Psychological Reactions of Children to the Situation of Surgical Treatment: a Review of Studies

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Abstract

The article presents a review of studies on the psychological reactions of children to a situation of surgical treatment. Surgical treatment is considered as a situation with a high potential for stress, which is due to the variety and high intensity of stress effects which are experienced by the child as new and uncontrolled. Negative psychological responses are observed in children both at the preoperative and postoperative stages. At the preoperative stage, preoperative anxiety is highly prevalent. The risk of its development depends on a complex of factors related to the child themself, his/her environment, as well as the disease, hospital environment, the treatment and the circumstances of hospitalization. Preoperative anxiety is a risk factor for more severe pain symptoms, emotional and behavioral changes in the postoperative period. The article discusses the modern methods for the prevention and correction of preoperative anxiety and postoperative emotional and behavioral changes in children: the presence of parents during the induction of anesthesia, providing information using modern technologies and principles of social learning, distraction and other cognitive and behavioral methods for the correction of the mental state, multimodal methods for harmonizing the emotional state and behavior of children (art therapy, play therapy, clown therapy). The authors come to the conclusion that further research is needed in order to develop algorithms for the psychological support of children in a situation of surgical treatment, taking into account their age, clinical characteristics, the psychological features of the child and his/her parents.

General Information

Keywords: preoperative anxiety, surgical treatment, stress, attitude to treatment, emotional disorders, preoperative psychological preparation

Journal rubric: Theoretical Research

Article type: scientific article

DOI: https://doi.org/10.17759/cpse.2023120401

Received: 08.08.2023

Accepted:

For citation: Dubinina E.A., Alekhin A.N. Psychological Reactions of Children to the Situation of Surgical Treatment: a Review of Studies [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2023. Vol. 12, no. 4, pp. 5–26. DOI: 10.17759/cpse.2023120401. (In Russ., аbstr. in Engl.)

