Parent/Health Care Provider Behaviors & Child's Anxiety

描述(由申请人提供)：在美国，每年有超过500万儿童接受手术，据报道，高达50%的这些儿童在手术前会出现严重的恐惧。结果，大约20%的接受手术的儿童在麻醉诱导过程中哭、踢和尖叫时被强行约束。术前镇静剂和麻醉诱导期间父母在场(PPIA)目前可用于帮助儿童在这一极其紧张的时期。然而，术前镇静剂虽然有效，但与显著增加的操作成本有关；因此，许多医院积极不鼓励常规使用。因此，目前美国约50%的麻醉师在不同程度上使用了PPIA。有趣的是，虽然最初的观察研究表明PPIA可以减少儿童的焦虑，但最近的随机试验表明PPIA并没有可靠的益处。然而，到目前为止，所有的PPIA研究只涉及一个问题--父母是否应该在麻醉诱导过程中或在诱导期间在场。我们认为，我们需要解决的问题不是父母在场或不在场的问题，而是父母在手术室里实际做什么的问题。事实上，之前对接受痛苦手术的癌症儿童的初步调查表明，父母和医疗保健提供者的行为对儿童在痛苦手术期间的焦虑有很大影响。正是因为目前所采用的PPIA是无效的，而且PPIA的使用正在增加，所以我们呼吁开发一种干预措施，将父母在OR中的存在转变为一种有效的、临床适用的、低成本的方式，以减少焦虑并改善术后结果。然而，要将PPIA转变为有效的干预措施，最重要的是首先经验性地确定在麻醉诱导和术后期间增加或减少儿童焦虑的特定父母和医护人员的行为。这将通过获得术前以顺序流程为导向的亲子保健提供者行为相互作用的观点并通过使用稳健的顺序分析技术来实现。作为下一步，我们将开发数据驱动的行为准备程序，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.