 40

Appendix E. The modified Yale Preoperative Anxiety Scale-Short Form ................................... 41

Appendix F. Caregiver Questionnaire: Satisfaction with the Surgical Experience ...................... 42

Appendix G. Calculations for Rank-Biserial Correlations......................................................... 43

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Surgery Education, Health
Palabra Clave	Pediatric surgery Preoperative anxiety Preoperative education
Committee Chair / Thesis Advisor	Prickett, Kara, Emory University
Committee Members	Dobbin-Bennett, Tasha, Emory University Frenzel, Kristen, Emory University O'Toole, Kate, Emory University

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