References

  1. Aleksandrovich Yu.S., Pshenisnov K.V. Predoperatsionnaya podgotovka k anestezii u detei [Pre-operative preparation to anesthesia in children]. Vestnik anesteziologii i reanimatologii=Messenger of Anesthesiology and Resuscitation, Vol. 17, no. 3, pp. 79–94. DOI: 10.21292/2078-5658-2020-17-3-79-94 (In Russ., abstr. in Engl.).
  2. Kochetova Yu.A., Klimakova M.V. Zarubezhnye issledovaniya separatsionnoi trevogi [Foreign Studies of Separational Anxiety]. Sovremennaya zarubezhnaya psikhologiya=Journal of Modern Foreign Psychology, Vol. 11, no. 1, pp.39–47. DOI: 10.17759/jmfp.2022110104 (In Russ., abstr. in Engl.).
  3. Milenin V.V. Psikhosomaticheskie narusheniya v detskom vozraste posle gospitalizatsii [Posthospital psychosomatic disorders in children]. Anesteziologiya i reanimatologiya=Russian Journal of Anaesthesiology and Reanimatology, No. 1, pp. 69–74. (In Russ., abstr. in Engl.).
  4. Milenin V.V., Tolasov K.R., Ostreikov M.F. Otsenka effektivnosti predoperatsionnykh podgotovitel'nykh programm u patsientov detskogo vozrasta v stomatologii [Efficiency assessment of preoperative preparatory programs in pediatric patients in dentistry]. Anesteziologiya i reanimatologiya=Russian Journal of Anaesthesiology and Reanimatology, No. 1, pp. 4–6. (In Russ., abstr. in Engl.).
  5. Aranha P.R, Dsouza S.N. Preoperative information needs of parents: A descriptive survey. Journal of Research in Nursing, Vol. 24, no. 5, pp. 305–314. DOI: 10.1177/1744987118821708
  6. Ayenew N.T., Endalew N.S., Agegnehu A.F. et al. Prevalence and factors associated with preoperative parental anxiety among parents of children undergoing anesthesia and surgery: A cross-sectional study. International Journal of Surgery Open, Vol. 24, pp. 18–26. DOI: 10.1016/j.ijso.2020.03.004
  7. Baghele A., Dave N., Dias R. et al. Effect of preoperative education on anxiety in children undergoing day-care surgery. Indian Journal of Anaesthesia, 2019. Vol. 63, no. 7, pp. 565–570. DOI: 10.4103/ija.IJA_37_19
  8. Ben-Ari A., Aloni R., Ben-David S. et al. Parental psychological flexibility as a mediating factor of post-traumatic stress disorder in children after hospitalization or surgery. International Journal of Environmental Research and Public Health, 2021. Vol. 18, no. 21, p. 11699. DOI: 10.3390/ijerph182111699
  9. Beringer R.M., Greenwood R., Kilpatrick N. Development and validation of the Pediatric Anesthesia Behavior score — an objective measure of behavior during induction of anesthesia. Pediatric Anesthesia, Vol. 24, no. 2, pp. 196–200. DOI:10.1111/pan.12259
  10. Bogusaite L., Razlevice I., Lukosiene L. et al. Evaluation of preoperative information needs in pediatric anesthesiology. Medical Science Monitor, 2018. Vol. 24, pp. 8773–8780. DOI: 10.12659/MSM.910734
  11. Byrne S.K. Healthcare avoidance: a critical review. Holistic Nursing Practice, 2008. Vol. 22, no. 5, pp. 280–292.
  12. Chen Y.J., Wang C.J., Chen C.W. Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials. Journal of Clinical Nursing, 2023. Vol. 32, no. 11– pp. 2494–2504. DOI: 10.1111/jocn.16394
  13. Chow C.H., Van Lieshout R.J., Schmidt L.A. et al. Systematic review: Audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. Journal of Pediatric Psychology, 2016. Vol. 41, no. 2, pp. 182–203. DOI: 10.1093/jpepsy/jsv094
  14. Chow C., Rizwan A., Poulin L. et al. Association of temperament with preoperative anxiety in pediatric patients undergoing surgery: A systematic review and meta-analysis. JAMA Network Open, 2019. Vol. 2, no. 6, article e195614. DOI: 10.1001/jamanetworkopen.2019.5614
  15. Chundamala J., Wright J.G., Kemp S.M. An evidence-based review of parental presence during anesthesia induction and parent/child anxiety. Canadian Journal of Anaesthesia, 2009. Vol. 56, no. 1, pp. 57–70. DOI: 10.1007/s12630-008-9008-3
