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
Palavra-chave	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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