Preparation Through Education

Fostering trust, reducing uncertainty, correcting misconceptions, enhancing the belief in his or her ability to cope with a procedure, and minimizing distress are some of the potential benefits in providing advance information about a procedure to a child (see Jaaniste et al. 2007 for a review). Providing accurate, minimally threatening information regarding upcoming procedures promotes realistic expectations that may allow children to focus on specific concrete sensations and concerns as well as develop adaptive strategies to cope with their worries.

Typically, medical preparation through education includes a developmentally appropriate verbal explanation of what the child will see, hear, feel, and smell during, before, and after the procedure. Visual materials and medical equipment are often used to enhance the learning experience. Children are further encouraged to ask questions. In such a manner, concerns that children may have can be elucidated and misconceptions corrected.

Research on the preparation of youngsters for medical procedures suggests that children who understand what will happen to them and how they should best behave cope more effectively and are more cooperative. In a study examining behavioral responses to preparation conducted prior to first bone marrow aspiration, Hubert et al. (1988) found that compared with children who were avoidant during the preparation program, children who were more involved demonstrated less distress. This finding suggests that youngsters who receive more preparation information prior to a medical procedure demonstrate better behavioral outcomes during the actual procedure.

Timing of Information

Importantly, although preparation is known to be associated with positive postprocedural outcomes, careful consideration must be given to the timing of the information provided as well as its content and format. Preparation provided too far in advance of the procedure may allow the child too much time to worry, think, and fantasize about the event, possibly leading to distorted thoughts and increased anticipatory anxiety. Too long a delay between preparation and the procedure, especially with young children, may prevent children from linking the two events. However, preparation provided too close to the procedure does not allow the child enough time to process the material, ask relevant questions, and practice coping skills.

The ideal time to prepare a child for a medical procedure greatly depends on age and developmental maturity. Kain et al. ( 1996b) found that children 6 years and older were least anxious if they received preparatory information 5-7 days prior to surgery and most anxious if the information was provided 1 day prior to surgery. Preparing older children for procedures about 1 week in advance allows children adequate time to process the information and to rehearse the new coping skills, without increasing anticipatory anxiety. Children younger than 6 years old usually do best if prepared 1-2 days prior to the medical procedure. In general, adolescents do best when they are included from the beginning in the decision-making process regarding the planned medical intervention.

Content of Information

The decision on how much information to give a child is influenced by age, maturity, temperament, and desire as well as the child's need for information, which is often signaled by his or her specific questions. Language used during preparation should be simple, unambiguous, and appropriate to the child's cognitive and developmental level. Content should be accurate but as least threatening as possible. Children who are given information that turns out not to be true (e.g., "You will not feel a thing" when in fact the child is liable to experience some pain) are more likely to develop a distrustful relationship with the medical team that may negatively affect future interactions.

Suls and Wan (1989) reported that preparatory information is most effective when it includes sensory information (i.e., description of the sensations a patient will likely experience) as well as procedural information (i.e., description of the actual procedure). In a study examining a preparation program in which parents of 3- to 8-year-olds read a story to their child that included both procedural and sensory information about venipuncture, Kolk et al. (2000) demonstrated that this was an effective technique for reducing anxiety both prior to and during the intervention.

Preparatory information will be most effective when it is specific rather than general, helping to facilitate a more accurate appraisal of the situation (Jaaniste et al. 2007) and thus avoid misconceptions and unnecessary or inaccurate fears. Specifically, children should be told what they will see, hear, feel, smell, and taste in the time leading up to, during, and after the procedure. It is of particular importance to discuss what is likely to happen after the procedure to avoid any unpleasant surprises. Moreover, reminding the child that he or she will eventually return home is a frequently overlooked piece of procedural information that can help the child more adaptively cope with the stress of the intervention (see Table 31-1).

Parental Presence

There are several reasons why it is essential to include parents in the preparation process, especially for younger children. First, children are usually sensitive to how their parents respond to situations and often look to their parents for signals on how they should react. Parents who display signs of anxiety tend to exacerbate their child's level of distress. Providing information and support to parents through involvement in preparation activities is likely to reduce parental anxiety, with positive indirect benefits for their children. In addition, whereas older children are more independent, younger children frequently require more direct help from adults to understand information and utilize coping skills.

In cases in which parents remain excessively anxious following preparation interventions, parental presence may do more harm than good. In such a situation, the value of the presence of the parents should be carefully considered. It may be helpful to explore the options of other supportive adult figures to improve the child's experience with the procedure.

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