  16. Copanitsanou P., Valkeapää K. Effects of education of paediatric patients undergoing elective surgical procedures on their anxiety — a systematic review. Journal of Clinical Nursing, 2014. Vol. 23, no. 7–8, pp. 940–954. DOI: 10.1111/jocn.12187
  17. Davidson A.J., Shrivastava P.P., Jamsen K. et al. Risk factors for anxiety at induction of anesthesia in children: A prospective cohort study. Pediatric Anesthesia, 2006. Vol. 16, no. 9, pp. 919–927. DOI: 10.1111/j.1460-9592.2006.01904.x
  18. Fernandes S.C., Arriaga P., Esteves F. Providing preoperative information for children undergoing surgery: A randomized study testing different types of educational material to reduce children's preoperative worries. Health Education Research, 2014. Vol. 29, no. 6, pp. 1058– DOI: 10.1093/her/cyu066
  19. Fortier M.A., Chorney J.M., Rony R.Y. et al. Children's desire for perioperative information. Anesthesia & Analgesia, 2009. Vol. 109, no. 4. pp. 1085–1090. DOI: 10.1213/ane.0b013e3181b1dd48
  20. Getahun A.B., Endalew N.S., Mersha A.T. et al. Magnitude and factors associated with preoperative anxiety among pediatric patients: Cross-sectional study. Pediatric Health, Medicine and Theraupetics, 2020. Vol. 11, pp. 485–494. DOI: 10.2147/PHMT.S288077
  21. Gornitzky A., O'Donnell J., Diab M. More than just medication: Exploring the potential of a perioperative psychosocial intervention following major pediatric orthopaedic surgery: Quality, Safety and Value (QSVI). Journal of Pediatric Orthopaedic Society of North America, 2023. Vol. 5, no. 2. URL: https://www.jposna.org/index.php/jposna/article/view/592/763 (Accessed 25.12.2023)
  22. Kain Z., Maclaren J., Hammell C. et al. Healthcare provider-child-parent communication in the preoperative surgical setting. Pediatric Anaesthesia, 2009. Vol. 19, no. 4, pp. 376–384. DOI: 10.1111/j.1460-9592.2008.02921.x
  23. Kain Z.N., Caldwell-Andrews A.A., Maranets I. et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia & Analgesia, 2004. Vol. 99, no. 6, pp. 1648–1654. DOI: 10.1213/01.ANE.0000136471.36680.97
  24. Kain Z.N., Mayes L.C., Caldwell-Andrews A.A. et al. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics, 2006. Vol. 118, no. 2, pp. 651–658. DOI: 10.1542/peds.2005-2920
  25. Kain Z.N., Mayes L.C., O'Connor T.Z. et al. Preoperative anxiety in children. Predictors and outcomes. Archives of Pediatrics & Adolescent Medicine, 1996. Vol. 150, no. 12, pp. 1238–1245. DOI: 10.1001/archpedi.1996.02170370016002
  26. Kain Z.N., Wang S.M., Mayes L.C. et al. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesthesia & Analgesia, 1999. Vol. 88, no. 5, pp. 1042–1047. DOI: 10.1097/00000539-199905000-00013.
  27. Kar S.K., Ganguly T., DasGupta C.S. et al. Preoperative Anxiety in pediatric population: Anesthesiologists nightmare. Translational Biomedicine, 2015. Vol. 6, no. 4, p. 30. DOI: 10.21767/2172-0479.100030
  28. Keaney A., Diviney D., Harte S. et al. Postoperative behavioral changes following anesthesia with sevoflurane. Pediatric Anaesthesia, 2004. Vol. 14, no. 10, pp. 866–870. DOI: 10.1111/j.1460-9592.2004.01310.x
  29. Kim J., Jo B., Oh H. et al. High anxiety, young age and long waits increase the need for preoperative sedatives in children. Journal of International Medical Research, 2012. Vol. 40, no. 4, pp. 1381–1389. DOI: 10.1177/147323001204000416
  30. Li L., Zhang J., Li J. et al. Development of a nomogram to predict negative postoperative behavioral changes based on a prospective cohort. BMC Anesthesiology, 2023. Vol. 23, no. 1, pp. 261. DOI: 10.1186/s12871-023-02228-4
  31. Li W.H.C., Chung J.O.K., Ho K.Y. et al. Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatrics, 2016. Vol. 16. Р. 36 DOI: 10.1186/s12887-016-0570-5
