Assessment of children's distress during painful medical procedures.

Abstract

Pediatric cancer patients encounter painful medical procedures on a routine basis. Extreme anticipatory anxiety and behavioral distress are exhibited by these children prior to and during the procedures. This study investigated the relationship between children's distress and a number of psychosocial, medical, and demographic variables. Results indicated that the observation scale used to measure distress was a reliable, valid instrument. The three variables most highly predictive of children's distress included the age of the child, the number of previous medical procedures experienced by the child, and parental anxiety in relation to the medical procedures. A number of other significant variables are discussed and implications for intervention are reviewed.Painful medial procedures must be administered during the course of diagnosis and treatment of the pediatric cancer patient, which exacerbate the emotional and physical distress inherent in the disease itself. Of these procedures, bone marrow aspirations are reported by both parents and their parents to be the most painful and traumatic events in the entire therapeutic regimen. Bone marrow aspirations are diagnostic procedures in which a needle is inserted into the bone and marrow is extracted to determine the presence or absence of cancer cells.The anxiety produced by anticipation of these procedures can be so severe that patients (and sometimes parents) may report symptoms such as nausea, vomiting, skin rashes, and insomnia days before procedures are scheduled.

Análise funcional da interação profissional-paciente em odontopediatria

“…Também com base em observações específicas ao contexto odontopediátrico em questão e em algumas categorizações já existentes (Ambrosano et al, 2004;Gongora & Silvares, 1998;Jay et al, 1983), esta Tabela continha a descrição operacional de seis condutas das crianças consideradas cooperativas, tais como falar, responder verbalmente, solicitar informação, buscar suporte emocional, olhar para a execução do procedimento e auxiliar na execução do procedimento, bem como de outras seis categorias de comportamentos opositores, incluindo o chorar e o choramingar, o comportar-se de modo nervoso, o agredir fisicamente, o fugir ou movimentar-se até a imobilização e o protestar.…”

“…Duas observadoras previamente treinadas mediante a análise de trechos de interações de díades profissional-paciente não participantes da pesquisa procederam a categorização dos comportamentos dos profissionais e das crianças, registrando a freqüência de cada uma das respostas em questão, de acordo com a descrição e com os exemplos fornecidos nos quadros para Categorização das Condutas dos Profissionais e das Crianças (Ambrosano et al, 2004;Gongora & Silvares, 1998;Jay et al, 1983). Questão verbal em que a criança pede informações acerca do procedimento.…”

Using an Educational Multimedia Application to Prepare Children for Outpatient Surgeries

“…An increase in parental anxiety has been shown to be positively related with their child's anxiety levels and fears during medical procedures (e.g. Kain et al, 2003;Wright et al, 2007), which may be a consequence of a contagious interaction (Jay, Ozolins, Elliott & Caldwell, 1983). Several studies have documented this relationship between child and parental anxiety (Fincher, Shaw & Ramelet, 2012).…”

Intravenous Methohexital for Brief Sedation of Pediatric Oncology Outpatients: Physiologic and Behavioral Responses

“…Although for ethical reasons this study did not evaluate a comparable control group of unsedated children undergoing painful procedures, we believe the observed levels of distress were far below those expected without MHX sedation, based upon our own historical observations of children before its regular use, as well as behavioral studies documenting the extreme anxiety and physical discomfort caused by these invasive procedures for children with cancer. [1][2][3][4] This study did not specifically evaluate whether children had any substantial, unpleasant, immediate or remote recall of the invasive procedures performed while they were sedated with MHX. However, the minimal levels of any distress measured preprocedure and at end of monitoring suggest they did not.…”

“…The physical and emotional distress caused by these procedures are notable and have been well documented in behavioral studies of children with cancer. [1][2][3] Because procedure-related discomfort has been identified by children as the most negative aspect of their cancer treatment, efforts to improve their quality of life have included minimizing the acute distress associated with the procedures. 4 One such approach has been the use of brief sedation or anesthesia to reduce the anticipation and actual experience of pain during the invasive procedures.…”