Parent/Health Care Provider Behaviors & Child's Anxiety

描述（申请人提供）：美国每年有超过500万儿童接受手术，据报道，这些儿童中有高达50%在手术前会产生严重的恐惧。因此，大约20%接受手术的儿童随后在整个麻醉诱导过程中被强行控制，同时哭泣，踢打和尖叫。术前镇静剂和麻醉诱导（PPIA）期间的父母在场目前可帮助儿童度过这一极度紧张的时期。然而，术前镇静剂，虽然有效，与手术成本显着增加，因此，许多医院积极劝阻他们的日常使用。因此，PPIA目前在不同程度上被美国约50%的麻醉师使用。有趣的是，尽管最初的观察性研究表明PPIA可以减少儿童的焦虑，但最近的随机试验表明PPIA并不可靠。然而，到目前为止，所有的PPIA研究都只涉及一个问题--父母是否应该在麻醉诱导时在场。我们认为，我们需要解决的问题不是父母是否在场，而是父母在手术室里实际上做了什么。事实上，先前的初步调查涉及癌症儿童谁经历了痛苦的程序表明，父母和医疗保健提供者的行为显着影响儿童的焦虑在痛苦的程序。这是因为PPIA作为实践今天是无效的，因为PPIA的使用正在上升，我们呼吁开发一种干预措施，将父母在手术室的存在转化为一种有效的，临床适用的，低成本的方式，减少焦虑和改善术后结果。然而，要将PPIA转换为有效的干预措施，首先要根据经验确定特定的父母和医护人员的行为，增加或减少儿童的焦虑在麻醉诱导和术后期间是至关重要的。这将通过获得一个术前序贯过程为导向的观点，父母-儿童-医疗保健提供者的行为互动，并通过使用强大的序贯分析技术。下一步，我们将开发数据驱动的行为准备计划，培训父母、护士、麻醉师和外科医生如何在术前过程中减少儿童的痛苦。

DESCRIPTION (provided by applicant): Over five million children undergo surgery in the US each year and it is reported that up to 50 percent of these children develop significant fear prior to surgery. As a result, about 20 percent of children who undergo surgery are subsequently forcefully restrained while crying, kicking and screaming throughout the induction of anesthesia process. Preoperative sedatives and parental presence during induction of anesthesia (PPIA) are available at the current time to help children during this extremely stressful period. However, preoperative sedatives, although effective, are associated with significant increases in operational costs; thus, many hospitals actively discourage their routine use. As a result, PPIA is currently used to a varying degree by about 50 percent of all anesthesiologists in the US. Interestingly, whereas initial observational studies suggested that PPIA reduces children's anxiety, recent randomized trials indicate that PPIA is not reliably beneficial. All PPIA research to date, however, only deals with one question - whether or not parents should be present in the or during induction of anesthesia. It is our opinion that the question we need to address is not that of parental presence or absence, but rather what parents actually do while in the OR. In fact, previous preliminary investigations involving children with cancer who underwent painful procedures indicate that parental and health care provider behaviors significantly influence children's anxiety during painful procedures. It is because PPIA as practiced today is ineffective, and because the use of PPIA is on the rise, that we call for the development of an intervention that will convert parental presence in the OR into an effective, clinically applicable, low-cost modality that reduces anxiety and improves postoperative outcomes. To convert PPIA into an effective intervention, however, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's anxiety during induction of anesthesia and the postoperative period. This will be achieved by obtaining a preoperative sequential process-oriented view of parent-child-health care provider behavioral interaction and by using robust sequential analysis techniques. As the next step we will develop data-driven behavioral preparation programs that will train parents, nurses, anesthesiologists and surgeons in how to reduce children's distress during the preoperative process.