  32. Litman R., Berger A., Chhibber A. An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery. Pediatric Anesthesia, 1996. Vol. 6, pp. 443–447. DOI: 10.1046/j.1460-9592.1996.d01-17.x
  33. Litman R.S., Perkins F.M., Dawson S.C. Parental knowledge and attitudes toward discussing the risk of death from anesthesia. Anesthesia & Analgesia, 1993. Vol. 77, no. 2. Р. 256–260. DOI: 10.1213/00000539-199308000-00008
  34. Litman R.S. Allaying anxiety in children: when a funny thing happens on the way to the operating room. Anesthesiology, 2011. Vol. 115, no.1, pp. 4–5. DOI: 10.1097/ALN.0b013e318220860b
  35. Liu W., Xu R., Jia J. et al. Research progress on risk factors of preoperative anxiety in children: A scoping review. International Journal of Environmental Research and Public Health, 2022. Vol. 19, no. 16, p. 9828. DOI: 10.3390/ijerph19169828
  36. Lonsdale M., Hutchison G.L. Patients' desire for information about anaesthesia. Scottish and Canadian attitudes. Anaesthesia, 1991. Vol. 46, no. 5, pp. 410–412. DOI: 10.1111/j.1365-2044.1991.tb09560.x
  37. Martin S.R., Chorney J.M., Cohen L.L. et al. Sequential analysis of mothers' and fathers' reassurance and children's postoperative distress. Journal of Pediatric Psychology, 2013. Vol. 38, no. 10, pp. 1121–1129. DOI: 10.1093/jpepsy/jst061
  38. Martin S.R., Chorney J.M., Tan E.T. et al. Changing healthcare providers' behavior during pediatric inductions with an empirically based intervention. Anesthesiology, 2011. Vol. 115, no. 1, pp. 18–27. DOI: 10.1097/ALN.0b013e3182207bf5
  39. Mellish R.W. Preparation of a child for hospitalization and surgery. Pediatric Clinics of North America, 1969. Vol. 16, no. 3, pp. 543–553. DOI: 10.1016/s0031-3955(16)32305-7
  40. Pate J.T., Blount R.L., Cohen L.L. et al. Childhood medical experience and temperament as predictors of adult functioning in medical situations. Children's Health Care, 1996. Vol. 25, no. 4, pp. 281–298.
  41. Quiles Sebastián M.F., Méndez Carrillo F., Ortigosa Quiles J. Preocupaciones prequirúrgicas: Estudio empírico con población infantil y adolescente [Pre-surgical worries: An empirical study in the child and adolescent population]. Anales Espanoles de Pediatria, 2001. Vol. 55, no. 2, pp. 129–134. DOI: 10.1016/S1695-4033(01)77648-5
  42. Rajeswari S.R., Chandrasekhar R., Vinay C. et al. Effectiveness of cognitive behavioral play therapy and audiovisual distraction for management of preoperative anxiety in children. International Journal of Clinical Pediatric Dentistry, 2019. Vol. 12, no. 5, pp. 419–422. DOI: 10.5005/jp-journals-10005-1661
  43. Shih M.C., Elvis P.R., Nguyen S.A. et al. Parental presence at induction of anesthesia to reduce anxiety: A systematic research and meta-analysis. Journal of Perianesthesia Nursing, 2023. Vol. 38, no. 1, pp. 12– DOI: 10.1016/j.jopan.2022.03.008
  44. Squires V.L. Child-focused perioperative education: helping children understand and cope with surgery. Seminars in Perioperative Nursing, 1995. Vol. 4, no. 2, pp. 80–87.
  45. Sridharan K., Sivaramakrishnan G. Therapeutic clowns in pediatrics: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pediatrics, 2016. Vol. 175, no. 10, pp. 1353–1360. DOI: 10.1007/s00431-016-2764-0
  46. Stanzel A., Sierau S. Pediatric Medical Traumatic Stress (PMTS) following surgery in childhood and adolescence: A systematic review. Journal of Child & Adolescent Trauma, 2022. Vol. 15, pp. 795–809. DOI: 10.1007/s40653-021-00391-9
  47. Stargatt R., Davidson A.J., Huang G.H. et al. A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia. Pediatric Anaesthesia, 2006. Vol. 16, no. 8, pp. 846–859. DOI: 10.1111/j.1460-9592.2006.01869.x
