Parent/Health Care Provider Behaviors & Child's Anxiety

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): About 4 million children undergo surgery in the US each year and up to 65% of these children experience significant anxiety and distress before surgery. Not only is high preoperative anxiety emotionally traumatic, but it also leads to postoperative adverse outcomes such as increased pain and analgesic requirements, delayed hospital discharge, and maladaptive behavioral changes. In a study completed at Yale, our group identified specific behaviors by health care providers and parents that can easily be incorporated into a busy practice environment and positively impact children's distress and coping behaviors prior to surgery. Based on these data we developed a Provider Tailored Intervention for Perioperative Stress (P-TIPS) that is aimed at reducing anxiety and distress in children prior to surgery by modifying adults' behavior. A pilot trial conducted at University of California Los Angeles and University of California Irvine successfully demonstrated the feasibility and initial efficacy of P-TIPS and examined dose-effectiveness. The proposed clustered randomized trial of four California children's hospitals, each with a total of approximately 20 anesthesia and nursing health care providers (HCP) will examine the effectiveness of P-TIPS in preventing high anxiety and improving the recovery process in children undergoing surgery. Objective measures of children's preoperative anxiety and postoperative recovery will be collected. The primary aim of the study is to determine if P-TIPS is more effective than standard care for preventing high preoperative anxiety among children undergoing anesthesia and surgery. Secondary aims of the study are to: 1. Examine the impact of P-TIPS on surgical recovery parameters such as postoperative pain, recovery room stay, nausea and vomiting, emergence delirium and maladaptive behavioral changes; 2. Determine if the use of P-TIPS results in higher satisfaction and lower anxiety scores in parents and 3. Determine if HCP in the P-TIPS group display more desired behaviors and less undesired behaviors as compared to the control group. We expect this project to be transformative in nature as in the past all treatment modalities for preoperative anxiety have focused on an individual child- parent dyad. In contrast, this intervention is aimed at health care providers who are likely to treat thousands of child-parent dyads in their career. Once tested for effectiveness P-TIPS will be implemented in hospitals across the country.