A scoping review as an exploratory method to inform future research on nonpharmacological interventions to prevent anxiety in adolescents in the perioperative period.

Abstract

Scoping reviews enable researchers to explore the breadth and extent of the literature, map and summarize the evidence, identify and analyze knowledge gaps, and inform future research.1,2 Because of this versatility, and the ability to answer multiple questions about a topic, we determined that a scoping review was the most appropriate methodology to answer the questions we posed in our review in this issue of JBI Evidence Synthesis.3 As the evidence on the topic was scattered, a scoping review allowed us to examine and map the range of nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents.4 This methodology enabled us to identify the interventions and their characteristics; categorize the participants according to age (ie, subgroups of adolescence) and type of surgery; record which anxiety-related effects were reported; and identify the professionals who led and delivered those interventions to reduce adolescents’ anxiety in the perioperative period.3 Preparing adolescents for surgery is a challenge for nurses and other health care providers because of the heterogeneity of the patients and their preferences.3 Although surgery may be planned and perceived as “easy” by the health care providers, it represents one of the most stressful medical procedures that an adolescent can experience.5 This stress is generally reflected as anxiety, with undesirable consequences for a patient's health and well-being.3 Nonpharmacological interventions can be used in people with diverse health conditions (acute or chronic), of any age (children, adolescents, adults, or older people), in different care settings,3,6-8 and to achieve different outcomes such as prevention of anxiety,3 reduction of fatigue,6 management of pain,7 or provision of comfort to patients.8 The findings of our review informed which nonpharmacological interventions are generally administered to adolescents in the perioperative period, their characteristics (eg, duration, dose, frequency), the contexts of implementation, which anxiety-related effects are concomitantly evaluated, and which professionals deliver these interventions. In the 11 included studies, eight nonpharmacological interventions were identified. Music therapy/music and guided imagery/hypnosis were the most common nonpharmacological interventions used in the adolescent population, and it was primarily nurses who led and delivered these interventions.3 Early adolescents (10 to 14 years of age) were the most studied population, whereas adolescents in the medium stage (15 to 16 years of age) and late stage (17 to 19 years age) were the populations least reported in the included studies.3 Although the concept of pain was found to most relate to anxiety, distress was also considered. Possibly because of the relationship between anxiety and pain, some studies also assessed the patient's need for opioid consumption.3 The interventions in the included studies were delivered mainly preoperatively, either one week before, one day before, or on the day of the scheduled surgery, although some of the interventions started in the preoperative period and continued to be delivered through the postoperative period. The frequency of the interventions ranged from one to three sessions, and their duration ranged from five to 10 minutes to two hours.3 Although we did not include any geographical or time limitations in our search, we found that most of the included studies in our review were developed during the previous decade. This reveals an increasing interest in the implementation of nonpharmacological interventions in adolescents perioperatively to prevent anxiety. On one hand, it was challenging to synthesize all the information and answer six questions in a single review. On the other hand, by using a scoping review, it was possible to identify gaps in the research about the topic, such as the need to separate adolescents from children when reporting nonpharmacological interventions, and to present specific results about the effect of the interventions. The preparation and presentation of our findings was also a challenge. The use of tables was incorporated to link the extracted characteristics of the included studies, concept, and context to the review questions. Given the comprehensiveness of this review, it was possible to gather a set of information on the topic of interest, which was important to do prior to developing further studies on these types of interventions in this population. Our results indicated that a systematic review of effectiveness could be developed on the topic, which is now underway.9