  48. Suleiman-Martos N., García-Lara R.A., Membrive-Jiménez M.J. et al. Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis. Journal of Clinical Nursing, 2022. Vol. 31, no. 23–24, pp. 3350– DOI: 10.1111/jocn.16227.
  49. Thompson R.H., Vernon D.T. Research on children's behavior after hospitalization: A review and synthesis. Journal of Developmental and Behavioral Pediatrics, 1993. Vol. 14, no. 1, pp. 28–35.
  50. Turgoose D.P., Kerr S., Coppi P.D. et al. Prevalence of traumatic psychological stress reactions in children and parents following paediatric surgery: A systematic review and meta-analysis. BMJ Paediatrics Open, Vol. 5, no. 1, article e001147. DOI: 10.1136/bmjpo-2021-001147
  51. Vagnoli L., Bettini A., Amore E. et al. Relaxation-guided imagery reduces perioperative anxiety and pain in children: A randomized study. European Journal of Pediatrics, 2019. Vol. 178, no. 6, pp. 913–921. DOI: 10.1007/s00431-019-03376-x
  52. Vinall J., Connors A., Rice T. et al. Parent emotional availability is associated with reduced preoperative anxiety in children undergoing a tonsillectomy procedure. The Journal of Pain, 2018. Vol. 19, no. 3, p. S61. DOI: 10.1016/j.jpain.2017.12.159
  53. Visintainer M.A., Wolfer J.A. Psychological preparation for surgery pediatric patients: The effects on children's and parents' stress responses and adjustment. Pediatrics, 1975. Vol. 56, no. 2, pp. 187–202.
  54. Wang R., Huang X., Wang Y. et al. Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Frontiers in Public Health, 2022. Vol. 10, p. 854673. DOI: 10.3389/fpubh.2022.854673
  55. Weber F.S. The influence of playful activities on children's anxiety during the preoperative period at the outpatient surgical center. Jornal de Pediatria, 2010. Vol. 86, no. 3, pp. 209–214. DOI: 10.2223/JPED.2000
  56. Wolfer J.A, Visintainer M.A. Pediatric surgical patients' and parents' stress responses and adjustment as a function of psychologic preparation and stress-point nursing care. Nursing Research, 1975. Vol. 24, no. 4, pp. 244–255.
  57. Wolfer J.A., Visintainer M.A. Prehospital psychological preparation for tonsillectomy patients: Effects on children's and parents' adjustment. Pediatrics, 1979. Vol. 64, no. 5, pp. 646–655.
  58. Wright K.D., Stewart S.H., Finley G.A. et al. Prevention and intervention strategies to alleviate preoperative anxiety in children: A critical review. Behavior Modification, 2007. Vol. 31, no. 1, pp. 52–79. DOI: 10.1177/0145445506295055
  59. Wu J., Yan J., Zhang L. et al. The effectiveness of distraction as preoperative anxiety management technique in pediatric patients: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies, Vol. 130, p. 104232. DOI: 10.1016/j.ijnurstu.2022.104232
  60. Yuki K., Daaboul D.G. Postoperative maladaptive behavioral changes in children. Middle East Journal of Anaesthesiology, 2011. Vol. 21, no. 2, pp. 183–189.
  61. Zastowny T.R., Kirschenbaum D.S., Meng A.L. Coping skills training for children: Effects on distress before, during, and after hospitalization for surgery. Health Psychology, 1986. Vol. 5, no. 3. Р. 231–247. DOI: 10.1037//0278-6133.5.3.231

Information About the Authors

Elena A. Dubinina, PhD in Psychology, Associate Professo, Russian State Pedagogical University named after A.I. Herzen (FSBEI HE RGPU named after A.I. Herzen), Research Associate, V.M. Bekhterev’ National Research Medical Center for Psychiatry and Neurology, St.Petersburg, Russia, ORCID: https://orcid.org/0000-0003-1740-6659, e-mail: trifonovahelen@yandex.ru

Anatoly N. Alekhin, Doctor of Medicine, Professor, Head of the Clinical Psychology and Psychological Help Department, Herzen State Pedagogical University, St.Petersburg, Russia, ORCID: https://orcid.org/0000-0002-6487-0625, e-mail: termez59@mail.ru

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